ObjectiveTo investigate the association of alpha-fetoprotein （AFP） and prealbumin （PAB） with the 90-day prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure （HBV-ACLF）， as well as the difference in 90-day prognosis between the patients with different levels of AFP and PAB. MethodsA total of 371 HBV-ACLF patients who were hospitalized in The General Hospital of Western Theater Command from January 2018 to January 2023 were enrolled， and according to the follow-up results on day 90 after discharge， they were divided into survival group with 216 patients and death group with 155 patients. The medical record system was used to collect general data， AFP， PAB， and other related laboratory markers. The t-test was used for comparison of normally distributed continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test was used for comparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups and further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. The multivariate logistic regression analysis was used to identify the influencing factors for the prognosis of HBV-ACLF patients. The receiver operating characteristic （ROC） curve was plotted for AFP and PAB to determine their cut-off values. The Kaplan-Meier method was used to plot survival curves， and the Log-rank test was used for comparison. ResultsCompared with the death group， the survival group had significantly higher levels of hemoglobin （Hb）， PAB， AFP， and platelet count （PLT） （all P<0.05） and significantly lower age， total bilirubin （TBil）， white blood cell count （WBC）， cystatin， creatinine， urea， international normalized ratio （INR）， Model for End-Stage Liver Disease （MELD） score， proportion of patients with Child-Pugh class C， and incidence rates of ascites and hepatic encephalopathy （all P<0.05）. The multivariate logistic regression analysis showed that PAB （odds ratio ［OR］=0.985， 95% confidence interval ［CI］： 0.972‍ ‍—‍ ‍0.998， P=0.024）， AFP （OR=0.998， 95%CI： 0.996‍ ‍—‍ ‍1.000， P=0.028）， PLT （OR=0.989， 95%CI： 0.982‍ ‍—‍ ‍0.996， P=0.003）， age （OR=1.046， 95%CI： 1.018‍ ‍—‍ ‍1.075， P=0.001）， TBil （OR=1.004， 95%CI： 1.002‍ ‍—‍ ‍1.006， P<0.001）， and WBC （OR=1.237， 95%CI： 1.110‍ ‍—‍ ‍1.379， P<0.001） were independent influencing factors for 90-day prognosis in HBV-ACLF patients. According to the cut-off values of AFP and PAB on ROC curves， the patients were divided into group A with 102 patients （AFP≥73.19 ng/mL and PAB≥22.55 mg/L）， group B with 170 patients （AFP≥73.19 ng/mL and PAB<22.55 mg/L； AFP<73.19 ng/mL and PAB≥22.55 mg/L）， and group C with 99 patients （AFP<73.19 ng/mL and PAB<22.55 mg/L）. There were significant differences between these three groups in age， Hb， INR， MELD score， and Child-Pugh class （all P<0.05）. The Kaplan-Meier survival analysis showed that group A had a significantly higher 90-day cumulative survival rate than groups B and C （χ²=19.825， P<0.001）. ConclusionAFP combined with PAB can better predict the 90-day prognosis of HBV-ACLF patients， and patients with high levels of AFP and PAB tend to have a lower mortality rate on day 90.

Objective To investigate the changes of 22 bile acid sub components and 17 traditional bio-chemical indicators in serum of patients with non-alcoholic fatty liver disease(NAFLD),and the diagnostic value of detecting the above indicators alone or in combination for NAFLD.Methods A total of 168 NAFLD patients(NAFLD group)and 216 non-NAFLD apparently healthy individuals(non-NAFLD group)were se-lected,bile acid sub components were determined by liquid chromatography tandem mass spectrometry,and traditional biochemical indicators were detected by automatic biochemical analyzer.Results There were sta-tistically significant differences in the levels of 12 bile acid sub components and 12 traditional biochemical indi-cators between NAFLD group and non-NAFLD group(P<0.05).Compared to traditional biochemical indica-tors,bile acid sub components were less affected by body mass index(BMI).The area under the curve for di-agnosing NAFLD by combining three bile acid sub components[taurocholic acid(TCA),sodium taurodeoxy-cholate(TDCA),and tauroursodeoxycholic acid(UDCA)]with three traditional biochemical indicators[ala-nine aminotransferase(ALT),5'Nucleotidase(5'-NT),and small and dense low-density lipoprotein cholester-ol(sd-LDL-C)]was the largest,which was 0.810.Conclusion Twelve kinds of bile acid sub components in the blood of NAFLD patients have changed,and the combined detection of bile acid sub components and tradi-tional biochemical indicators could improve the diagnostic efficacy of NAFLD to a certain extent.

Objective To investigate the association of alpha-fetoprotein(AFP)and prealbumin(PAB)with the 90-day prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF),as well as the difference in 90-day prognosis between the patients with different levels of AFP and PAB.Methods A total of 371 HBV-ACLF patients who were hospitalized in The General Hospital of Western Theater Command from January 2018 to January 2023 were enrolled,and according to the follow-up results on day 90 after discharge,they were divided into survival group with 216 patients and death group with 155 patients.The medical record system was used to collect general data,AFP,PAB,and other related laboratory markers.The t-test was used for comparison of normally distributed continuous data between two groups;a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for comparison between two groups.The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups and further comparison between two groups.The chi-square test was used for comparison of categorical data between groups.The multivariate logistic regression analysis was used to identify the influencing factors for the prognosis of HBV-ACLF patients.The receiver operating characteristic(ROC)curve was plotted for AFP and PAB to determine their cut-off values.The Kaplan-Meier method was used to plot survival curves,and the Log-rank test was used for comparison.Results Compared with the death group,the survival group had significantly higher levels of hemoglobin(Hb),PAB,AFP,and platelet count(PLT)(all P<0.05)and significantly lower age,total bilirubin(TBil),white blood cell count(WBC),cystatin,creatinine,urea,international normalized ratio(INR),Model for End-Stage Liver Disease(MELD)score,proportion of patients with Child-Pugh class C,and incidence rates of ascites and hepatic encephalopathy(all P<0.05).The multivariate logistic regression analysis showed that PAB(odds ratio[OR]=0.985,95%confidence interval[CI]:0.972-0.998,P=0.024),AFP(OR=0.998,95%CI:0.996-1.000,P=0.028),PLT(OR=0.989,95%CI:0.982-0.996,P=0.003),age(OR=1.046,95%CI:1.018-1.075,P=0.001),TBil(OR=1.004,95%CI:1.002-1.006,P<0.001),and WBC(OR=1.237,95%CI:1.110-1.379,P<0.001)were independent influencing factors for 90-day prognosis in HBV-ACLF patients.According to the cut-off values of AFP and PAB on ROC curves,the patients were divided into group A with 102 patients(AFP≥73.19 ng/mL and PAB≥22.55 mg/L),group B with 170 patients(AFP≥73.19 ng/mL and PAB<22.55 mg/L;AFP<73.19 ng/mL and PAB≥22.55 mg/L),and group C with 99 patients(AFP<73.19 ng/mL and PAB<22.55 mg/L).There were significant differences between these three groups in age,Hb,INR,MELD score,and Child-Pugh class(all P<0.05).The Kaplan-Meier survival analysis showed that group A had a significantly higher 90-day cumulative survival rate than groups B and C(χ2=19.825,P<0.001).Conclusion AFP combined with PAB can better predict the 90-day prognosis of HBV-ACLF patients,and patients with high levels of AFP and PAB tend to have a lower mortality rate on day 90.

Bupivacaine is a long-acting local anesthetic widely used clinically,but its 6-8 hours duration is insufficient for postoperative analgesia.Designing drug dosage forms to prolong the action time of local anesthetics is the research content of local anesthetics.In 2011,the FDA approved a bupivacaine liposome preparation based on DepoFoam TM technology:Exparel,which can be used for more than 72 hours.This article reviewed the clinical safety research of Exparel and the research progress of its application in clinical postoperative analgesia.

ObjectiveTo observe the effect of enriched environment (EE) combined with acupuncture at head point (HA) on behavior in rats with autism spectrum disorder. MethodsHealthy female Wistar rats were given peritoneal injection of sodium valproate at 12.5 days of gestation. Twenty-four male offspring rats were randomly selected and then randomly divided into model group (n = 6), EE group (n = 6), HA group (n = 6) and EE combined with HA group (the combined group, n = 6). Six male offspring rats born from female mice injected with the same amount of saline intraperitoneally were as control group. After four weeks of treatment, all the five groups were tested with three-chamber test and marble burying test, and the sociability index, the social novelty index and the number of buried marbles were recorded. The levels of interleukin (IL)-1β and IL-6 in peripheral blood were determined by enzyme-linked immunosorbent assay (ELISA). ResultsAfter treatment, compared with the model group, the sociability index and the social novelty index improved (P < 0.05), the number of buried marbles reduced (P < 0.05), and the levels of IL-6 and IL-1β in peripheral blood decreased in EE group, HA group and the combined group (P < 0.05); while the combined group was the best (P < 0.01). ConclusionBoth EE or acupuncture at HA could improve behavioral symptoms, and reduce the expression of inflammatory factors in rats with autism spectrum disorder. The combination of the two methods showed the best result.

ObjectiveTo investigate the association of the dynamic changes of serum total bilirubin （ΔTBil） and alpha-fetoprotein （AFP） with the short-term prognosis of patients with hepatitis B virus-associated acute-on-chronic liver failure （HBV-ACLF）， to establish a new scoring model， and to investigate the value of this model in evaluating the short-term prognosis of HBV-ACLF through comparison with Model for End-Stage Liver Disease （MELD） score and other scoring systems. MethodsThe patients with HBV-ACLF who were hospitalized and treated in Department of Gastroenterology， The General Hospital of Western Theater Command， from January 2015 to December 2022 were enrolled as the retrospective study cohort. Clinical data within 24 hours after admission were collected from all patients， and the patients were divided into survival group and death group according to the survival after 90 days of follow-up. The independent-samples t test was used for comparison of normally distributed continuous data between groups； the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between groups； the chi-square test or the corrected chi-square test was used for comparison of categorical data between two groups. A multivariate Logistic regression analysis was used to determine the risk factors for the prognosis of HBV-ACLF patients and establish a predictive model for prognosis， and the receiver operating characteristic （ROC） curve was used to investigate the value of the new model in predicting the short-term prognosis of HBV-ACLF patients. ResultsA total of 361 patients were included in the analysis， with a 90-day survival rate of 67.3% （243/361）. Compared with the survival group （n=243）， the death group （n=118） had significantly higher age， incidence rates of upper gastrointestinal bleeding and hepatic encephalopathy， international normalized ratio， prothrombin time （PT）， leukocytes， monocytes， neutrophils， creatinine， ΔTBil， MELD score， and ALBI score （all P<0.05）， as well as significantly lower levels of total cholesterol， high-density lipoprotein， low-density lipoprotein， albumin， AFP， platelet count， lymphocytes， and Na⁺ （all P<0.05）. The multivariate Logistic regression analysis showed that AFP， PT， Na⁺， and ΔTBil were independent influencing factors for the 90-day prognosis of patients with HBV-ACLF （all P<0.05）. The new ΔTBil-AFP scoring model was established as 11.987+1.168×ΔTBil （%）－0.095×Na⁺ （mmol/L）+0.25×PT （s）－0.002×AFP （ng/mL）， which had a relatively high predictive value， with an area under the ROC curve of 0.796， a sensitivity of 0.766， and a specificity of 0.723， and the decision curve showed good benefits. ConclusionCompared with the commonly used prediction models such as MELD score and ALBI score， the ΔTBil-AFP scoring model has a better prediction performance.

Objective To investigate the clinical features of elderly patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)and the risk factors affecting the short-term prognosis of patients.Methods A retrospective analysis was performed for 417 patients with HBV-ACLF who were admitted to The General Hospital of Western Theater Command from January 2015 to January 2023,and related clinical data were collected,including general status,routine blood test results,biochemical parameters,and conditions of liver cirrhosis and decompensated events(ascites,hepatic encephalopathy,and their severities).The patients were followed up to observe 90-day survival.According to the age,the patients were divided into elderly group(with 106 patients aged≥60 years)and non-elderly group(with 311 patients aged＜60 years),and according to the 90-day survival,the elderly group were further divided into survival group with 41 patients and death/transplantation group with 65 patients.The independent-samples t test or the Mann-Whitney U test was used for comparison of quantitative data between two groups,and the chi-square test was used for comparison of qualitative data between two groups.The binary logistic regression analysis was used to determine the independent influencing factors for the risk of death within 90 days in elderly patients with HBV-ACLF,and a nomogram model was constructed for predicting the risk of death.The receiver operating characteristic(ROC)curve was used to investigate the value of the model in predicting the prognosis of HBV-ACLF patients in both the training set and the validation set.Calibration curve and decision curve were plotted for the models constructed in the training set and the validation set,and the model was assessed in terms of the degree of fitness and predicting benefits.Results The elderly patients had a significantly higher 90-day mortality rate than the non-elderly patients(P＜0.05),and compared with the non-elderly group,the elderly group had significantly higher incidence rate in female individuals,basic incidence rate of liver cirrhosis,incidence rate and grade of hepatic encephalopathy,incidence rate of ascites,and liver fibrosis markers(aspartate aminotransferase-to-platelet ratio index and fibrosis-4)(all P＜0.05),as well as significantly lower total cholesterol,high-density lipoprotein,albumin,alpha-fetoprotein,and lymphocytes(all P＜0.05).As for the elderly patients with HBV-ACLF,there were significant differences between the survival group and the death/transplantation group in total cholesterol,total bilirubin,international normalized ratio(INR),alpha-fetoprotein,platelet,creatinine,serum sodium,monocytes,and the incidence rate and grade of hepatic encephalopathy(all P＜0.05).In addition,the multivariate logistic regression analysis showed that INR(odds ratio[OR]=11.351,95%confidence interval[CI]:1.942-66.362,P＜0.05),monocyte count(OR=23.636,95%CI:1.388-402.529,P＜0.05),total bilirubin(OR=1.007,95%CI:1.001-1.013,P＜0.05),and platelet count(OR=0.968,95%CI:0.945-0.993,P＜0.05)were independent influencing factors for the 90-day prognosis of elderly patients with HBV-ACLF,and the nomogram model constructed based on these factors had a relatively high predictive value,with an area under the ROC curve of 0.915,a sensitivity of 88.0%,and a specificity of 86.7%.The nomogram model showed relatively high efficiency and degree of fitness in the verification set,and the decision curve suggested that the model had good benefits,with a higher prediction efficiency compared with the commonly used prediction models such as MELD score and COSSH-ACLF Ⅱ score.Conclusion Elderly HBV-ACLF patients may have a high short-term mortality rate due to the reductions in liver synthesis,reserve function,and regenerative ability and immune dysfunction.INR,monocyte count,total bilirubin,and platelet count have a relatively high value in predicting the risk of death in elderly HBV-ACLF patients,and the nomogram model constructed based on these factors has a relatively high prediction efficiency.

To investigate the initial experience of coated metal ureteral stent(CMUS)for treatment of pelvic lipomatosis induced hydronephrosis(PLH).The clinical and follow-up data of 8 patients who were diagnosed as PLH treated with CMUS in Peking University People's Hospital from August 2018 to February 2021 were retrospectively analyzed.Inclusion criteria included:Imaging evidence of excessive adipose tissue around the bladder in the pelvic cavity,bladder elevation in an"inverted pear shape",and bladder wall thickening;Cystoscopy indicated follicular hyperplasia of bladder mucosa and biopsy pathology indicated glandular cystitis;Unilateral or bilateral hydronephrosis and ureteromegaly.Exclusion criteria included:Ureteral atresia;Recurrent obstruction of the bladder outlet.Preoperative baseline data included age,gender,serum creatinine,pelvis width and ureteric stent symptoms questionnaire(USSQ)score.Intraoperative data included the location and length of ureteral stenosis observed by retrograde urography.Postoperative follow-up data included serum creatinine,pelvis width,and USSQ score.In the study,8 patients(11 sides)with PLH were all male,with an average age of(38.7±8.6)years.Uni-lateral hydronephrosis was found in 5 cases and bilateral hydronephrosis in 3 cases.Preoperative mean serum creatinine was(90.0±10.3)μmol/L,and the mean renal pelvis width was(3.0±1.5)cm.The lower ureteral stricture was found in all cases,and the mean stricture length was(1.9±0.9)cm.Before operation,3 patients had ureteral Double-J stents,with USSQ scores of 97.0,68.0 and 100.0,respectively.Five patients underwent retrograde CMUS stenting,and 3 patients retrograde and antegrade.At the last follow-up,the average serum creatinine was(82.0±11.1)μmol/L and the mean renal pel-vis width was(1.9±0.5)cm,which were significantly lower than those before operation(t=3.12,P=0.02;t=3.23,P=0.02).In the 3 patients with Double-J stent before surgery,the USSQ scores were 87.0,62.0 and 89.0,respectively,which were significantly improved after CMUS stenting.The average follow-up time was(10.0±6.3)months.During the follow-up,1 patient developed CMUS re-lated symptoms,and no stent-associated infection and stent encrustation were found.In one case,the stent migrated to the bladder 3 months after operation,and the hydronephrosis disappeared after 3 months follow-up.CMUS stenting for treatment of PLH has certain efficacy and safety,which can explore a new therapeutic method for the long-term treatment of PLH.

Outpatient humanistic care refered to providing a full process of caring medical services to outpatients. In order to standardize the human caring services for outpatients in medical institutions, promote the comprehensive service level of outpatient services, and improve the patient′s medical experience, Chinese Association for Life Care issued the group standard of Management Norms for Human caring of Outpatients in April 2023. This standard clarified the relevant terms and definitions of human caring for outpatients, specified the basic requirements for human caring, the humanistic quality and care responsibilities of outpatient staff, the outpatient care environment and facilities, the outpatient care process and measures, and quality management. It designed standardized and personalized full process care service norms, providing references for medical institutions at all levels to promote the development of human caring for outpatients.

During the pain treatment process,to reduce the use of opioids,alternative pain relievers have been used.Increasing data indicated that N-methyl-D-aspartic acid(NMDA)receptor antagonists may enhance the analgesic effect of opioids.Furthermore,numerous studies have shown that the auxiliary analgesic effect of magnesium sulfate has a good application prospect in pain treatment and perioperative anesthesia.The primary pharmacological mechanism of magnesium sulfate in pain treatment is that it acts as a physiological voltage-dependent blocker of NMDA coupling channels,and its anti-nociceptive effect is related to magnesium blocking calcium inflow,thereby inhibiting central sensitization and reducing preexisting hyperalgesia.This paper reviewed the current application of magnesium sulfate in perioperative period,focusing on its auxiliary analgesic effect through intravenous,intrathecal,and local administration,and the reduction of opioid consumption.As well as its potential role and application prospects in opioid-free anesthesia program.