Objective:To explore the safety and efficacy of shunt reduction using the Interlock-35 fibered interlocking detachable coil (IDC) occlusion system in the treatment of refractory hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS).Methods:From August 2022 to December 2023, at the Department of Gastroenterology of the Air Force Medical Center, the clinical data of patients with refractory HE after TIPS who were treated with shunt reduction using the Interlock-35 fibered IDC occlusion system were retrospectively collected, which included portal vein pressure gradient (PVPG), HE grades, blood ammonia levels, prothrombin time (PT), liver function parameters, and other related indicators. The primary indicators related to the efficacy of the shunt reduction included symptom improvement, and changes in PVPG, blood ammonia levels, and Child-Pugh score. The safety of shunt reduction was analyzed based on the incidence of complications such as gastrointestinal bleeding and ascites during the follow-up period. Paired t-test was used for statistical analysis. Results:A total of 21 patients were enrolled. Prior to shunt reduction, there were 5 cases with HE of grade 3 and 16 cases with HE of grade 2. Before operation, the blood ammonia was (103.14±27.69) mol/L; and the liver function Child-Pugh grade of 1 case was classified as grade A, 16 cases as grade B, and 4 cases as grade C. Shunt reduction was performed between 7 and 1 879 d, with a median time of 99 (54, 806) d after TIPS. The procedure was technically successful in all patients, with a total of 25 coils implanted. Before shunt reduction, the PVPG was (14.02±5.28) cmH 2O (1 cmH 2O=0.098 kPa), after shunt reduction procedure, the PVPG increased to (25.05±6.04) cmH 2O, and the difference was statistically significant ( t=-11.26, P<0.001). After operation, 16 patients returned to the hospital for follow-up examinations, with a median follow-up time of 114 (46, 195) d, the blood ammonia levels, PT, and Child-Pugh scores during the follow-up were all lower than those before operation ((78.19±27.85) μmol/L vs. (105.00±30.53) μmol/L, (14.09±1.65) s vs. (15.41±2.35) s, and 6.88±1.59 vs. 8.13±1.75, respectively), and the differences were statistically significant ( t=2.23, 3.23, and 2.61; P=0.040, <0.001, =0.020). There was no statistically significant in PVPG between during follow-up and immediately post-procedure ((28.91±6.20) cmH 2O vs. (25.22±5.92) cmH 2O, P>0.05). During the follow-up period, HE symptoms disappeared in 12 patients among the 16 patients who returned to hospital for follow-up, however gastrointestinal bleeding occurred in 5 patients and ascites occurred in 3 patients; additionally, 4 patients experienced intermittent HE symptoms (grade 1 in 3 cases, grade 2 in 1 case). After operation, 5 patients were followed up via telephone, among them, 3 patients died, and 2 patients experienced intermittent HE (grade 1) which could be spontaneously restored with dietary adjustments and(or) medication. Conclusions:Interlock-35 fibered IDC occlusion system for shunt reduction is a feasible and effective treatment for refractory HE after TIPS. It can effectively improve symptoms and decrease liver function score. After shunt reduction, early follow-up and adjustment of flow reduction can help reduce the occurrence of severe complications.

Objective:To explore the safety and efficacy of shunt reduction using the Interlock-35 fibered interlocking detachable coil (IDC) occlusion system in the treatment of refractory hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS).Methods:From August 2022 to December 2023, at the Department of Gastroenterology of the Air Force Medical Center, the clinical data of patients with refractory HE after TIPS who were treated with shunt reduction using the Interlock-35 fibered IDC occlusion system were retrospectively collected, which included portal vein pressure gradient (PVPG), HE grades, blood ammonia levels, prothrombin time (PT), liver function parameters, and other related indicators. The primary indicators related to the efficacy of the shunt reduction included symptom improvement, and changes in PVPG, blood ammonia levels, and Child-Pugh score. The safety of shunt reduction was analyzed based on the incidence of complications such as gastrointestinal bleeding and ascites during the follow-up period. Paired t-test was used for statistical analysis. Results:A total of 21 patients were enrolled. Prior to shunt reduction, there were 5 cases with HE of grade 3 and 16 cases with HE of grade 2. Before operation, the blood ammonia was (103.14±27.69) mol/L; and the liver function Child-Pugh grade of 1 case was classified as grade A, 16 cases as grade B, and 4 cases as grade C. Shunt reduction was performed between 7 and 1 879 d, with a median time of 99 (54, 806) d after TIPS. The procedure was technically successful in all patients, with a total of 25 coils implanted. Before shunt reduction, the PVPG was (14.02±5.28) cmH 2O (1 cmH 2O=0.098 kPa), after shunt reduction procedure, the PVPG increased to (25.05±6.04) cmH 2O, and the difference was statistically significant ( t=-11.26, P<0.001). After operation, 16 patients returned to the hospital for follow-up examinations, with a median follow-up time of 114 (46, 195) d, the blood ammonia levels, PT, and Child-Pugh scores during the follow-up were all lower than those before operation ((78.19±27.85) μmol/L vs. (105.00±30.53) μmol/L, (14.09±1.65) s vs. (15.41±2.35) s, and 6.88±1.59 vs. 8.13±1.75, respectively), and the differences were statistically significant ( t=2.23, 3.23, and 2.61; P=0.040, <0.001, =0.020). There was no statistically significant in PVPG between during follow-up and immediately post-procedure ((28.91±6.20) cmH 2O vs. (25.22±5.92) cmH 2O, P>0.05). During the follow-up period, HE symptoms disappeared in 12 patients among the 16 patients who returned to hospital for follow-up, however gastrointestinal bleeding occurred in 5 patients and ascites occurred in 3 patients; additionally, 4 patients experienced intermittent HE symptoms (grade 1 in 3 cases, grade 2 in 1 case). After operation, 5 patients were followed up via telephone, among them, 3 patients died, and 2 patients experienced intermittent HE (grade 1) which could be spontaneously restored with dietary adjustments and(or) medication. Conclusions:Interlock-35 fibered IDC occlusion system for shunt reduction is a feasible and effective treatment for refractory HE after TIPS. It can effectively improve symptoms and decrease liver function score. After shunt reduction, early follow-up and adjustment of flow reduction can help reduce the occurrence of severe complications.

In the perspective of the theory of intersubjectivity, the educators and the educated in the mental health education of college students establish a subject-subject relationship by experience teach-ing as an intermediary. By focusing on the needs of students, mobilizing the students ' active participation, adopting the experience teaching in small class, the way of formative evaluation, the relationship of mutual integration and mutual promotion are established , which realizes the validity of the College Students ' Mental Health Educationcourse.

Objective To investigate the changes of autoantibodies in hepatitis B disease and its clinical sig-nificance.Methods 418 cases of hepatitis B patients were selected as hepatitis B group.At the same time,148 hos-pitalized patients in our hospital with autoimmune hepatitis( AIH) were chosen as AIH group.And 100 healthy people with physical examination were selected as control group at the same time .The antinuclear antibodies , anti -smooth muscle antibody( SMA) and anti-kidney microsomal antibodies and other autoantibodies of the three groups were detected and analyzed statistically.Results ANA-positive rate of hepatitis B group was 22.73%,ANA titer was mainly 1:100,only two cases of liver cirrhosis titers were 1:320,ANA karyotype was mainly homogenous,only four cases belonged speckled pattern;ANA positive rate of AIH patients was 60.14%,ANA titer was mainly 1:320,or even 1:1 000, primarily as a spot -type karyotype, nucleolar and centromere type.Differences between the two groups were statistically significant (P<0.05).The positive rates of hepatitis B,chronic hepatitis,severe hepatitis B and hepatitis B patients with cirrhosis ANA were significantly higher than in patients with acute hepatitis B,the differ-ences were statistically significant (χ2 =12.172,12.560,28.123,all P<0.05).Compared with AIH group,the posi-tive rate of SMA and LKM in patients with hepatitis decreased 51.98%,32.22%,respectively,the differences were statistically significant (χ2 =196.843,107.357,all P<0.05).The positive rate of hepatitis B level ANA ( +) patients of ALT and AST,HBV DNA was significantly higher than ANA (-) group.The level of hepatitis B patients ALT and AST,HBV DNA positive group were significantly higher than AIH.Differences were statistically significant (all P<0.05).Conclusion Autoantibody detection helps to study autoimmune etiology and pathogenesis of great importance for patients with hepatitis B and cirrhosis,but the reaction involved in the pathogenesis of autoimmune hepatitis level research still needs to be deeper.

Objective To evaluate the diagnostic value of non-invasive imaging modalities to evaluate lower limb arterial disease associated with diabetes.Methods Two hundred and twenty seven patients (292 lower limb arteries) with lower limb arterial disease due to diabetes underwent both DSA and one of the pre-operative imaging modalities including CTA,CE-MRA and DUS were included in this study.The diagnostic consistency of CT angiography(CTA),contrast enhanced magnetic resonance angiography (CE-MRA) and Doppler ultrasonography(DUS) compared with DSA were calculated respectively.CTA was performed in 169 lower limb arteries,while 123 in CE-MRA and DUS in 192.DSA was used as the gold standard.Consistency analysis was performed to evaluate the three imaging modalities with lower limb artery classified as Grade 1,Grade 2 and Grade 3.Results The sensitivity of CTA to evaluate mild stenosis in Grade 1 to Grade 3 was 100％(56/56),97.6％(82/84) and 93.8％(30/32) respectively,while 100％(19/19),94.4％ (34/36)and 61.5％ (8/13) for severe stenosis.The diagnostic accuracy of mild and severe stenosis was 95.9％ (162/169) to 99.4％ (168/169),which showed good consistency with the result of DSA with Kappa value of 0.760 to 0.916,and P＜0.05.The sensitivity of CE-MRA to evaluate mild stenosis in Grade 1 to Grade 3 was 93.2％(68/73),97.2％(103/106) and 93.2％ (69/74)respectively,while 91.3％ (21/23),80.8％ (42/52)and 42.1％ (8/19)for severe stenosis.The diagnostic accuracy of mild and severe stenosis was 86.2％ (106/123) to 96.7％ (119/123),which showed good consistency with the result of DSA with Kappa value of 0.767 to 0.868 and P＜0.05.The sensitivity of DUS to evaluate mild stenosis in Grade 1 to Grade 3 was 89.9％ (62/69),88.8％ (87/98) and 79.2％ (42/53) respectively,while 73.1％ (19/26),84.8％ (39/46) and 44.4％ (8/18) for severe stenosis.The diagnostic accuracy of mild and severe stenosis was 89.7％ (174/194) to 93.8％ (182/194),which showed good consistency with the result of DSA with Kappa value of 0.476 to 0.864 and P＜0.05.Conclusions The non-invasive imaging modalities,namely CTA,CE-MRA and DUS all have good diagnostic consistency compared with DSA.CTA is superior to CE-MRA and DUS in evaluating the severe stenosis of lower limb arterial disease in diabetes patients.

Objective +o evaluate percutaneous intervetional therapy for portal vein anastomotic occlusion after liver transplantation.Method From July 2005 to July 2013,13 patients (9 male and 4 female; aged 25-65 years) with portal vein occlsion underwent interventional therapy.All patients accepted the imaging examation and 8 patients had typical clinical signs of portal hypertension.Percutaneous hepatic balloon venoplasty and stent placement was performed,trans-catherter urokinase infusion for thrombolysis and embolization for collateral pathways performed if necessary.+echnical success rate,complication rate and clinical symptoms were analyzed.Follow-ups including clinical course,stent patency and potal vein thrombosis which evaluated by imaging were performed.Result +echnical success was achieved in l1of 13 patients (84.6％) and 15 stents were deployed.Seven patients with localized portal vein occulsion accepted balloon dilation and stents deployment,4 patients with long segment cculsion also accept trans-catherter urokinase infusion for thrombolysis and embolization for collateral pathways.Portal vein flow recovered in all 11 patients.Procedure related complication occurred in 2 patient with hemothorax.During the follow-up period of 4-42 months,the clinical signs of portal hypertension were not observed in all patients.Stent stenosis was found in one patient with ultrasound in 23 months,but stent patency was proved by the percutaneous portal angiography.Conclusion Interventional therapy is effective for portal vein occulsion after liver transplantation,comprehensive interventional therapy should be performed in long segment portal vein cculsion.

Objective To investigate SNP and distribution of haplotypes in differentially m ethylated region (DMR) upstream of H19 gene in Chinese Korean nationality in order to provide basic data for forensic application and population genetics research. Methods One hundred and one blood sam ples from unrelat-ed Chinese Korean individuals and 14 blood sam ples from 5 Chinese Korean intergenerational fam ilies which known genetic relationship were collected. The SNP in DMRupstream of H19 gene were investi-gated by PCR-cycle sequencing and McrB Cdigestion followed by PCR . The haplotypes detected by parentally im printed allele (PIA) m ethod and relevant genetic param eters were calculated. Results Thirteen SNPs (rs10840167, rs2525883, rs12417375, rs4930101, rs2525882, rs2735970, rs2735971, rs11042170, rs2735972, rs10732516, rs2071094, rs2107425, and rs4930098) and five haplotypes were detected in 1 174 bp target product in DMRupstream of H19 gene, with 9 SNPs having high discrim ination power as good genetic markers. The average gene diversity (GD) of haplotypes was 0.714. The maternal haplotype was confirm ed correctly by PIAm ethod from McrB C-digested products of genom ic DNA. Conclusion High polym orphism sexist in DMRupstream of H19 gene in Chinese Korean nationality. And determ ination of the maternal haplotype could furtherm ore enhance the forensic identification efficiency of im printed gene.

ObjectiveTo evaluate the effectiveness of the interventional treatment for portal vein stenosis in patients who had undergone liver transplantation.MethodsFromApr.2004 to Oct.2011,30 patients with portal vein stenosis after liver transplantation were referred for angiographic analysis and interventional treatment. All patients had typical clinical signs and symptoms or surveillance by imaging.After percutaneous transhepatic portography and balloon angioplasty,stents were deployed.Embolization was performed on patients with varices or portal vein flow changes.The therapeutic results were monitored by the follow-up on clinical symptoms,laboratory tests and imaging examinations.ResultsAngiography was performed successfully on all patients.Twenty-four patients received balloon dilation and 26 stents were deployed subsequently.The guide-wire cannot pass through the lesion of portal trunk in 1patient.Four patients received balloon angioplasty only.The technical success rate was 96.7％ (29/30).Stainless steel coils were applied in 7 patients for varices embolization.The complication related to interventional treatment was bleeding in thoracic cavity which happened in 2 patients.Portal vein patency was maintained in all the patients who received interventional treatment for 1-72 months (mean 21.5 months).No re-stenosis was identified.ConclusionInterventional therapy is an effective method for the treatment of portal vein stenosis after liver transplantation and excellent patency can be achieved by this method.

Automation workstation refers to a kind of fully automatic platform,which use the automatic technology to analysis,processe batches of biological samples.It can finish liquid handling,transfering,mixing and other operatious in short time,particularly suitable for PCR templates'preparation of large amount of biological samples.This article mainly discusses the basic patterns,methods and forensic applications of automated DNA extraction workstation,aimed at making the technology more widely applied in forensic DNA analysis.

Objective To evaluate the long-term safety, efficacy and complications of placement vena cava filter in prevention of pulmonary embolism. Methods Seventy-three patients with proven diagnosis of deep venous thrombosis (DVT) and (or) pulmonary embolism (PE) by Doppler ultrasonography, DSA, CT or MRI, received percutaneous inferior vena cava filters (IVCF) from January 1994 to June 2005. The clinical data and imaging findings were evaluated retrospectively. The patients underwent telephone interview or questionnaire, abdominal X-rays, Doppler ultrasonography, computed tomographic pulmonary angiography (CTPA) or indirect CT venography (CTV) after a follow-up duration of 5 months to 11 years. Results Seventy-eight vena cava filters were used. There was 1 case of incomplete filter opening when placing filter. In follow-up, thrombi were trapped in the filter in 2 cases, filter tilting happened in 1 case, and there were no filter migration, filter disruption, filter perforation. Five of 73 cases were lost in follow-up visit, 14 patients died after implantation (5 days to 41 months, average 14.5 months). Among the 54 living patients, the identified recurrent PE was not noted. Three cases of recurrent DVT, 1 case of inferior vena caval thrombosis and 1 case of thrombosed filters were seen in follow- up. Conclusion Inferior veua cava filter is safe and effective for the long-term prevention pulmonary embolism, and the long-term major complications after filter placement are not frequent.