Objective:To explore the predictive value of ferritin combined with the COSSH-ACLF Ⅱ score for the prognosis of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (HBV-ACLF).Methods:The clinical data of 419 cases with HBV-ACLF hospitalized at the Third Hospital of Hebei Medical University were retrospectively analyzed between January 1, 2013 and September 30, 2022, and were divided into the death ( n=127) and survival group ( n=292) according to the survival status of 28 days of follow-up. The Mann-Whitney U test was used to compare confirmation of non-normally distributed continuous data between two groups. The chi-square test was used for the comparison of numerical data between the two groups. Binary logistic regression analysis was used to analyze the independent risk factors affecting the prognosis of HBV-ACLF patients. The predictive value of ferritin combined with the COSSH-ACLF Ⅱ score on the prognosis of HBV-ACLF was evaluated by the receiver operating characteristic curve (ROC curve) and area under the curve (AUC), net reclassification index (NRI), and comprehensive discriminant improvement index (IDI). Results:There were statistically significant differences in age, neutrophil count (NEUT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), serum creatinine (Scr), serum urea, prothrombin time (PT), prothrombin activity (PTA), international normalized ratio (INR), serum ferritin (SF), hepatic encephalopathy, and COSSH-ACLF Ⅱ scores between the two groups ( P<0.05). Ferritin ( OR=1.001, 95% CI:1.001-1.002, P<0.001) and COSSH-ACLF Ⅱ score ( OR=2.898, 95% CI:1.560-5.384, P<0.001) were independent factors for predicting short-term prognosis for patients with HBV-ACLF. Ferritin combined with COSSH-ACLF II score had a higher prognostic predictive value than ferritin (AUC=0.697, 95% CI: 0.651-0.741) and COSSH-ACLF II score (AUC=0.819, 95% CI: 0.779-0.855) for patients with HBV-ACLF (AUC=0.857, 95% CI: 0.819-0.889), with a statistically significant difference ( Z=6.287 and 2.666, respectively, P <0.05). The predictive effect was significantly improved following the addition of ferritin to the COSSH-ACLF Ⅱ score ( P<0.001), and the NRI and IDI were both >0 (NRI=0.144, 95% CI: 0.064-0.225; IDI=0.080, 95% CI: 0.052-0.108). Conclusion:Ferritin and COSSH-ACLF Ⅱ scores are independent factors that can predict short-term prognosis for patients with HBV-ACLF, and combing both has a higher predictive value.

Objective To investigate the effects of miR-139-5p-modified human umbilical cord mensenchymal stem cell(UC-MSC)-derived exosomes on stemness and radiotherapy sensitivity of breast cancer cells.Methods MCF-7 cells were divided into the control,miR-NC Exo,and miR-139-5p Exo groups.Immunofluorescence staining was used to observe the cellular uptake of exosomes.A tumor sphere formation assay determined the number of tumor spheres formed.Western blotting detected NANOG,SOX2,and OCT4 protein expression levels.MCF-7 cells were divided into control,2 Gy X ray,miR-139-5p Exo,and miR-139-5p Exo+2 Gy X ray groups.The survival rate of MCF-7 cells was detected by the MTT method.The apoptosis rate of MCF-7 cells was determined using flow cytometry.Results Compared to the control and miR-NC Exo groups,the number of tumor spheres formed by MCF-7 cells in the miR-139-5p Exo group was significantly decreased,and the relative expression levels of Nanog,SOX2,and OCT4 proteins were significantly downregulated(P＜0.05).Compared to the control group,the survival rate of MCF-7 cells in the 2 Gy X ray and miR-139-5p Exo groups was significantly decreased,and the apoptosis rate was significantly increased(P＜0.05).Compared to the 2 Gy X ray group,the survival rate of MCF-7 cells in the miR-139-5p Exo+2 Gy X ray group was significantly decreased,and the apoptosis rate was significantly increased(P＜0.05).Conclusion UC-MSC-derived exosomes modified by miR-139-5p inhibit the stemness of MCF-7 cells and enhance the radiotherapy sen-sitivity of MCF-7 cells.

Objective:To explore the predictive value of ferritin combined with the COSSH-ACLF Ⅱ score for the prognosis of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (HBV-ACLF).Methods:The clinical data of 419 cases with HBV-ACLF hospitalized at the Third Hospital of Hebei Medical University were retrospectively analyzed between January 1, 2013 and September 30, 2022, and were divided into the death ( n=127) and survival group ( n=292) according to the survival status of 28 days of follow-up. The Mann-Whitney U test was used to compare confirmation of non-normally distributed continuous data between two groups. The chi-square test was used for the comparison of numerical data between the two groups. Binary logistic regression analysis was used to analyze the independent risk factors affecting the prognosis of HBV-ACLF patients. The predictive value of ferritin combined with the COSSH-ACLF Ⅱ score on the prognosis of HBV-ACLF was evaluated by the receiver operating characteristic curve (ROC curve) and area under the curve (AUC), net reclassification index (NRI), and comprehensive discriminant improvement index (IDI). Results:There were statistically significant differences in age, neutrophil count (NEUT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), serum creatinine (Scr), serum urea, prothrombin time (PT), prothrombin activity (PTA), international normalized ratio (INR), serum ferritin (SF), hepatic encephalopathy, and COSSH-ACLF Ⅱ scores between the two groups ( P<0.05). Ferritin ( OR=1.001, 95% CI:1.001-1.002, P<0.001) and COSSH-ACLF Ⅱ score ( OR=2.898, 95% CI:1.560-5.384, P<0.001) were independent factors for predicting short-term prognosis for patients with HBV-ACLF. Ferritin combined with COSSH-ACLF II score had a higher prognostic predictive value than ferritin (AUC=0.697, 95% CI: 0.651-0.741) and COSSH-ACLF II score (AUC=0.819, 95% CI: 0.779-0.855) for patients with HBV-ACLF (AUC=0.857, 95% CI: 0.819-0.889), with a statistically significant difference ( Z=6.287 and 2.666, respectively, P <0.05). The predictive effect was significantly improved following the addition of ferritin to the COSSH-ACLF Ⅱ score ( P<0.001), and the NRI and IDI were both >0 (NRI=0.144, 95% CI: 0.064-0.225; IDI=0.080, 95% CI: 0.052-0.108). Conclusion:Ferritin and COSSH-ACLF Ⅱ scores are independent factors that can predict short-term prognosis for patients with HBV-ACLF, and combing both has a higher predictive value.

Objective:To explore the potential influencing factors of parenteral nutrition-associated cholestasis（PNAC）in extremely premature infants.Methods:A total of 83 cases of extremely premature infants who received parenteral nutrition and developed PNAC admitted to Shanxi Children's Hospital between October 2020 and October 2023 were selected as the case group，while 99 extremely premature infants who received parenteral nutrition but did not develop PNAC during the same period were selected as the control group. Basic information such as gender，gestational age，birth weight，and duration of parenteral nutrition were collected for the extremely premature infants. The health status of the infants at 1 minute and 5 minutes after birth was assessed using the Apgar standardized scoring method. One week after parenteral nutrition,platelet count(PLC)，mean platelet volume(MPV)，and platelet volume distribution width(PDW) were measured. Univariate analysis and non-conditional Logistic regression were used to analyze the potential influencing factors of PNAC in extremely premature infants after parenteral nutrition. Receiver operating characteristic(ROC) curves were plotted to evaluate the performance of the influencing factors and combined predictive factors in predicting PNAC in extremely premature infants receiving parenteral nutrition.Results:The 1-min and 5-min Apgar scores in the case group were lower than those in the control group( P<0.001);the percentages of gestational hypertension in mothers and postnatal infections in children were higher than those in the control group( P<0.05);and the duration of parenteral nutrition was longer than that in the control group( t=4.655, P<0.001), the differences were statistically significant. In the case group, after one week of parenteral nutrition,PLC was lower than that in the control group( t=4.949, P<0.001),MPV was higher than that in the control group( t=12.193, P<0.001), and PDW was higher than that in the control group( t=10.744, P<0.001), the differences were statistically significant.Multifactorial Logistic analysis showed that after adjusting for gender and gestational age，1-minute Apgar score（ OR=0.898），5-minute Apgar score（ OR=0.900），postnatal infection（ OR=1.256），duration of parenteral nutrition（ OR=1.426），one week after parenteral nutrition，PLC（ OR=0.902），MPV（ OR=1.441），and PDW（ OR=1.195）were independent influencing factors for PNAC in extremely premature infants（all P<0.05）. ROC curves showed that each factor and combined predictive factors had certain efficacy in predicting the occurrence of PNAC in extremely premature infants after parenteral nutrition. Conclusion:One-minute Apgar score,5-minute Apgar score，duration of parenteral nutrition，postnatal infection，one week after parenteral nutrition，the PLC,MPV and PDW are independent influencing factors for PNAC in extremely premature infants receiving parenteral nutrition.Each factor predicts the efficacy of parenteral nutrition for PNAC in extremely premature infants, and relevant factors should be controlled in time to reduce the incidence of PNAC in extremely premature infants.

Objective To investigate the effects of miR-139-5p-modified human umbilical cord mensenchymal stem cell(UC-MSC)-derived exosomes on stemness and radiotherapy sensitivity of breast cancer cells.Methods MCF-7 cells were divided into the control,miR-NC Exo,and miR-139-5p Exo groups.Immunofluorescence staining was used to observe the cellular uptake of exosomes.A tumor sphere formation assay determined the number of tumor spheres formed.Western blotting detected NANOG,SOX2,and OCT4 protein expression levels.MCF-7 cells were divided into control,2 Gy X ray,miR-139-5p Exo,and miR-139-5p Exo+2 Gy X ray groups.The survival rate of MCF-7 cells was detected by the MTT method.The apoptosis rate of MCF-7 cells was determined using flow cytometry.Results Compared to the control and miR-NC Exo groups,the number of tumor spheres formed by MCF-7 cells in the miR-139-5p Exo group was significantly decreased,and the relative expression levels of Nanog,SOX2,and OCT4 proteins were significantly downregulated(P＜0.05).Compared to the control group,the survival rate of MCF-7 cells in the 2 Gy X ray and miR-139-5p Exo groups was significantly decreased,and the apoptosis rate was significantly increased(P＜0.05).Compared to the 2 Gy X ray group,the survival rate of MCF-7 cells in the miR-139-5p Exo+2 Gy X ray group was significantly decreased,and the apoptosis rate was significantly increased(P＜0.05).Conclusion UC-MSC-derived exosomes modified by miR-139-5p inhibit the stemness of MCF-7 cells and enhance the radiotherapy sen-sitivity of MCF-7 cells.

Objective:To explore the potential influencing factors of parenteral nutrition-associated cholestasis（PNAC）in extremely premature infants.Methods:A total of 83 cases of extremely premature infants who received parenteral nutrition and developed PNAC admitted to Shanxi Children's Hospital between October 2020 and October 2023 were selected as the case group，while 99 extremely premature infants who received parenteral nutrition but did not develop PNAC during the same period were selected as the control group. Basic information such as gender，gestational age，birth weight，and duration of parenteral nutrition were collected for the extremely premature infants. The health status of the infants at 1 minute and 5 minutes after birth was assessed using the Apgar standardized scoring method. One week after parenteral nutrition,platelet count(PLC)，mean platelet volume(MPV)，and platelet volume distribution width(PDW) were measured. Univariate analysis and non-conditional Logistic regression were used to analyze the potential influencing factors of PNAC in extremely premature infants after parenteral nutrition. Receiver operating characteristic(ROC) curves were plotted to evaluate the performance of the influencing factors and combined predictive factors in predicting PNAC in extremely premature infants receiving parenteral nutrition.Results:The 1-min and 5-min Apgar scores in the case group were lower than those in the control group( P<0.001);the percentages of gestational hypertension in mothers and postnatal infections in children were higher than those in the control group( P<0.05);and the duration of parenteral nutrition was longer than that in the control group( t=4.655, P<0.001), the differences were statistically significant. In the case group, after one week of parenteral nutrition,PLC was lower than that in the control group( t=4.949, P<0.001),MPV was higher than that in the control group( t=12.193, P<0.001), and PDW was higher than that in the control group( t=10.744, P<0.001), the differences were statistically significant.Multifactorial Logistic analysis showed that after adjusting for gender and gestational age，1-minute Apgar score（ OR=0.898），5-minute Apgar score（ OR=0.900），postnatal infection（ OR=1.256），duration of parenteral nutrition（ OR=1.426），one week after parenteral nutrition，PLC（ OR=0.902），MPV（ OR=1.441），and PDW（ OR=1.195）were independent influencing factors for PNAC in extremely premature infants（all P<0.05）. ROC curves showed that each factor and combined predictive factors had certain efficacy in predicting the occurrence of PNAC in extremely premature infants after parenteral nutrition. Conclusion:One-minute Apgar score,5-minute Apgar score，duration of parenteral nutrition，postnatal infection，one week after parenteral nutrition，the PLC,MPV and PDW are independent influencing factors for PNAC in extremely premature infants receiving parenteral nutrition.Each factor predicts the efficacy of parenteral nutrition for PNAC in extremely premature infants, and relevant factors should be controlled in time to reduce the incidence of PNAC in extremely premature infants.

Objective: To analyze the relationship between the risk of tuberculosis outbreaks in schools and the visit interval of index cases, so as to provide a scientific reference for predicting the risks of tuberculosis outbreak and making preventive measures. Methods: A total of 630 index cases from school tuberculosis outbreaks were studied during January, 2015 to December, 2022. Data on demographics, consultation history, etiological diagnosis, and methods of detection were collected. Restricted Cubic Splines (RCS), unconditional Logistic regression, and the receiver operating characteristic curve (ROC curve) were used for analysis. Results: The RCS fitted curve showed that the risk of a tuberculosis outbreak linearly increased when the consultation interval for etiologically negative patients exceeded 5.79 days, or for etiologically positive patients exceeded 8.37 days. After multi factor adjustment, for every additional day in the visit interval of the index case, the odds ratio ( OR ) value for a high risk outbreak was 1.10 (95% CI =1.07-1.13)( P <0.05). When analyzed by tertiles of visit intervals, compared to an interval of <14 days, the OR values (95% CI ) for high risk outbreaks in schools with intervals of 14-<28 days and ≥28 days were 10.32(3.04-35.10) and 82.58( 28.42 -239.95), respectively( P <0.01), indicating a trend of increasing outbreak risk with longer visit intervals. Based on the ROC curve analysis, the optimal threshold for predicting a high risk school tuberculosis outbreak was 23.5 days, with an area under the curve ( AUC ) of 0.93 (95% CI =0.89-0.98). Conclusion An extended visit interval of index cases is a good early warning indicator for high risk tuberculosis outbreaks in schools and could be considered a key factor in early intervention and risk control strategies.

Background::In the clinic, practitioners encounter many patients with an abnormal pattern of dense punctate magnetic resonance imaging (MRI) signal in the basal ganglia, a phenomenon known as "cheese sign". This sign is reported as common in cerebrovascular diseases, dementia, and old age. Recently, cheese sign has been speculated to consist of dense perivascular space (PVS). This study aimed to assess the lesion types of cheese sign and analyze the correlation between this sign and vascular disease risk factors.Methods::A total of 812 patients from Peking Union Medical College Hospital (PUMCH) dementia cohort were enrolled. We analyzed the relationship between cheese sign and vascular risk. For assessing cheese sign and defining its degree, the abnormal punctate signals were classified into basal ganglia hyperintensity (BGH), PVS, lacunae/infarctions and microbleeds, and counted separately. Each type of lesion was rated on a four-level scale, and then the sum was calculated; this total was defined as the cheese sign score. Fazekas and Age-Related White Matter Changes (ARWMC) scores were used to evaluate the paraventricular, deep, and subcortical gray/white matter hyperintensities.Results::A total of 118 patients (14.5%) in this dementia cohort were found to have cheese sign. Age (odds ratio [OR]: 1.090, 95% confidence interval [CI]: 1.064-1.120, P <0.001), hypertension (OR: 1.828, 95% CI: 1.123-2.983, P = 0.014), and stroke (OR: 1.901, 95% CI: 1.092-3.259, P = 0.025) were risk factors for cheese sign. There was no significant relationship between diabetes, hyperlipidemia, and cheese sign. The main components of cheese sign were BGH, PVS, and lacunae/infarction. The proportion of PVS increased with cheese sign severity. Conclusions::The risk factors for cheese sign were hypertension, age, and stroke. Cheese sign consists of BGH, PVS, and lacunae/infarction.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.