The number of women entering pregnancy with chronic liver disease is rising， and gestational liver disorders affect 3% of the pregnant population. Both can be associated with significant maternal and fetal morbidity and mortality. An international panel of experts with extensive experience in managing liver disease during pregnancy from various continents contributed to the formulation of these guidelines. This edition of the International Federation of Gynecology and Obstetrics guidelines on liver disease and pregnancy systematically addresses the most common diseases of gestational liver disorders and pregnancy comorbid with acute and chronic liver diseases and summarizes evidence-based clinical guidance and management recommendations， in order to enhance the clinical management of this patient population.

Pelvic organ prolapse (POP), whose etiology is influenced by genetic and clinical risk factors, considerably impacts women's quality of life. However, the genetic underpinnings in non-European populations and comprehensive risk models integrating genetic and clinical factors remain underexplored. This study constructed the first polygenic risk score (PRS) for POP in the Chinese population by utilizing 20 disease-associated variants from the largest existing genome-wide association study. We analyzed a discovery cohort of 576 cases and 623 controls and a validation cohort of 264 cases and 200 controls. Results showed that the case group exhibited a significantly higher PRS than the control group. Moreover, the odds ratio of the top 10% risk group was 2.6 times higher than that of the bottom 10%. A high PRS was significantly correlated with POP occurrence in women older than 50 years old and in those with one or no childbirths. As far as we know, the integrated prediction model, which combined PRS and clinical risk factors, demonstrated better predictive accuracy than other existing PRS models. This combined risk assessment model serves as a robust tool for POP risk prediction and stratification, thereby offering insights into individualized preventive measures and treatment strategies in future clinical practice.
Humans ; Female ; Pelvic Organ Prolapse/epidemiology* ; Middle Aged ; Risk Assessment/methods* ; China/epidemiology* ; Multifactorial Inheritance ; Aged ; Risk Factors ; Genome-Wide Association Study ; Genetic Predisposition to Disease ; Case-Control Studies ; Adult ; Polymorphism, Single Nucleotide ; Genetic Risk Score ; East Asian People

Objective To investigate the mechanism and protective effect of Humanin(HN)on rotenone(Rot)-induced toxic damage for dopamine neurons.Methods The Rot-poisened PC12 cell model was constructed,and the control group,the Rot poisening group,the HN pretreated Rot poisening group,and the HN treatment group were set up.ELISA was used to detect the content of HN inside and outside of Rot-infected cells,CCK-8 assay was used to detect cell viability,and ATP detection kit was used to detect the intracellular ATP content.Dichloro-dihydro-fluorescein diacetate(DCFH-DA)assay was used to detect the level of reactive oxygen species(ROS)in cells.Western blotting was performed to detect the expression level of mitochondrial autophagy regulatory proteins Pink1,Parkin,p62,LC3,mitochondrial biogenesis regulatory protein PGC1α,division/fusion regulatory proteins OPA1,MFN2,DRP1,p-DRP1 and antioxidant stress regulatory proteins Keap1 and Nrf2.HBAD-mcherry-EGFP-LC3 adenovirus transfected cells was used to observed the number of autophagosomes and autophagolysosomes.Results The results showed that the intracellular concentration of HN in PC12 in the Rot poisening group was significantly higher than that in the control group(P＜0.05);Compared with the control group,the Rot poisening group had significantly decreased activity of PC12 cells,decreased ATP content and increased production of ROS.After the poisen of Rot in PC12 cells,the expression of Pink1 and p-Parkin,the ratio of LC3Ⅱ/LC3Ⅰ and the expression of p-DRP1 in mitochondrial fusion protein was increased,while the expression of p62,the expression of mitochondrial biogenesis protein PGC1 α,mitochondrial fusion proteins MFN2 and OPA1,and antioxidant stress proteins Keap1 and Nrf2 were decreased(all P＜0.05).The number of autophagosomes and autophagolysosomes in PC12 cells in the Rot poisening group was higher than that in the control group(P＜0.05),and HN pretreatment(20 μmol/L)could significantly improve the changes mentioned above caused by Rot poisening(P＜0.05).Conclusion HN ameliorates Rot-induced toxic damage for dopamine neurons by inhibiting mitophagy and mitochondrial division and promoting mitochondrial biogenesis and fusion,and anti-oxidative stress.

Radiotherapy combined with immunotherapy for the treatment of cancer can induce stronger abscopal effect (AE) and inhibit the growth of tumors outside of radiation field, but the occurrence of AE is distinctly uncommon and unpredictable in clinical practice. The complex molecular mechanism underlying AE remains to be in-depth understood. It has been reported that some new factors are involved in the regulation of AE induced by radiation, but the molecular mechanism has not been fully unravelled. In this article, the roles of macrophages, tumor draining lymph node, p53 and exosomes in the new mechanisms of AE were reviewed, aiming to provide a theoretical basis for the development of more effective cancer therapeutics.

Adult ; Antibodies, Viral/isolation & purification* ; COVID-19/virology* ; Feces/chemistry* ; Female ; Humans ; Intestines/virology* ; Male ; RNA, Ribosomal, 16S/genetics* ; RNA, Viral/isolation & purification* ; SARS-CoV-2/pathogenicity*

OBJECTIVE：To introduce the development and application of automatic dosing and mixing system of intravenous infusion in PIVAS of our hospital. METHODS ：Based on the bar code management system in PIVAS ，combined with automatic mixing equipment ，our hospital developed and designed automatic dosing and mixing system of intravenous infusion which could realize real-time scanning and charging of drugs ，setting parameters of mixed dispensing and automatic dosing and mixed dispensing of intravenous infusion. Compared with manual dispensing model ，work efficiency of 5 staff who dispensed Coenzyme complex for injection and Carbazochrome sodium s ulfonate for injection 300 bags each as well as the amount of drug residues in empty bottle were investigated to evaluate the effects of the system. RESULTS ：The system realized automatic mixing of intravenous infusion. In manual dispensing model and automatic dispensing model ，the mixing efficiency of Coenzyme complex for injection were （96.6±10.0）and（195.2±10.7）bag/h（P＜0.001）；mixing efficiency of Carbazochrome sodium sulfonate for injection were （83.8±12.9）and（118.8±6.7）bag/h（P＜0.001）. The amount of residual liquid in Coenzyme complex for injection empty bottle were （0.09±0.02）and（0.11±0.01）mL；Carbazochrome sodium sulfonate for injection empty bottle were （0.08± 0.02）and（0.12±0.01）mL，which were all lower than the internal control requirements that injected solvent volume was no more than 5％ （0.15 mL）. CONCLUSIONS ：The automatic dosing and mixing system of intravenous infusion could improve the efficiency of intravenous infusion dispensing and reduce the labor intensity of the staff .

Objective To study the clinical, laboratorial, histopathological, imaging features of two cases of hypothyroid myopathy. Method Clinical manifestations, thyroid function, electromyography, muscle MRI, muscle biopsy and follow-up results were collected, and analyzed with the literature. Result These two patients were middle-age to old age and the onset of disease was insidious. Their common clinical manifestations included subacute progressive weakness in the proximal muscles,myalgia after sports and reduction in tendon reflex.The blood test showed an increase in serum concentration of CK and TSH, and a decrease in FT3 and FT4. The electromyography showed suspicious myogenic damage.Muscle histopathological findings were largely nonspecific,such as type I fiber predominance and type 2 atrophy. The MRI revealed extensive muscular dystrophy and fatty filtration in the posterior group of thighs. Treatment of replacement therapy with L-T4 relieved the myopathic symptoms quickly. Conclusion When a patient presents with a subacute progressive weakness in the proximal muscles, the hypothyroidism should be consideration. Muscle histopathological findings may be nonspecific. The muscle MRI have a value of differential diagnosis and lesion assessment.

Objective To compare the short-term outcomes between lateral retinacular release (LRR) via a prolonged incision versus arthroscopic LRR in osteofascial medial patellofemoral ligament reconstruction (MPFL-R) for recurrent patellofemoral dislocation.Methods From May 2012 to March 2015,51 patients with recurrent patellofemoral dislocation were treated at the Department of Joint Surgery,The Third Affiliated Hospital to Hebei Medical University.They were 16 males and 35 females,aged from 20 to 36 years (mean 27.2 years).Of them,28 underwent LRR via a prolonged incision in MPFL-R (incision group) and 23 did arthroscopic LRR in MPFL-R (microscopic group).Imaging changes were assessed by comparing preoperative and postoperative values of patella extensibility,patellar tilt angle,trochlear groove angle and tibial tuberosity-trochlear groove spacing (TT-TG);the knee joints were scored with Kujala and Lysholm functional rating systems at the last follow-ups.Results The 2 groups were compatible due to insignificant differences in the general data between them preoperatively (P ＞ 0.05).The 51 patients were followed up for 10 to 32 months (average,20 months).The rate of dislocation in the incision and microscopic groups were 0 and 8.7％ (2/23),respectively.There were no such complications in either group as patellar fracture,deep venous thrombosis of the lower extremity or limited joint extension or flexion.The last follow-ups revealed that no patients in either group were inflicted with patellofemoral re-dislocation.In the incision group,the patella extensibility,patellar tilt angle,Kujala score and Lysholm score were,respectively,19.65％ ± 0.75％,12.39°±0.76°,56.37 ±2.94 points and 51.64 ±6.22 points preoperatively,and 10.34％ ± 0.60％,8.83°±0.89°,92.68 ±2.75,and 90.71 ± 1.91 points postoperatively;in the microscopic group,the patella extensibility,patellar tilt angle,Kujala score and Lysholm score were,respectively,19.56％ ±0.62％,12.35° ± 0.66°,57.46 ± 3.08 points and 52.20 ± 6.94 points preoperatively,and 10.24％ ±0.66％,8.78° ± 0.92°,92.53 ± 3.32 points and 90.41 ± 2.90 points postoperatively.There were significant differences between the preoperative and postoperative values in both 2 groups (P ＜ 0.05).However,there were no significant differences between the preoperative and the postoperative values in trochlear groove angle or TT-TG in either group (P ＞ 0.05).There were no significant differences between the 2 groups in all the above preoperative and postoperative values (P ＞ 0.05).Conclusion In MPFL-R for recurrent patellofemoral dislocation,both LRR via a prolonged incision and arthroscopic LRR can improve the patellofemoral joint alignment and stability of the tibia,leading to good short-term outcomes.

ObjectiveTo investigate the associations of fetal-type posterior cerebral artery (FTP) with infarction distribution and stroke severity in patients with acute ischemic stroke.MethodsThe patients with acute ischemic stroke were enrolled.They were divided into either a FTP group or a non-FTP group according to the results of magnetic resonance imaging.The former group was further divided into complete FTP (cFTP) and partial FTP (pFTP).According to the results of diffusion-weighted imaging, the infarction distribution was divided into the territory of the anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and vertebrobasilar artery.According to the National Institutes of Health Stroke Scale (NIHSS), the stroke severity was assessed, <8 was defined as mild stroke, and ≥8 was defined as moderate to severe stroke.Multivariate logistic regression analysis was used to determine the associations of FTP with infarction distribution and stroke severity.ResultsA total of 647 patients with acute ischemic stroke were enrolled, and 201 (31.1%) had FTP, including 162 (25.0%) cFTP and 39 (6.0%) pFTP.Multivariate logistic regression analysis showed that cFTP and pFTP were the independent risk factors for MCA infarction (cFTP: odds ratio [OR] 24.714, 95% confidence interval [CI] 10.952-45.766, P<0.001;pFTP: OR 14.526, 95% CI 6.832-25.931, P<0.001), and the independent protective factors for PCA infarction (cFTP: OR 0.214, 95% CI 0.022-0.531, P<0.001;pFTP: OR 0.326, 95% CI 0.018-0.739, P<0.001), they were also the independent risk factor for the severity of acute ischemic stroke (cFTP: OR 22.138, 95% CI 12.492-64.067, P<0.001;cFTP: OR 19.510, 95% CI 8.956-23.514, P<0.001).ConclusionscFTP and pFTP are the independent risk factors for MCA infarction, and the independent protective factors for PCA infarction, and at the same time, they were also the independent risk factors for the moderate to severe stroke.FTP is associated with the infarction distribution and the stroke severity in acute ischemic stroke.