Objective Acute liver injury(ALI)exacerbates the condition of patients with severe acute pancreatitis(SAP)and neg-atively affects their prognosis.Recent studies have highlighted the crucial role of chaperone-mediated autophagy(CMA)in regulating liver injury.This study aims to explore the effects of CMA on the pathophysiologic mechanisms of SAP-induced acute liver injury(SAP-ALI).Methods A SAP rat model was established via retrograde injection of 5％sodium taurocholate into the biliary-pancreat-ic duct.Rats were randomly divided into the sham operation(Sham)group,SAP group,CMA activator(AR7)control group,and AR7+SAP treatment group.After 24hours,serum amylase(AMY),liver function,and oxidative stress-specific markers were meas-ured.HE staining was used to evaluate the pathological injury in the pancreatic and liver tissues.The expression levels of lysosomal-as-sociated membrane protein 2 A(LAMP2A),GAPDH,keleh-like ECH-associated protein 1(Keap1),and nuclear factor E2-related factor 2(Nrf2)proteins and LAMP2A,Nrf2mRNA were analyzed by Western blot,immunofluorescence staining,and qRT-PCR.Results AR7 pretreatment significantly improved liver function(P＜0.05),alleviated the pathological damage to the pancreas and liver and enhanced the antioxidant stress capacity(P＜0.05)of SAP-ALI rats.The downregulation of LAMP2A(P＜0.05)and accumula-tion of the CMA substrate GAPDH(P＜0.05)indicated CMA dysfunction in SAP-ALI.Furthermore,AR7-induced upregulation of CMA promoted the activation of the Keap1/Nrf2 pathway in liver(P＜0.05),contributing to its antioxidative effect.Conclusion Our study demonstrates that CMA dysfunction is involved in the pathological process of SAP-induced acute liver injury.AR7-induced CMA reactivation regulates the Keap1/Nrf2 antioxidant pathway,providing protection against SAP-induced acute liver injury in rats.

Objective Acute liver injury(ALI)exacerbates the condition of patients with severe acute pancreatitis(SAP)and neg-atively affects their prognosis.Recent studies have highlighted the crucial role of chaperone-mediated autophagy(CMA)in regulating liver injury.This study aims to explore the effects of CMA on the pathophysiologic mechanisms of SAP-induced acute liver injury(SAP-ALI).Methods A SAP rat model was established via retrograde injection of 5％sodium taurocholate into the biliary-pancreat-ic duct.Rats were randomly divided into the sham operation(Sham)group,SAP group,CMA activator(AR7)control group,and AR7+SAP treatment group.After 24hours,serum amylase(AMY),liver function,and oxidative stress-specific markers were meas-ured.HE staining was used to evaluate the pathological injury in the pancreatic and liver tissues.The expression levels of lysosomal-as-sociated membrane protein 2 A(LAMP2A),GAPDH,keleh-like ECH-associated protein 1(Keap1),and nuclear factor E2-related factor 2(Nrf2)proteins and LAMP2A,Nrf2mRNA were analyzed by Western blot,immunofluorescence staining,and qRT-PCR.Results AR7 pretreatment significantly improved liver function(P＜0.05),alleviated the pathological damage to the pancreas and liver and enhanced the antioxidant stress capacity(P＜0.05)of SAP-ALI rats.The downregulation of LAMP2A(P＜0.05)and accumula-tion of the CMA substrate GAPDH(P＜0.05)indicated CMA dysfunction in SAP-ALI.Furthermore,AR7-induced upregulation of CMA promoted the activation of the Keap1/Nrf2 pathway in liver(P＜0.05),contributing to its antioxidative effect.Conclusion Our study demonstrates that CMA dysfunction is involved in the pathological process of SAP-induced acute liver injury.AR7-induced CMA reactivation regulates the Keap1/Nrf2 antioxidant pathway,providing protection against SAP-induced acute liver injury in rats.

Objective:To investigate the application of combined gastroscopy and laparoscopy (dual scope) in the treatment of early gastric cancer.Methods:In this descriptive case series study, we retrospectively collected data on 15 patients with cT1b stage gastric cancer who had undergone combined laparoscopic and endoscopic surgery in the 900th Hospital of the People's Liberation Army of China from May 2020 to October 2022. The study cohort comprised nine men and six women of median age 59 (range: 47–76) years and median body mass index 20.9 (range: 18.3–26.2) kg/m 2. Seven of the lesions were located on the lesser curvature of the gastric antrum and eight in the gastric angle. All lesions were biopsied for pathological examination and evaluated by endoscopic ultrasonography, followed by endoscopic submucosal dissection (ESD) and laparoscopic regional lymph node dissection. Studied variables included surgical and pathological features, postoperative factors, and outcomes. Results:In this group of patients, the median (range) operative time for ESD was 45 (30–82) minutes, the duration of laparoscopic lymph node dissection (45.1±8.6) minutes, and the median (range) intraoperative blood loss during lymph node dissection 30 (10–80) mL. Of the 13 patients with negative postoperative horizontal margins, four were stage SM1 and had no lymph node metastases (Stage SM1) and nine were Stage SM2, of which had one positive regional lymph node and two received additional standard distal gastrectomy with D2 lymphadenectomy concurrently because of positive ESD specimens (lymph node negative). No lymph node metastases were found in the surgical specimens of these patients. The remaining two patients had positive vertical margins; both had undergone concurrent standard distal gastrectomy with D2 lymphadenectomy. One of them was found to be lymph node positive (No. 3, one node). Four patients had impaired gastric emptying after dual-scope treatment, all of whom recovered well with symptomatic management; one patient with a suspected lymphatic leak was also managed conservatively. There were no cases of postoperative bleeding, abdominal infection, or incisional infection. At a median follow-up of 14 (6–26) months, no tumor recurrence or metastasis had been identified in any of the patients. Three patients had a grade B nutrition score 3 to 6 months after surgery, all of whom had undergone major gastrectomy, and two patients who had undergone dual-scope surgery reported an increase in acid reflux and belching after surgery compared with the preoperative period.Conclusion:A combined technique is safe and feasible for the treatment of early gastric cancer and is worthy of further exploration.

Objective:To investigate the application of combined gastroscopy and laparoscopy (dual scope) in the treatment of early gastric cancer.Methods:In this descriptive case series study, we retrospectively collected data on 15 patients with cT1b stage gastric cancer who had undergone combined laparoscopic and endoscopic surgery in the 900th Hospital of the People's Liberation Army of China from May 2020 to October 2022. The study cohort comprised nine men and six women of median age 59 (range: 47–76) years and median body mass index 20.9 (range: 18.3–26.2) kg/m 2. Seven of the lesions were located on the lesser curvature of the gastric antrum and eight in the gastric angle. All lesions were biopsied for pathological examination and evaluated by endoscopic ultrasonography, followed by endoscopic submucosal dissection (ESD) and laparoscopic regional lymph node dissection. Studied variables included surgical and pathological features, postoperative factors, and outcomes. Results:In this group of patients, the median (range) operative time for ESD was 45 (30–82) minutes, the duration of laparoscopic lymph node dissection (45.1±8.6) minutes, and the median (range) intraoperative blood loss during lymph node dissection 30 (10–80) mL. Of the 13 patients with negative postoperative horizontal margins, four were stage SM1 and had no lymph node metastases (Stage SM1) and nine were Stage SM2, of which had one positive regional lymph node and two received additional standard distal gastrectomy with D2 lymphadenectomy concurrently because of positive ESD specimens (lymph node negative). No lymph node metastases were found in the surgical specimens of these patients. The remaining two patients had positive vertical margins; both had undergone concurrent standard distal gastrectomy with D2 lymphadenectomy. One of them was found to be lymph node positive (No. 3, one node). Four patients had impaired gastric emptying after dual-scope treatment, all of whom recovered well with symptomatic management; one patient with a suspected lymphatic leak was also managed conservatively. There were no cases of postoperative bleeding, abdominal infection, or incisional infection. At a median follow-up of 14 (6–26) months, no tumor recurrence or metastasis had been identified in any of the patients. Three patients had a grade B nutrition score 3 to 6 months after surgery, all of whom had undergone major gastrectomy, and two patients who had undergone dual-scope surgery reported an increase in acid reflux and belching after surgery compared with the preoperative period.Conclusion:A combined technique is safe and feasible for the treatment of early gastric cancer and is worthy of further exploration.

Objective:To investigate the expression of RASAL3 in intrahepatic cholangiocarcinoma (iCCA) and the mechanism of promoting iCCA development.Methods:Tumor and paracancerous tissues were collected from 185 iCCA patients, the expression of RASAL3 was detected by immunohistochemistry, RT-qPCR and Western blot. The expression of RASAL3 and FXYD6 mRNA and protein in human cholangiocarcinoma cell line and human bile duct epithelial cells were detected with RT-qPCR and Western blot, the cell proliferation was detected with CCK-8 assay, and the activity of Na +-K +-ATPase was also detected. Results:RASAL3 was highly expressed in cholangiocarcinoma tissues and cell lines; Survival analysis showed that RASAL3 overexpression was associated with poor prognosis of cholangiocarcinoma( P<0.05) and knockdown of RASAL3 inhibits the proliferation of cholangiocarcinoma cells; Silencing RASAL3 decreases the expression of FXYD6 inhibiting the activity of Na +-K +-ATPase. Conclusion:RASAL3 is up-regulated in human cholangiocarcinoma, which can promote the occurrence and development of cholangiocarcinoma by activating FXYD6 and affecting Na +-K +-ATPase activity.

OBJECTIVE: To extend the application of Gibbs artifact reduction method that exploits local subvoxel- shifts (LSS) to zero- padded k-space magnetic resonance imaging (MRI) data. METHODS: We investigated two approaches to extending the application of LSS-based method to under-sampled data. The first approach, namely LSS+ interpolation, utilized the original LSS-based method to minimize the local variation on nonzero-padding reconstructed images, followed by image interpolation to obtain the final images. The second approach, interlaced local variation, used zero-padded Fourier transformation followed by elimination of Gibbs artifacts by minimizing a novel interlaced local variations (iLV) term. We compared the two methods with the original LSS and Hamming window filter algorithms, and verified their feasibility and robustness in phantom and data. RESULTS: The two methods proposed showed better performance than the original LSS and Hamming window filters and effectively eliminated Gibbs artifacts while preserving the image details. Compared to LSS + interpolation method, iLV method better preserved the details of the images. CONCLUSIONS The iLV and LSS+interpolation methods proposed herein both extend the application of the original LSS method and can eliminate Gibbs artifacts in zero-filled k-space data reconstruction images, and iLV method shows a more prominent advantage in retaining the image details.
Algorithms ; Artifacts ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging ; Phantoms, Imaging

Objective To investigate the clinical effect and value of meropenem in the treatment of purulent meningitis .Methods 88 patients with purulent meningitis in our hospital from January 2009 to December 2012 were randomly divided into observation group and control group, according to the proportion of 1:1, the subjects were randomly divided into observation group and control group, with 44 cases in each group.The control group was treated with ceftriaxone and amoxicillin sulbactam.The observation group was treated with meropenem for injection.Comparison of the two groups of children with temperature decline time, the time of disappearance of intracranial pressure, brain marrow fluid returned to normal time, clinical efficacy and bacteriological efficacy and adverse reactions.Results After treatment,The cure rate of the observation group was 68.18%, the total effective rate was 95.45%, higher than the control group 45.45%, 65.91%, the difference was statistically significant ( P<0.05 ) .Bacterial clearance rate of the observation group was 65.91%, higher than the control group 43.18%, the difference was statistically significant (P<0.05).The unclear rate 2.27%, replacement rate 2.27%, and the re-infection rate 2.27% of the observation group were significantly lower than those of the control group 18.18%, 9.09%, 9.09%, the difference was statistically significant (P<0.05).The temperature decline time, the time of disappearance of intracranial pressure and CSF recovery time of the observation group were significantly shorter than the control group, the difference was statistically significant (P<0.05). Gastrointestinal symptoms, neurological symptoms and skin symptoms and other adverse reaction rate of 4.55% of the observation group compared with the control group 4.55%, the difference was not statistically significant.Conclusion Meropenem treatment of purulent meningitis in children with significant effect, safe and reliable, is purulent meningitis in children is an ideal choice, it is worth further expanding the sample to be studied for the rationalization of the drug to provide more reference basis for clinical services .

Objective To evaluate the relationship between the incidence rate of hepatic encephalopathy in patients with cirrhosis and the model for end-stage liver disease (MELD).Methods The total of 120 patients with decompensated cirrhosis were enrolled and followed-up.MELD score was obtained to observe the incidence of hepatic encephalopathy.Results The incidence of hepatic encephalopathy was 44.17％(53/120).MELD score in hepatic encephalopathy patients was significantly higher than that in none hepatic encephalopathy patients[(21.69 ± 9.22) scores vs.(9.32 ± 4.63) scores],and there was significant difference (P ＜ 0.05).With the increase of MELD score,the incidence of hepatic encephalopathy increased (P ＜ 0.01).The best critical value of MELD score was 14.13 scores (the sensitivity of 86.05％ and the specificity of 88.37％),when MELD ≥14.13 scores,the incidence of hepatic encephalopathy within 3 months was significantly higher [63.16％(48/76) vs.11.36％(5/44)] (x2 =30.32,P＜ 0.01).Conclusion MELD can help predicting the incidence of hepatic encephalopathy in decompensated cirrhosis patients.

Objective:To optimize 3.0T MRI diagnosis indicator in breast cancer and to select the best MRI scan program.
Methods:Totally 45 patients with breast cancers were collected, and another 35 patients with benign breast tumor served as the control group. All patients underwent 3.0T MRI, including T1-weighted imaging (T1WI), fat suppression of the T2-weighted imaging (T2WI), diffusion weighted imaging (DWI), 1H magnetic resonance spectroscopy (1H-MRS) and dynamic contrast enhanced (DCE) sequence. With operation pathology results as the gold standard in the diagnosis of breast diseases, the pathological results of benign and malignant served as dependent variables, and the diagnostic indicators of MRI were taken as independent variables. We put all the indicators of MRI examination under Logistic regression analysis, established the Logistic model, and optimized the diagnosis indicators of MRI examination to further improve MRI scan of breast cancer.
Results:By Logistic regression analysis, some indicators were selected in the equation, including the edge feature of the tumor, the time-signal intensity curve (TIC) type and the apparent diffusion coeffcient (ADC) value when b=500 s/mm2. hTe regression equation was Logit (P)=-21.936+20.478X6+3.267X7+21.488X3.
Conclusion:Valuable indicators in the diagnosis of breast cancer are the edge feature of the tumor, the TIC type and the ADC value when b=500 s/mm2. Combining conventional MRI scan, DWI and dynamic enhanced MRI is a better examination program, while MRS is the complementary program when diagnosis is diffcult.

Objective To explore the values of pixel indexes (PI) with multiple-slice spiral CT low-dose two-phase scanning for assessing the pulmonary function in chronic obstructive pulmonary disease (COPD).Methods Thirty-six patients with COPD (COPD group)and 30 healthy people (control group)underwent pulmonary function test (PFT).Chest 64-MSCT low-dose (50 mAs) scanning at full inspiration and expiration,routine scanning (100 mAs) at inspiration were performed.The effective dose (ED) was calculated.The lung was divided into three regions ( upper,middle,lower).PI of lung were divided into five groups:-960--1024, -910--960, -800--910, -700--800,-400--700.ThePI-910 (sum of the PI under -910 HU) of low-dose scanning at each region were measured and calculated using pulmo software. All PI included PIin-910,PIex-910,PIin-910-PIex-910, PIex-910/PIin-910 and (PIin-910-PIex-910)/PIin-910.All patients underwent PFT within 3 days after 64-MSCT canning,FEV1％ and FEV1/FVC were selected for comparison. Results The PIin in three regions ( - 960 - - 1024,-910 - -960,-800 - -910) were statistically significant between normal and COPD groups( U =0.00,57.00,20.50,P ＜ 0.01 ). The PIex in all regions were statistically significant ( U =0.00,0.00,71.52,191.00,6.00,P ＜ 0.01 ). PI-910--1024 at expiration and inspiration were correlated with FEV1％ and FEV1/FVC( r =- 0.548,- 0.664,- 0.752,- 0.781,P ＜ 0.01 ).PIin -910,PIex -910,PIex-910/PIin -910,( PIin -910-PIex -910 )/PIin -910 had a good correlation with FEV1％ and FEV1/FVC ( r =- 0.548,- 0.664,- 0.752,- 0.781,- 0.674,- 0.642,0.674,0.642,P ＜ 0.01 ).Conclusion Pixel indexes of 64-MSCT low-dose two-phase scanning can be used to evaluate pulmonary function in COPD patients.