Portal vein thrombosis (PVT) is one of the most common complications of liver cirrhosis. The formation of PVT can increase the mortality rate of cirrhotic patients and adversely affect the successful implementation and prognosis of liver transplantation. A hypercoagulable state is a unique mechanism underlying PVT formation in cirrhotic patients. In recent years, the pathogenesis of PVT has gradually been elucidated, with specific mechanisms including the following aspects: systemic and local inflammatory responses lead to vascular endothelial cell dysfunction, thereby promoting the activation of the coagulation system; abnormal activation of the monocyte-macrophage system exacerbates local inflammation, enhancing platelet adhesion and aggregation, and facilitating thrombus formation; an imbalance between the coagulation and fibrinolytic systems results in a sustained hypercoagulable state; and intestinal microbiota dysbiosis induces inflammation and metabolic disturbances, thereby increasing the risk of PVT. This article summarizes the latest research progress on these key mechanisms and their interactions, providing new insights into the molecular and cellular mechanisms of PVT. It also offers directions for the early diagnosis of PVT and the exploration of novel intervention strategies in the future.

Objective To investigate the effect of fluid shear(FS)on apoptosis of glomerular epithelial cells(GECs)and the role of Piezo 1 protein in it.Methods GECs(glomerular epithelial cells)of SD rat were cul-tured.Fluid shear stimulation was simulated by a Flexcell-T5000 tensiometer.Apoptosis level was detected by flow cytometry.The expression of Piezo 1 proteins in GECs was detected by immunofluorescence staining.The activating of Piezo 1 channels by fluid shear was observed using Ca2+indicator(Cal-590 AM).The effect of Piezo 1 on apop-tosis in GECs was analyzed after modulating the function or expression of Piezo 1 protein using the chemical activa-tor Yoda1,the inhibitor GsMtx 4 was regulated by lentivirus Lv-shPiezo 1.Results Compared with the blank controlgroup,apoptosis increased in the fluid shear group(P＜0.05).The rate of apoptosis increased with the enhancing of fluid shear strength;Piezo 1 was commonly expressed in GECs.Fluid shear activated Piezo 1 chan-nel and enhanced expression of Piezo 1.The agonist Yoda1 promoted the apoptosis of GECs GsMtx 4 inhibited the apoptosis induced by fluid shear.Lv-shPiezo 1 knocked down the expression of Piezo 1 in GECs and the apoptosis rate of GECs in the knockdown group was reduced as compared to that in the control group and Lv-Ctrl group(P＜0.05).Conclusions Fluid shear may promote apoptosis of GECs by activation of Piezo 1 and by enhancing expression of Piezo 1.

Persistent HBV infection alters the expression of receptors on the surface of innate and acquired immune cells, which may cause a variety of immune disorders and finally lead to immune escape and disease chronicity. Studies have shown that the upregulation of inhibitory receptors is the main cause of immune disorders in patients, and blocking inhibitory receptors can restore immune function to a certain extent. T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) is a new type of inhibitory receptor attracting much attention at present, and it is highly expressed in NK cells and T cells. It has been found that TIGIT plays an important role in chronic viral infection, and this article briefly reviews the research advances in the association between TIGIT and immune disorders in chronic HBV infection.

The chemical constituents of solid rice culture of the endophytic fungus Aspergillus sp.Dq-25 from barnacle were isolated and purified by silica gel, Sephadex LH-20, C18 reversed silica gel column chromatography and recrystallization.Their structures were identified by the physical and chemical properties, and by various spectroscopic methods.Six compounds were isolated and identified as: demethyldihydropenicillic acid (1), dihydropenicillic acid (2), penicillic acid (3), fortisterol (4), 22E, 24R-3P, 5a-dihydroxyerogosta-7, 22-diene-6-one (5), and (22E, 24R)-ergosterol-7, 22-diene-3β, 5α, 9α-triol-6-one (6).Compound 1 was a new butyrolactone.MTT method was used to analyze cytotoxicity, and the result showed that compound 3 exhibited inhibitory activity on five cell lines, including K562, HeLa, SGC-7901, A542 and BEL-7402, with IC50 values of 38.0 ~ 105.0 μmol/L.

Monkeypox (MPX) is a zoonotic disease caused by monkeypox virus (MPXV) and its re-emergence is a potential global threat. The number of human MPX-positive cases reported by some coutries was increasing since it was detected in the UK on May 7, 2022, which has become a public health emergency and attracted global attention. Understanding the virological characteristics, route of transmission, pathogenic mechanism, vaccines and antiviral drugs of MPX is of great significance for the prevention and control of monkeypox. This paper briefly described the etiological characteristics and the prevention and control measures for MPX.

Objective To investigate the role of P-I-R classification and Laennec grading in evaluating histological changes in patients with hepatitis B cirrhosis after receiving antiviral therapy, as well as the association of these two evaluation systems with clinical prognosis. Methods A total of 218 patients from 14 centers were consecutively screened from October 2013 to October 2014, and these patients were diagnosed with liver cirrhosis based on pathology (Ishak score ≥5), received antiviral therapy for 72 weeks, completed two liver biopsies, and met the P-I-R classification criteria. The 218 patients were divided into non-hepatocellular carcinoma (HCC) group with 186 patients and HCC group with 32 patients. The chi-square test and the Fisher's exact test were used for comparison of categorical data between groups. For the comparison of HCC after antiviral therapy, the non-parametric Mann-Whitney U test was used for continuous variables, and for the comparison of P-I-R classification and Laennec grading, the non-parametric Kruskal-Wallis H test was used for continuous variables. Univariate and multivariate Cox regression analyses were used to calculate hazard ratio ( HR ) and 95% confidence interval ( CI ), and the Kaplan-Meier method was used to calculate the cumulative incidence rate of HCC. Results After 72 weeks of antiviral therapy, there was a significant difference in P-I-R classification between the non-HCC group and the HCC group ( P < 0.001). There were significant differences in the distribution of Laennec grading and P-I-R classification before and after antiviral therapy ( P < 0.001). After antiviral therapy, the 218 patients were divided into 4A group with 33 patients, 4B group with 71 patients, and 4C group with 114 patients according to Laennec grading, and there were significant differences between these three groups in platelet count (PLT) ( H =36.429, P < 0.001), liver stiffness measurement (LSM) ( H =13.983, P =0.004), Ishak score ( χ 2 =23.060, P < 0.001), and HAI score ( P < 0.001). After antiviral therapy, the 218 patients were divided into R group with 70 patients, I group with 52 patients, and P group with 96 patients according to P-I-R classification, and there were significant differences between these three groups in PLT ( H =7.193, P =0.028), LSM ( H =6.238, P =0.045), Ishak score ( χ 2 =7.986, P < 0.001), HAI score ( P =0.002), and HCC ( P < 0.001). There was a significant difference in the incidence rate of HCC between the P and R groups based on P-I-R classification ( HR =24.21, 95% CI : 0.46-177.99, P =0.002). After adjustment for other confounding factors, P-I-R classification was an independent predictive factor for HCC ( HR =12.69, 95% CI : 4.63-34.80, P =0.002). Conclusion Both P-I-R classification and Laennec grading can reflect the features and changes of fibrosis before and after antiviral therapy, and P-I-R classification is more sensitive to fibrosis changes after antiviral therapy. P-I-R classification (after treatment) can be used to assess the risk of HCC in patients after antiviral therapy.

Objective:To investigate the factors that influence the number of oocytes retrieved of patients with polycystic ovary syndrome (PCOS) undergoing unstimulated natural cycles and the association between the number of oocytes retrieved and in vitro maturation (IVM) outcomes. Methods:This retrospective cohort study reviewed clinical data of 586 patients with PCOS undergoing unstimulated natural cycle at Reproductive Medicine Center, Department of Obstetrics and Gynecology of Peking University Third Hospital from 2006 January 1 to 2019 December 31. All patients were divided into three groups according to the number of oocytes retrieved (0-8, 9-19, ≥20). Basic information, basal endocrine hormones, oocyte and embryo development index and clinical outcomes were compared among the three groups.Results:Luteinizing hormone (LH)/follicle-stimulating hormone (FSH) [1.00(0.61,1.76), 1.41 (0.86, 1.96), 1.62(0.96, 2.14)], testosterone [1.07 (0.69, 1.91) nmol/L, 1.28 (0.77, 1.95) nmol/L, 1.67 (1.03, 2.75) nmol/L] and antral follicle count (AFC) [24 (19,24), 24 (24, 30), 30 (24, 40)] were significantly different among 0-8 group, 9-19 group and ≥20 group (all P<0.001). Multivariate logistic regression analysis showed that AFC was a significant factor affecting the number of oocytes retrieved ( P9-19/0-8=0.002, P≥20/0-8<0.001), and LH/FSH was an significant internal factor affecting the number of oocytes retrieved ( P9-19/0-8=0.006, P≥20/0-8=0.003) after the removal of AFC. Results of the analysis in patients after propensity score matching (PSM) showed that the number of oocytes retrieved was negatively correlated with oocyte maturation rate [0-8 group: 48.0% (242/504), 9-19 group: 44.8% (539/1202), ≥20 group: 40.4% (1067/2640), P=0.001], fertilization rate [0-8 group: 31.7% (160/504), 9-19 group: 25.5% (306/1202), ≥20 group∶ 23.7% (625/2640), P=0.001] and transferable embryo rate [0-8 group: 19.2% (97/504), 9-19 group: 11.6% (140/1202),≥20 group: 6.0% (153/2540), P<0.001], while positively correlated with transferable embryo formation cycle rate [0-8 group: 51.1% (47/92), 9-19 group: 66.3% (61/92), ≥20 group: 73.9% (68/92), P=0.005]. There were no differences in clinical pregnancy rate and live birth rate per fresh or frozen embryo transfer cycles, cumulative clinical pregnancy rate and cumulative live birth rate among the three groups. Conclusion:AFC has predictive value for the number of oocytes retrieved in natural cycles, and LH/FSH is an important internal factor affecting the number of oocytes retrieved. Oocyte maturation quality and development potential decrease with the increase of the number of oocytes retrieved in natural cycles, which has no direct effect on clinical outcomes.

Objective:To investigate the factors that influence the number of oocytes retrieved of patients with polycystic ovary syndrome (PCOS) undergoing unstimulated natural cycles and the association between the number of oocytes retrieved and in vitro maturation (IVM) outcomes. Methods:This retrospective cohort study reviewed clinical data of 586 patients with PCOS undergoing unstimulated natural cycle at Reproductive Medicine Center, Department of Obstetrics and Gynecology of Peking University Third Hospital from 2006 January 1 to 2019 December 31. All patients were divided into three groups according to the number of oocytes retrieved (0-8, 9-19, ≥20). Basic information, basal endocrine hormones, oocyte and embryo development index and clinical outcomes were compared among the three groups.Results:Luteinizing hormone (LH)/follicle-stimulating hormone (FSH) [1.00(0.61,1.76), 1.41 (0.86, 1.96), 1.62(0.96, 2.14)], testosterone [1.07 (0.69, 1.91) nmol/L, 1.28 (0.77, 1.95) nmol/L, 1.67 (1.03, 2.75) nmol/L] and antral follicle count (AFC) [24 (19,24), 24 (24, 30), 30 (24, 40)] were significantly different among 0-8 group, 9-19 group and ≥20 group (all P<0.001). Multivariate logistic regression analysis showed that AFC was a significant factor affecting the number of oocytes retrieved ( P9-19/0-8=0.002, P≥20/0-8<0.001), and LH/FSH was an significant internal factor affecting the number of oocytes retrieved ( P9-19/0-8=0.006, P≥20/0-8=0.003) after the removal of AFC. Results of the analysis in patients after propensity score matching (PSM) showed that the number of oocytes retrieved was negatively correlated with oocyte maturation rate [0-8 group: 48.0% (242/504), 9-19 group: 44.8% (539/1202), ≥20 group: 40.4% (1067/2640), P=0.001], fertilization rate [0-8 group: 31.7% (160/504), 9-19 group: 25.5% (306/1202), ≥20 group∶ 23.7% (625/2640), P=0.001] and transferable embryo rate [0-8 group: 19.2% (97/504), 9-19 group: 11.6% (140/1202),≥20 group: 6.0% (153/2540), P<0.001], while positively correlated with transferable embryo formation cycle rate [0-8 group: 51.1% (47/92), 9-19 group: 66.3% (61/92), ≥20 group: 73.9% (68/92), P=0.005]. There were no differences in clinical pregnancy rate and live birth rate per fresh or frozen embryo transfer cycles, cumulative clinical pregnancy rate and cumulative live birth rate among the three groups. Conclusion:AFC has predictive value for the number of oocytes retrieved in natural cycles, and LH/FSH is an important internal factor affecting the number of oocytes retrieved. Oocyte maturation quality and development potential decrease with the increase of the number of oocytes retrieved in natural cycles, which has no direct effect on clinical outcomes.

The pregnancy registry for medicine is a common method for risk evaluation for drug safety evaluation during pregnancy. The authors introduced the exploration and practice of the pregnancy drug registry mode based on pharmacy service in Women′s Hospital School of Medicine Zhejiang University. The registry of pregnancy medication with the drug consultation clinic as the fulcrum was managed by the pharmacist team in a homogenization way, and implemented according to the information process of consultation, pharmacy guidance and regular follow-up. In the consultation and follow-up work, the pharmacists established the consultation drug history through three data sources: independent report of the consultant, inquiry of pharmaceutical personnel and case sampling. The pharmacists designed and constructed information screening system, classified the consultation medicine history according to the pregnancy exposure of specific drugs. The prospective research method was designed to meet the characteristics of pregnancy medication. The study was carried out on the relationship between pregnancy exposure and birth defects of offspring. Relying on the improvement of standardization, refinement and information management level of pharmaceutical services, multi center cooperation will be strengthened in the future to carry out continuous research on pregnancy drug exposure registry and follow-up system.

Objective:To evaluate the value of lung ultrasound score (LUS) on predicting weaning outcome in patients with intro-abdominal infection (IAI) undergoing mechanical ventilation.Methods:Patients with IAI undergoing mechanical ventilation admitted to Research Institute of General Surgery of East War Zone Hospital and intensive care unit (ICU) of the First People's Hospital of Lianyungang from January to December in 2018 were included. The patients who satisfied weaning criteria were enrolled in the weaning process, which included spontaneous breathing trial (SBT) and extubation. They were divided into SBT success group and SBT failure group according to whether passed 120-minute SBT or not. LUS scores before and after SBT were compared between the two groups. The patients in the SBT success group were extubated, and they were divided into successful extubation group and failed extubation group for sub-group analysis according to whether re-intubation was needed in 48 hours after extubation. LUS score before extubation (at the end of SBT) and 48 hours after extubation (48 hours after extubation in the successful extubation group or before re-intubation in the failed extubation group) were compared. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of LUS score before SBT for SBT failure and LUS score before extubation for the failure.Results:A total of 76 patients with IAI undergoing mechanical ventilation were included. Twenty-three patients had duration of mechanical ventilation less than 48 hours, severe chronic obstructive pulmonary disease (COPD), tracheotomy or automatic discharge were excluded, and 53 patients were enrolled. SBT was failed in 9 patients, and successfully performed in 44 patients, of whom 23 patients with successful extubation, and 21 with failed extubation. The LUS scores before and after SBT in the SBT failure group were significantly higher than those in the SBT success group (before SBT: 13.22±1.99 vs. 10.79±1.64, t = -3.911, P = 0.000; after SBT: 19.00±1.12 vs. 13.41±1.86, t = -8.665, P = 0.000). ROC curve analysis showed that the area under ROC curve (AUC) of LUS score before SBT for predicting SBT failure was 0.82 [95% confidence interval (95% CI) was 0.67-0.98, P = 0.002]. When the optimum cut-off value was 12.5, the sensitivity was 66.7%, and the specificity was 84.1%. Sub-group analysis showed that the LUS scores before and after extubation in the failed extubation group were significantly higher than those in the successful extubation group (before extubation: 14.19±1.60 vs. 12.69±1.81, t = -2.881, P = 0.006; after extubation: 16.42±1.59 vs. 12.78±1.54, t = -7.710, P = 0.000). ROC curve analysis showed that the AUC of LUS score before extubation for predicting the failure was 0.81 (95% CI was 0.69-0.92, P = 0.000). When the optimum cut-off value was 13.5, the sensitivity was 80.0%, and the specificity was 65.2%. Conclusion:LUS score can effectively predict SBT outcome, risk of re-intubation after extubation in patients with IAI undergoing mechanical ventilation.