Background/Aims: Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy. Methods: We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues. Results: We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts. Conclusion Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.

Objective To evaluate the efficacy of soft channel minimally invasive puncture hematoma evacuation in treatment of hypertensive intracerebral hemorrhage based on intracranial pressure and blood-brain barrier index.Methods A total of 78 patients with hypertensive intracerebral hemorrhage who were admitted to No.904 Hospital of Joint Logistics Support Force of PLA from February 2019 to September 2021 were enrolled and divided into two groups according to different treatment methods.Control group(n=35)received craniotomy,and observation group(n=43)received soft channel minimally invasive puncture hematoma evacuation.Operation related indexes(operation time,intraoperative blood loss,and drainage time),intracranial pressure,blood-brain barrier index and therapeutic effect were compared between two groups.Results The observation group had shorter operation time,shorter drainage time and less intraoperative blood loss than the control group(P<0.05).Intracranial pressure at 24 h postoperatively was lower than that at the end of surgery in both groups(P<0.05).Intracranial pressure at the end of surgery and 24 h postoperatively in the observation group was lower than those in the control group(P<0.05).The blood-brain barrier index was decreased in both groups after surgery,and the index in the observation group was lower than that in the control group(P<0.05).The overall efficacy rate of the observation group was significantly higher than that of the control group(93.02%vs 74.29%,P<0.05).Conclusion Soft channel minimally invasive puncture hematoma evacuation can effectively reduce the intracranial pressure and blood-brain barrier index in patients with hypertensive intra cerebral hemorrhage,with shorter operation time and less intraoperative bleeding.It can be used for preferred surgical procedure for hypertensive intra cerebral hemorrhage.

ObjectiveTo rapidly identify the chemical constituents in Tongxie Yaofang decoction by ultra-performance liquid chromatography-linear ion trap-electrostatic field orbitrap high-resolution mass spectrometry（UPLC-LTQ-Orbitrap-MS）. MethodChromatographic conditions were ACQUITY UPLC BEH C₁₈ column（2.1 mm×100 mm， 1.7 μm）， mobile phase of 0.1% formic acid aqueous solution（A）-acetonitrile（B） for gradient elution （0-4 min， 5%-15%B； 4-10 min， 15%-25%B； 10-15 min， 25%-60%B； 15-20 min， 60%-90%B； 20-25 min， 90%-100%B； 25-27 min， 100%B； 27-30 min， 100%-5%B； 30-32 min， 5%B）， flow rate of 0.3 mL·min^-1， column temperature at 35 ℃ and injection volume of 3 μL. UPLC-LTQ-Orbitrap-MS was equipped with an electrospray ionization（ESI）， the MS and MS/MS data were collected in positive and negative ion modes， and detection range was m/z 100-1 250. Combining the reference substance， chemical databases and related literature information， TraceFinder 4.1 and Xcalibur 2.1 were used to identify the chemical constituents of Tongxie Yaofang decoction. ResultA total of 90 compounds， mainly including flavonoids， coumarins， monoterpene glycosides， chromones and lactones， were identified from Tongxie Yaofang decoction. By attributing the sources of Chinese medicines for all identified compounds， 9 of them were found to be derived from Atractylodis Macrocephalae Rhizoma， 21 from Paeoniae Radix Alba， 24 from Citri Reticulatae Pericarpium， 29 from Saposhnikoviae Radix， and 7 from at least two Chinese medicines. ConclusionThe method can effectively， quickly and comprehensively identify the chemical components of Tongxie Yaofang decoction， and clarify the chemical composition. These identified compounds cover the main active ingredients of the four herbs with high abundance， which indicates that the extraction method and the ratio of the medicinal materials of Tongxie Yaofang are scientific， and can provide a reference for the research on the material basis and quality evaluation of this famous classical formula.

An 86-year-old male patient with acute exacerbation of chronic heart failure developed diuretic resistance due to long-term use of diuretics, and was added tolvaptan 3.75 mg once daily orally, with significant diuretic effect. The next day, the dose was increased to 7.5 mg once daily orally. After taking medication, the patient′s urine volume increased and the symptoms of heart failure were improved. On the third day, the patient developed frequent dry mouth, thirst, transient restlessness, and convulsion of extremities. Laboratory tests showed pH 7.51, partial pressure of blood oxygen (PaO 2) 67.4 mmHg, standard bicarbonate concentration (SB) 28.4 mmol/L, actual bicarbonate concentration (AB) 28.5 mmol/L, blood potassium 3.0 mmol/L, blood sodium 143 mmol/L, and blood chlorine 104 mmol/L. It was considered that the metabolic alkalosis and respiratory acidosis were caused by tolvaptan. Tolvaptan was stopped and arginine injection, 0.9 % sodium chloride, potassium supplementation, and other symptomatic treatments were given, and the patient′s water drinking was not restricted. On the day of tolvaptan discontinuation, the patient′s dry mouth and thirst were significantly reduced, his mental state was improved, with no convulsion of extremities, and lower limb and facial edema subsided. After 1 day of drug withdrawal, the laboratory tests showed pH 7.49, SB 31.1 mmol/L, AB 31.4 mmol/L, and blood potassium 3.6 mmol/L. After 3 days of drug withdrawal, the patient developed drowsiness, poor mental state, and weakened breathing compared to before, which was considered that the patient suffered from metabolic alkalosis combined with respiratory acidosis and secondary type II respiratory failure. Intravenous pumping of nikethamide was given. After 5 days of drug withdrawal, the patient′s 24-hour urine volume was 3 285 ml, and the levels of AB, SB, and pH slightly decreased. However, the patient′s condition was not improved significantly. After 13 days of drug withdrawal, symptomatic and supportive treatments such as tracheal intubation and ventilation assistance were given, but the patient′s condition continue to worsen.

An 86-year-old male patient with acute exacerbation of chronic heart failure developed diuretic resistance due to long-term use of diuretics, and was added tolvaptan 3.75 mg once daily orally, with significant diuretic effect. The next day, the dose was increased to 7.5 mg once daily orally. After taking medication, the patient′s urine volume increased and the symptoms of heart failure were improved. On the third day, the patient developed frequent dry mouth, thirst, transient restlessness, and convulsion of extremities. Laboratory tests showed pH 7.51, partial pressure of blood oxygen (PaO 2) 67.4 mmHg, standard bicarbonate concentration (SB) 28.4 mmol/L, actual bicarbonate concentration (AB) 28.5 mmol/L, blood potassium 3.0 mmol/L, blood sodium 143 mmol/L, and blood chlorine 104 mmol/L. It was considered that the metabolic alkalosis and respiratory acidosis were caused by tolvaptan. Tolvaptan was stopped and arginine injection, 0.9 % sodium chloride, potassium supplementation, and other symptomatic treatments were given, and the patient′s water drinking was not restricted. On the day of tolvaptan discontinuation, the patient′s dry mouth and thirst were significantly reduced, his mental state was improved, with no convulsion of extremities, and lower limb and facial edema subsided. After 1 day of drug withdrawal, the laboratory tests showed pH 7.49, SB 31.1 mmol/L, AB 31.4 mmol/L, and blood potassium 3.6 mmol/L. After 3 days of drug withdrawal, the patient developed drowsiness, poor mental state, and weakened breathing compared to before, which was considered that the patient suffered from metabolic alkalosis combined with respiratory acidosis and secondary type II respiratory failure. Intravenous pumping of nikethamide was given. After 5 days of drug withdrawal, the patient′s 24-hour urine volume was 3 285 ml, and the levels of AB, SB, and pH slightly decreased. However, the patient′s condition was not improved significantly. After 13 days of drug withdrawal, symptomatic and supportive treatments such as tracheal intubation and ventilation assistance were given, but the patient′s condition continue to worsen.

Objective: To understand health literacy and associated factors of freshmen from Jiangsu Province, and to provide reference for youth health education. Methods: From 2017 October to 2018 October, a total of 15 602 college freshman were randomly selected from 20 universities in Jiangsu Province via stratified cluster sampling method. Structural questionnaires were used to investigate the status of health literacy. The χ 2 test and multivariate Logistic regression model were used to analyze the influencing factors of health literacy. Results: The health literacy level of college freshmen from Jiangsu Province was 20.2%, among which the literacy levels of knowledge, behavior and skills were 23.0%, 30.7% and 31.5% respectively. The literacy levels of the six public health issues, including safety and first aid, scientific health attitude, knowledge of prevention and treatment of infectious diseases, health information, basic health care, and prevention and treatment of chronic diseases, from high to low, were 72.8%, 58.7%, 28.5%, 28.2%, 20.3% and 15.9%, respectively. Multivariate Logistic regression analysis has showed that students from undergraduate colleges(OR=2.77, 95%CI=2.47-3.11), urban areas(OR=1.20, 95%CI=1.07-1.34), or southern Jiangsu regions(OR=1.10, 95%CI=1.00-1.22), being the only child(OR=1.13, 95%CI=1.03-1.25), higher maternal education level (OR=1.53, 95%CI=1.30-1.79), having both parents(OR=1.16, 95%CI=1.00-1.34), reported higher level of health literacy. Conclusion The three aspects and six dimensions of health literacy of college freshmen were unbalanced. Health literacy is a shared function of multiple factors including society, family, and individuals. It is essential to promote health education through more efforts on key issues, in order to effectively elevate the health literacy level of adolescent students.

Adolescent ; Adult ; Brain ; abnormalities ; pathology ; physiopathology ; Child ; Female ; Humans ; Image Processing, Computer-Assisted ; Male ; Nerve Net ; pathology ; physiopathology ; Schizophrenia ; etiology ; physiopathology ; Schizophrenic Psychology

Objective To explore the effect of oral-muscle biofeedback system training on the rehabilitation of cognitive dysfunction in patients with obstructive sleep apnea (OSA) after ischemic stroke.Methods A total of 60 cases of poststroke OSA patients with cognitive dysfunction admitted to the rehabilitation center of deAn hospital in changzhou city from June 2017 to March 2018 were selected.On the basis of routine rehabilitation treatment,the control group was given positive pressure ventilation treatment,and the observation group was given oral muscle biofeedback system training.The changes of polysomnography (PSG) parameters,Montreal cognitive assessment (MoCA) score,serum matrix metalloproteinase-9 (MMP-9) and plasma homcysteinemia (Hcy) expression levels in the two groups before and after treatment were compared.Results Apnea hypopnea index and maximum apnea time of the two groups were significantly decreased after treatment compared with those before treatment,and the lowest SpO2 and average SpO2 were significantly higher than those before treatment(P＜0.05).After treatment,MoCA total score and the dimensions score of patients in the observation group were significantly higher than those in the control group at the same time (P＜0.05).After treatment,the levels of Hcy((12.38±4.54) μmol/L) and MMP-9((124.52± 12.94) μg/L) in the observation group were significantly lower than those in the control group at the same time(Hcy(17.52±6.27) μmol/L,MMP-9(268.25±20.5 7)μg/L),and the difference was statistically significant (Hcy:t=3.637,P＜0.05;MMP-9:t =32.395,P＜0.05).Conclusions Positive pressure ventilation and oral muscle biofeedback system training have the same effect on OSA after stroke,but oral muscle biofeedback system training can also effectively improve patients' cognitive function.

Objective To explore the association between the structural patterns of orbitofrontal sulcogyral pattern (OSP)and the susceptibility to schizophrenia in children and adolescents patients with schizophrenia. Methods Seventy-two childhood and adolescence schizophrenia aged 6~18 years were enrolled as the case group and 78 sex-, age-, education-matched healthy children served as the control group. MR images were acquired with a 3.0 T Magnetom Symphony MRI system. Positive and Negative Syndrome Scale (PANSS) was used to evaluate the symptom severity of patients.The pattern type of OFC was classified based on continuity among medial (MOS),lateral (LOS)and transverse (TOS) orbital sulci according to the method of Chiavaras and Petrides'. The orbitofrontal cortex (OFC) sulcogyral pattern was classified into three types(TypeⅠ,TypeⅡ,TypeⅢ)in each hemisphere. Results There were significant differences in the distribution of OFC patterns between the control and the case group (Left hemisphere: Χ2=6.668,P=0.036; Right hemisphere: Χ2=7.501,P=0.024). The linear regression analysis showed that Type Ⅲ in either hemisphere was associated with more severe symptoms in schizophrenia patients (B=7.214, P=0.008). Conclusions Type Ⅲ sulcogyral pattern may be a morphological risk marker for schizophrenia. Compared to the other two types, the Type Ⅲ expression is associated with more severe clinical symptoms.

Objective To investigate the characteristics and relationship of cognitive function and resting state functional magnetic resonance imaging(fMRI) amplitude of low-frequency fluctuations (ALFF)in childhood and adolescence-first-onset obsessive-compulsive disorder(OCD).Methods Twenty-four childhood and adolescence-first-onset OCD patients (patient group) and thirty-three age/gender/education-matched healthy controls (healthy control group) were enrolled in this study.The participants' cognitive function was tested with trail making test (TMT),symbol coding,Hopkins verbal learning test-revised (HVLT-R),brief visuospatial memory test-revised (BVMT-R),verbal fluency test (VF),digital span test,maze test and Stroop test.Then a resting-state fMRI scan was conducted for each participant.Amplitude of low-frequency fluctuation approach was used to explore the differences of resting-state brain function between patients and controls,and analyze the significant brain regions by adopting t test.The cognitive functions of patients and healthy control group in the significant brain regions were compared by using Pearson correlation analysis.Results The patient group had lower scores than healthy control group in symbol coding,BVMT-R and digital span test,and the differences were statistically significant [(45.24 ± 10.32)scores vs.(56.85 ± 9.57) scores,(21.94 ± 6.99) scores vs.(30.58 ± 3.92) scores,(64.06 ± 20.00) scores vs.(78.03 ±18.08) scores;t =3.96,4.90,2.50;all P ＜ 0.05].Corrected by Alphasim,patient group showed significantly increased ALFF in the left and fight temporal lobe,left and fight posterior lobe of cerebellum,right middle temporal gyrus,but ALFF decreased in the area of left and right lenticula,left putamen compared with the healthy control group (all P ＜ 0.05).The patients group showed that TMT scores were positively correlated with the value of ALFF in the right temporal lobe (r =0.67),and color scores were positively correlated with the value of ALFF in the right middle temporal gyrus (r =0.53),but colour scores were negatively correlated with the value of ALFF in the right tcmporal lobe (r =-0.54);the healthy control group showed that BVMT-R and digital span test scores were positively correlated with the value of ALFF in the left temporal lobe (r =0.47,0.41),but digital span test scores were negatively correlated with the value of ALFF in the right temporal lobe (r =-0.49),and colour scores were negatively correlated with the value of ALFF in the left temporal lobe (r =-0.35),while word and color-word scores were negatively correlated with the value of ALFF in the right middle temporal gyrus (r =-0.39,-0.36);the correlation coefficient above had statistical significance (all P ＜ 0.05).Conclusions The childhood and adolescence-first-onset OCD patients had cognitive impairment,including speed of processing,visual learning and memory,working memory;and the patients showed abnormal spontaneous neural activity at some brain regions.The cognitive dysfunction may be associated with abnormal spontaneous neuronal activity in childhood and adolescence-first-onset OCD.