Drug-induced autoimmune-like hepatitis （DI-ALH） is one of the special phenotypes of drug-induced liver injury， and since it has similar autoimmune characteristics and liver histological manifestations as intrinsic autoimmune hepatitis， differential diagnosis of these two diseases may be difficult in some cases. This article reports a case diagnosed with DI-ALH after long-term follow-up and conducts a literature review to provide a reference for clinicians.

Objective:To evaluate the effect of low-opioid anesthesia based on combination of esketamine and dexmedetomidine on the postoperative mood in patients undergoing thoracoscopic surgery.Methods:In this randomized controlled trial, 130 American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients of either sex, aged 18-65 yr, with body mass index ≤30 kg/m 2, undergoing elective video-assisted thoracoscopic surgery, were divided into 2 groups using a random number table method: low-opioid anesthesia group and conventional opioid anesthesia group, with 65 patients in each group. The patients in two groups received either a low-opioid anesthesia based on combination of esketamine and dexmedetomidine or a sufentanil-based opioid anesthesia. Depression and anxiety were assessed using the Self-Rating Depression Scale and Self-Rating Anxiety Scale on day 1 before surgery and days 1, 3 and 7 after surgery. The intraoperative consumption of opioid, usage of vasoactive drugs, extubation time, duration of stay in the post-anesthesia care unit, Riker Sedation-Agitation Scale score after extubation, consumption of sufentanil within 24 h postoperatively, and pain score at 24 h postoperatively were recorded, and the occurrence of adverse reactions within 24 h postoperatively was also recorded. Results:Compared with conventional opioid anesthesia group, the postoperative Self-Rating Depression Scale score and incidence of depression were significantly decreased, the Self-Rating Anxiety Scale score and incidence of anxiety were decreased, the intraoperative consumption of opioid was reduced, the usage rate of metaraminol was decreased, the usage rate of nicardipine was increased, the duration of stay in the post-anesthesia care unit was shortened, the Riker Sedation-Agitation Scale score was decreased after tracheal extubation, the consumption of sufentanil was reduced after operation, the pain score was decreased, and the incidence of postoperative nausea and vomiting and dizziness was decreased in low-opioid anesthesia group ( P<0.05). Conclusions:The low-opioid anesthesia based on combination of esketamine and dexmedetomidine can relieve the postoperative depression and anxiety and improve the quality of postoperative recovery when used in patients undergoing thoracoscopic surgery.

Objective To investigate the utility of dual-energy computed tomography(DECT)virtual non-contrast(VNC)images instead of true non-contrast(TNC)images in the quantitative analysis of emphysema.Methods A retrospective selection was con-ducted on 59 patients who underwent chest CT plain scan plus dual-phase enhanced scan on APEX-CT.VNC images of arterial phase(VNCart)and venous phase(VNCven)were generated on AW4.7 workstation.Volume CT dose index(CTDIvol)and dose length product(DLP)were recorded respectively.In a double-blind manner,two physicians graded the severity of each patient's emphysema according to the Fleischner Society's emphysema visual classification system.The"digital lung"detection and analysis platform was used to quantitatively measure emphysema at three thresholds(-950 HU,-930 HU and-910 HU),and the difference in meas-urement results between VNC images and TNC images was compared.Quantitative differences in low attenuation volume(LAV),percentage of low attenuation area(LAA%)and mean lung density(MLD)at the-950 HU threshold were compared using Bland-Altman plots.Results Using TNC images as the standard,there was no significant difference in the results of the visual classifica-tion evaluation of emphysema between TNC and VNC images(χ2=2.80,P=0.247).In quantitative measurement,there was no significant difference in total lung volume(TLV)(χ2=3.26,P=0.196)between the three groups images.Compared to TNC ima-ges,there were no statistically significant differences in LAV,LAA%and MLD of VNCven images at 15th percentile lung density(Perc 15%)and different thresholds(P>0.05).Compared to the TNC mode,the VNC mode could reduce the effective dose(ED)by approximately 32.6%.Conclusion The use of DECT VNCven images on chest has the potential to replace TNC for the quantitative analysis of emphysema,thereby streamlining scans and reducing radiation dose.

Objective To investigate the impact of minocycline(MC)on myocardial cell damage in rats with chronic heart failure(CHF)by regulating the hypoxia-inducible factor 1α(HIF-1α)/B-cell lymphoma-2/adenovirus E1B 19-kDa interacting protein(BNIP3).Methods All rats were randomly divided into Sham,CHF,positive drug(LP),low dose MC,high dose MC(HMC),and HMC+HIF-1α activator(DMOG)groups.Cardiac function was detected using echocardiography.HE staining,transmission electron microscopy,and TUNEL assay were used to evaluate myocardial pathology and apoptosis.Enzyme-linked immunosorbent assay was applied to quantify tumor necrosis factor α(TNF-α),interleukin-1β,superoxide dismutase(SOD),and malondialdehyde(MDA).Quantitative real-time PCR was used to detect the mRNA levels of Bcl-2 and Bcl-2-related X protein(Bax),while Western blotting was applied to detect the expres-sion of HIF-1α,BNIP3,Beclin-1,and microtubule-associated protein 1 light chain 3(LC3)proteins.Results Compared to rats in the sham group,rats from the CHF group exhibited increased left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),cell apoptosis rate,TNF-α,IL-1β,MDA,Bax,HIF-1α,BNIP3,Beclin-1,and LC3Ⅱ/Ⅰwith decreased left ventricular ejection fraction(LVEF),left ventricular shortening fraction(LVFS),SOD,and Bcl-2 levels(P<0.05).Compared with CHF group,rats from LP group,LMC group and HMC group exhibited decreased levels of LVEDD,LVESD,apoptosis rate,TNF-α,IL-1β,MDA,Bax,HIF-1α,BNIP3,Beclin-1,LC3Ⅱ/Ⅰ,and increased levels of LVEF,LVFS,SOD and Bcl-2(P<0.05).DMOG attenuated the protective effect of high-dose MC on myocardial cell damage in rats of the CHF group(P<0.05).Conclusion MC improves myocardial cell damage in rats of CHF group by inhibiting the HIF-1α/BNIP3 signaling pathway.

Objective To investigate the utility of dual-energy computed tomography(DECT)virtual non-contrast(VNC)images instead of true non-contrast(TNC)images in the quantitative analysis of emphysema.Methods A retrospective selection was con-ducted on 59 patients who underwent chest CT plain scan plus dual-phase enhanced scan on APEX-CT.VNC images of arterial phase(VNCart)and venous phase(VNCven)were generated on AW4.7 workstation.Volume CT dose index(CTDIvol)and dose length product(DLP)were recorded respectively.In a double-blind manner,two physicians graded the severity of each patient's emphysema according to the Fleischner Society's emphysema visual classification system.The"digital lung"detection and analysis platform was used to quantitatively measure emphysema at three thresholds(-950 HU,-930 HU and-910 HU),and the difference in meas-urement results between VNC images and TNC images was compared.Quantitative differences in low attenuation volume(LAV),percentage of low attenuation area(LAA%)and mean lung density(MLD)at the-950 HU threshold were compared using Bland-Altman plots.Results Using TNC images as the standard,there was no significant difference in the results of the visual classifica-tion evaluation of emphysema between TNC and VNC images(χ2=2.80,P=0.247).In quantitative measurement,there was no significant difference in total lung volume(TLV)(χ2=3.26,P=0.196)between the three groups images.Compared to TNC ima-ges,there were no statistically significant differences in LAV,LAA%and MLD of VNCven images at 15th percentile lung density(Perc 15%)and different thresholds(P>0.05).Compared to the TNC mode,the VNC mode could reduce the effective dose(ED)by approximately 32.6%.Conclusion The use of DECT VNCven images on chest has the potential to replace TNC for the quantitative analysis of emphysema,thereby streamlining scans and reducing radiation dose.

Objective To investigate the impact of minocycline(MC)on myocardial cell damage in rats with chronic heart failure(CHF)by regulating the hypoxia-inducible factor 1α(HIF-1α)/B-cell lymphoma-2/adenovirus E1B 19-kDa interacting protein(BNIP3).Methods All rats were randomly divided into Sham,CHF,positive drug(LP),low dose MC,high dose MC(HMC),and HMC+HIF-1α activator(DMOG)groups.Cardiac function was detected using echocardiography.HE staining,transmission electron microscopy,and TUNEL assay were used to evaluate myocardial pathology and apoptosis.Enzyme-linked immunosorbent assay was applied to quantify tumor necrosis factor α(TNF-α),interleukin-1β,superoxide dismutase(SOD),and malondialdehyde(MDA).Quantitative real-time PCR was used to detect the mRNA levels of Bcl-2 and Bcl-2-related X protein(Bax),while Western blotting was applied to detect the expres-sion of HIF-1α,BNIP3,Beclin-1,and microtubule-associated protein 1 light chain 3(LC3)proteins.Results Compared to rats in the sham group,rats from the CHF group exhibited increased left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),cell apoptosis rate,TNF-α,IL-1β,MDA,Bax,HIF-1α,BNIP3,Beclin-1,and LC3Ⅱ/Ⅰwith decreased left ventricular ejection fraction(LVEF),left ventricular shortening fraction(LVFS),SOD,and Bcl-2 levels(P<0.05).Compared with CHF group,rats from LP group,LMC group and HMC group exhibited decreased levels of LVEDD,LVESD,apoptosis rate,TNF-α,IL-1β,MDA,Bax,HIF-1α,BNIP3,Beclin-1,LC3Ⅱ/Ⅰ,and increased levels of LVEF,LVFS,SOD and Bcl-2(P<0.05).DMOG attenuated the protective effect of high-dose MC on myocardial cell damage in rats of the CHF group(P<0.05).Conclusion MC improves myocardial cell damage in rats of CHF group by inhibiting the HIF-1α/BNIP3 signaling pathway.

Objective:To evaluate the effect of low-opioid anesthesia based on combination of esketamine and dexmedetomidine on the postoperative mood in patients undergoing thoracoscopic surgery.Methods:In this randomized controlled trial, 130 American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients of either sex, aged 18-65 yr, with body mass index ≤30 kg/m 2, undergoing elective video-assisted thoracoscopic surgery, were divided into 2 groups using a random number table method: low-opioid anesthesia group and conventional opioid anesthesia group, with 65 patients in each group. The patients in two groups received either a low-opioid anesthesia based on combination of esketamine and dexmedetomidine or a sufentanil-based opioid anesthesia. Depression and anxiety were assessed using the Self-Rating Depression Scale and Self-Rating Anxiety Scale on day 1 before surgery and days 1, 3 and 7 after surgery. The intraoperative consumption of opioid, usage of vasoactive drugs, extubation time, duration of stay in the post-anesthesia care unit, Riker Sedation-Agitation Scale score after extubation, consumption of sufentanil within 24 h postoperatively, and pain score at 24 h postoperatively were recorded, and the occurrence of adverse reactions within 24 h postoperatively was also recorded. Results:Compared with conventional opioid anesthesia group, the postoperative Self-Rating Depression Scale score and incidence of depression were significantly decreased, the Self-Rating Anxiety Scale score and incidence of anxiety were decreased, the intraoperative consumption of opioid was reduced, the usage rate of metaraminol was decreased, the usage rate of nicardipine was increased, the duration of stay in the post-anesthesia care unit was shortened, the Riker Sedation-Agitation Scale score was decreased after tracheal extubation, the consumption of sufentanil was reduced after operation, the pain score was decreased, and the incidence of postoperative nausea and vomiting and dizziness was decreased in low-opioid anesthesia group ( P<0.05). Conclusions:The low-opioid anesthesia based on combination of esketamine and dexmedetomidine can relieve the postoperative depression and anxiety and improve the quality of postoperative recovery when used in patients undergoing thoracoscopic surgery.

Objective:To investigate the application value of peri-gastric devasculariza-tion without dissociation of esophagus for portal hypertension.Methods:The retrospective and descriptive study was conducted. The clinical data of 94 patients with portal hypertension who were admitted to three medical centers, including 75 cases in the People′s Hospital of Ningxia Hui Autonomous Region, 12 cases in the People′s Hospital of Wuhai and 7 cases in the People′s Hospital of Wuzhong, from July 2018 to December 2022 were collected. There were 68 males and 26 females, aged 46(range, 21-70)years. All 94 patients underwent peri-gastric devascularization without dissociation of esophagus. Observation indicators: (1) intraoperative condition; (2) postoperative complications; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measure-ment data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Intraoperative condition. All 94 patients underwent surgery success-fully without operation death, including 82 cases receiving open surgery and 12 cases receiving laparoscopic surgery. The operation time and volume of intraoperative blood loss were (183±85)minutes and 289(range, 158-560)mL, respectively, for the 94 patients. (2) Postoperative complications. Of 94 patients, early portal vein thrombosis occurred in 24 cases, intra-abdominal infection occurred in 2 cases, hepatic encephalopathy occurred in 1 case, pulmonary embolism occurred in 1 case, intra-abdominal hemorrhage requiring operation to stop bleeding occurred in 1 case and pleural effusion requiring drainage occurred in 1 case. All patients with postoperative complications were cured after treatment. None of the 94 patient had postoperative esophageal complications such as odynophagia or dysphagia. (3) Follow-up. All 94 patients were followed up for 38(range, 6-60)months. Of the 45 patients with paraesophageal vein, there were 36 cases of thinner and 9 cases of occlusion of the distal subphrenic paraesophageal vein after surgery, respectively. Cases with esophageal varices disappearance, cases with mild and moderate residual of esophageal varices, cases with severe residual of esophageal varices, cases with recurrence of esophageal varices, cases with esophageal varices bleeding were 7, 70, 9, 4, 4 in the 94 patients after surgery. Cases with esophageal varices disappearance was 7 in the 45 patients with paraesophageal vein, versus 0 in the 49 patients without paraesophageal vein, showing a significant difference between them ( P<0.05). Of 94 patients, 17 cases developed postoperative late portal vein thrombosis and cavernous transformation, 7 cases developed liver cancer, 1 case had hepatic encephalopathy, and 6 cases died. Conclusion:Peri-gastric devascularization without dissociation of esophagus is safe and feasible for the treatment of portal hypertension.

Objective:To investigate the epidemiological characteristics of COVID-19 caused by 2019-nCoV Delta variant in Shangyu district, Shaoxing of Zhejiang province in 2021, and provide evidence for the improvement of COVID-19 control and prevention measures.Methods:The incidence data of COVID-19 in Shangyu from December 7 to 21, 2021 was obtained from Shangyu District Center for Disease Control and Prevention. The epidemiological characteristics of the cases, i.e. the population, time and space distributions, were analyzed, and the incubation period and time-varying reproduction numbers ( R t) were calculated. Results:From December 7 to 21, 2021, a total of 380 COVID-19 cases caused by 2019-nCoV Delta variant were detected in Shangyu, the median age of the cases was 52 years, M ( Q1，Q3: 38, 61). The male to female ratio of the cases was 1∶1.25, and the cases were mainly workers (36.58%) and farmers (27.63%). The epidemic affected 9 townships (or community) of Shangyu, especially Caoe and Baiguan communities with the cases accounting for 57.10% and 31.53% respectively. The median incubation period of cases was 4.00 days, M ( Q1，Q3: 3.00, 5.75). The basic reproduction number ( R0) was 4.06, and the R t was 5.62 in early phase of the outbreak (the highest) and continuously decreased to less than 1.00 within 10 days after the detection of the outbreak. The number of COVID-19 cases decreased to 0 within 14 days after the outbreak (December 7-21), and the main detection methods were screening in centralized isolation (55.53%) and home isolation (40.00%). The infection rates of close contacts and secondary close contacts were 2.06% and 0.46% respectively. Conclusion:The epidemic of COVID-19 in Shangyu characterized by short incubation period, large number of infected people, and case clustering, suggesting the strong transmission of Delta variant (B.1.617.2). Comprehensive prevention and control measures, such as management of close contacts and secondary close contacts, and high-risk area, are essential for the rapid control of the epidemic.

Objective:To explore the effect of mobile phone application support on medication compliance of stroke patients.Methods:China National Knowledge Infrastructure (CNKI) , Wanfang, VIP Database, PubMed, Cochrane Library, Embase were searched by computer to select randomized controlled trial studies on the effect of mobile application support on medication compliance of stroke patients. According to the inclusion and exclusion criteria, researchers selected the literature, extracted data and evaluated the quality. RevMan 5.3 software was used for Meta-analysis and the retrieval time was from the establishment of databases until August 31, 2019.Results:A total of 10 randomized controlled trials (RCTs) were included. In terms of improving medication compliance, the results of subgroup analysis showed that mobile phone application support could improve medication compliance of stroke patients [ SMD=0.70, 95% CI (0.34-1.06) , P<0.000 01]. In terms of blood pressure control, mobile phone application support was effective in controlling systolic blood pressure [ MD=-8.11, 95% CI (-15.82--0.40) , P=0.04], but there was no statistically significant difference in its effect on diastolic blood pressure control ( P=0.34) . Conclusions:Mobile phone application support is effective in improving medication compliance and controlling systolic blood pressure in stroke patients. It can effectively control blood pressure fluctuations and improve prognosis of the disease. However, it is still uncertain whether diastolic blood pressure can be effectively controlled and a large number of multi-center, large-sample clinical randomized controlled trials are still needed to confirm its effects.