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.

ObjectiveTo investigate the protective effect of Rehmanniae Radix iridoid glycosides （RIG） on the kidney tissue of streptozotocin （STZ）-induced diabetic mice and explore the underlying mechanism. MethodsTwelve of 72 male C57BL/6J mice were randomly selected as the normal group， and the remaining 60 mice were fed with a high-fat diet for six weeks combined with injection of 60 mg·kg^-1 STZ for 4 days to model type 2 diabetes mellitus. The successfully modeled mice were randomized into model， metformin （250 mg·kg^-1）， catalpol （100 mg·kg^-1）， low-dose RIG （RIG-L， 200 mg·kg^-1） and high-dose RIG （RIG-H， 400 mg·kg^-1） groups （n=11）. Mice in each group were administrated with corresponding drugs， while those in the normal group and model group were administrated with the same dose of distilled water by gavage once a day. After 8 weeks of intervention， an oral glucose tolerance test （OGTT） was performed， and the area under the curve （AUC） was calculated. After mice were sacrificed， both kidneys were collected. The body weight， kidney weight， and fasting blood glucose （FBG） were measured. Biochemical assays were performed to measure the serum levels of triglycerides （TG）， total cholesterol （TC）， serum creatinine （SCr）， and blood urea nitrogen （BUN）. Enzyme-linked immunosorbent assay （ELISA） was employed to determine the serum level of fasting insulin （FINS）， and the insulin sensitivity index （ISI） and homeostatic model assessment for insulin resistance （HOMA-IR） were calculated. The pathological changes in kidneys of mice were observed by hematoxylin-eosin staining and Masson staining. The immunohistochemical method （IHC） was employed to assess the expression of interleukin-1 （IL-1）， interleukin-6 （IL-6）， tumor necrosis factor-α（TNF-α）， transforming growth factor-β₁ （TGF-β₁）， and collagen-3 （ColⅢ） in the kidney tissue. The protein levels of TGF-β₁， cell signal transduction molecule 3 （Smad3）， matrix metalloproteinase-9 （MMP-9）， and ColⅢ in kidneys of mice were determined by Western blot. ResultsCompared with the normal group， the model group showcased decreased body weight and ISI （P<0.01）， increased kidney weight， FBG， AUC， FINS， HOMA-IR， TC， TG， SCr， and BUN （P<0.01）， glomerular hypertrophy， capsular space narrowing， and collagen deposition in the kidney， up-regulated protein levels of IL-1， IL-6， TNF-α， TGF-β₁， ColⅢ， and Smad3 （P<0.01）， and down-regulated protein level of MMP-9 （P<0.01） in the kidney tissue. Compared with the model group， the treatment groups had no significant difference in the body weight and decreased kidney weight （P<0.05， P<0.01）. The FBG level declined in the RIG-H group after treatment for 4-8 weeks and in the metformin， catalpol， and RIG-L groups after treatment for 6-8 weeks （P<0.01）. The AUC in the RIG-L， RIG-H， and metformin groups decreased （P<0.05， P<0.01）. The levels of TC， SCr， and BUN in the serum of mice in each treatment group became lowered （P<0.05， P<0.01）. The level of TG declined in the RIG-L， RIG-H， and metformin groups （P<0.05， P<0.01）. The serum level of FINS declined in the catalpol， RIG-L， and metformin groups （P<0.01）. Compared with the model group， the treatment groups showed decreased HOMA-IR （P<0.01）， increased ISI （P<0.01）， alleviated pathological changes in the kidney tissue， and down-regulated expression of IL-1 and TGF-β₁. In addition， the protein levels of IL-6， TNF-α， and ColⅢ in the RIG-H and metformin groups and IL-6 and TNF-α in the RIG-L group were down-regulated （P<0.05， P<0.01）， and the protein levels of IL-6， TNF-α， and ColⅢ in the catalpol group and ColⅢ in the RIG-L group showed a decreasing trend without statistical difference. The protein levels of TGF-β₁， Smad3， and ColⅢ in the RIG-H and metformin groups were down-regulated （P<0.01）. Compared with that in the model group， the protein level of MMP-9 was up-regulated in each treatment group （P<0.01）. ConclusionRIG can improve the renal structure and function of diabetic mice by regulating the TGF-β₁/Smads signaling pathway.

Background Non-suicidal self-injury(NSSI)behavior has become a major public health concern and can have significant implications for the physical and mental health of adolescents.Peer victimization is a risk factor for adolesents to have NSSI behavior,so exploring the relationship and underlying mechanism between peer victimization and NSSI functions will provide a promising strategy for the prevention and intervention of NSSI behavior.Objective To investigate the relationship between peer victimization and NSSI functions in adolescents with unipolar and bipolar depression,so as to provide references for the intervention of NSSI behavior in adolescent patients with unipolar and bipolar depression.Methods Using multi-stage stratified sampling,940 adolescents with unipolar and bipolar depression who met the Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5)criteria for bipolar depressive episodes or depressive disorders were selected from 14 psychiatric hospitals in China.All participations were assessed using Chinese version of the Functional Assessment of Self-Mutilation(C-FASM),Multidimensional Peer-Victimization Scale(MPVS),UCLA Loneliness Scale(UCLA-LS)and Patient Health Questionnaire-9 item(PHQ-9).Pearson correlation coefficient was to assess the correlation among above scales,and the model fit and path coefficients for mediation were analyzed with model 4 in Process 4.0 for SPSS.Results A total of 698(74.26%)adolescents with unipolar and bipolar depression completed the questionnaire survey.NSSI behavior was detected in 374 patients(53.58%).Among adolescents with unipolar and bipolar depression and NSSI behavior,MPVS total score was positively correlated with the scores of NSSI emotion regulation function,attention-seeking function and social avoidance function in C-FASM(r=0.104,0.130,0.266,P<0.05 or 0.01),UCLA-LS score also yielded a positive correlation with the scores of NSSI emotion regulation function,attention-seeking function and social avoidance function in C-FASM(r=0.321,0.112,0.246,P<0.05 or 0.01),and UCLA-LS score was positively correlated with MPVS total score(r=0.241,P<0.01).Loneliness demonstrated a complete mediating role in the relationship between peer victimization and emotion regulation function,with an indirect effect value of 0.033(95%CI:0.019～0.050)and an effect size of 73.33%.A partial mediating effect of loneliness was also observed for the relationship between peer victimization and social avoidance function,with an indirect effect value of 0.016(95%CI:0.007～0.025)and an effect size of 17.98%.Conclusion Loneliness may act as a mediator in the relationship between the peer victimization and the NISS emotion regulation and social avoidance functions in adolescents with unipolar and bipolar depression and NSSI behaviors.

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.

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 explore the relationship between anxiety, depression and various dimensions of cognitive function in patients with mild cognitive impairment (MCI) .Methods:The convenient sampling method was adopted to conduct memory screening for 727 elderly people who visited the multidisciplinary joint memory clinic of a Class Ⅲ Grade A hospital in Beijing from January to December 2019. With their consent, 247 MCI patients were investigated using Montreal Cognitive Assessment (MoCA) , Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) .Results:A total of 247 questionnaires were distributed and 233 valid questionnaires were returned. There were 67 cases (28.8%) of MCI patients with anxiety and depression, 11 cases (4.7%) with anxiety, 53 cases (22.7%) with depression and 102 cases (43.8%) without anxiety and depression. In MCI patients, anxiety was positively correlated with delayed recall ( P<0.05) , while depression was negatively correlated with language function ( P<0.05) . MCI patients with different emotional states had statistically significant differences in language function ( P<0.05) . Conclusions:MCI patients have a higher incidence of anxiety and depression, and anxiety and depression will affect different dimensions of cognitive function in MCI patients. Medical staff need to provide targeted interventions for MCI patients with different emotional characteristics.

OBJECTIVE:To establish a method for simultaneous determination of 4 effective components in the couple of Coptidis Rhizoma and Evodiae Fmctus,and to investigate rational proportion of the couple.METHODS:HPLC method was adopted.The determination was performed on Welch XB C18 column with mobile phase consisted of acetonitrile-1.5 mmol/L sodium dodecyl sulfate solution (pH adjusted to 5.0 with phosphoric acid) (gradient elution) at the flow rate of 1.0 mL/min.The detection wavelength was set at 265 nm,and the column temperature was 30 ℃.The sample size was 10 μL.RESULTS:The linear ranges of berberine hydrochloride,martin hydrochloride,evodiamine and rutacarpine were 2.24-44.80 μg/mL(r=0.999 9),1.26-31.50 μg/mL(r=0.999 8),2.70-81.00 μg/mL(r=0.999 8),1.65-49.50 μg mL(r=0.999 9),respectively.RSDs of precision,stability and reproducibility tests were all lower than 3.0％.The recoveries were 98.11％-100.73％ (RSD=1.04％,n=6),96.54％-103.47％(RSD=1.86％,n=6),95.49％-102.36％ (RSD=2.05％,n=6),97.19％-103.24％ (RSD=2.19％,n=6),respectively.When the proportion of Coptidis Rhizoma-Evodiae Fructus(m/m) was 2∶ 1,the comprehensive content of each component was the highest.CONCLUSIONS:The method is simple,accurate,stable and reproducible,and can be used for simultaneous determination of 4 effective components in different compatibility proportions of the couple of Coptidis Rhizoma and Evodiae Fructus.The rational proportion of the couple of Coptidis Rhizoma and Evodiae Fructus is 2 ∶ 1.

Objective To study the association of body mass index (BMI) and waist circumference (WC) with dyslipidemia and the risk of dyslipidemia at different BMI and WC level among adults in Suzhou Industrial Park District. Methods A total of 6219 participants were chosen by stratified random cluster sampling method. Four streets were selected form the district first, then one community as a cluster was selected randomly from each street. Questionnaire survey, physical examination and laboratory tests were done by all subjects. Results The prevalence of dyslipidemia was 35.9％;the rates of overweight, obesity and central obesity were 36.6％, 9.6％ and 49.5％ respectively. The prevalence of dyslipidemia in underweight group, normal weight group, overweight group and obesity group were 13.6％, 30.2％, 47.7％and 59.0％ for male, and 17.2％, 27.3％, 38.6％和 48.8％ for female respectively. The prevalence of dyslipidemia for male and female both rose with BMI (χ2=139.848, P<0.001; χ2=92.387, P<0.001). The prevalence of dyslipidemia in the high waist circumference group and normal group were 50.2％and 30.9％for male, and 40.8％and 23.8％for female respectively. Prevalence of groups with high waist circumference for male and female were significantly higher than normal groups (χ2=108.669, P<0.001; χ2=110.642, P<0.001). Pearson correlation analysis showed that total cholesterol (TC), triglyceride(TG), and low density lipoprotein cholesterol (LDL-C) were positively correlated with BMI ( r=0.153, P<0.001;r=0.227, P<0.001;r=0.192, P<0.001), and were also positively correlated with WC(r=0.138, P<0.001; r=0.234, P<0.001; r=0.159, P<0.001). High density lipoprotein cholesterol(HDL-C) was negatively correlated with BMI (r=-0.189, P<0.001) and WC (r=-0.185, P<0.001). Logistic regression analysis after age adjustment showed that, compared to the group with BMI<24 kg/m2 and WC<85 cm(male)/WC<85 cm (female), odds ratios (OR) for male in group with BMI<24 kg/m2 and WC≥85 cm, group with BMI≥24 kg/m2 and WC<85 cm and group with BMI≥24.0 kg/m2and WC≥85 cm were 1.602, 1.834 and 3.064 respectively, and ORs for female in group with BMI<24.0 kg/m2 and WC≥80 cm and group with BMI≥24.0 kg/m2 and WC≥80 cm were 1.703 and 2.381 respectively, however, the OR for female in group with BMI≥24.0 kg/m2 and WC<85 cm was not statistically significant (P>0.05). Conclusions BMI, waist circumference and dyslipidemia were closely correlated. Waist circumference is more important than BMI for female.