Downhill esophageal varices (DEV) is a rare cause of upper gastrointestinal bleeding. It is different from ascending esophageal varices caused by portal hypertension, and caused by obstruction of the superior vena cava. It can be secondary to an indwelling central venous catheter. It is very dangerous when DEV is complicated with upper gastrointestinal bleeding,and there is no unified treatment strategy at present. We report a case of hemodialysis patient with left upper limb swelling for 6 months and intermittent hematemesis for 3 months. Combined with gastroscopy and CT venography, the patient was considered to have DEV rupture and hemorrhage. The patient was discharged after comprehensive treatment including closure of internal arteriovenous fistula, ligation of bleeding points of esophageal varices, recanalization of superior vena cava, and "culprit" vein embolization. There was no recurrence after half a year of follow-up. This case is helpful for clinicians to improve the recognition on this disease and explore the experience of diagnosis and treatment.

Objective To investigate the influencing factors of bone mineral density(BMD)in school-stage children with different degrees of obesity and their relationship with body composition.Methods A total of 271 obese children aged 6-12 years who underwent pediatric health checkups in our hospital between October 2018 and December 2023 were selected.The children were divided into two groups according to their degree of obesity:a simple obesity group(n=171)and an extreme obesity group(n=100).All children were examined for metabolic indicators,body composition,BMD,and abdominal ultrasonography.Comparisons of various indicators between the two groups were made using the independent samplesttest,Mann-Whitney Utest,or chi-square test.The relationship between BMD and body composition was analyzed using multiple linear regression and Spearman correlation analyses.Results Compared with simple obesity group,the body weight,body mass index(BMI)z-score,body fat index,muscle mass index,fat-free body mass index,body fat percentage,waist-to-hip ratio,fasting insulin level,insulin resistance index,uric acid,and fatty liver incidence were significantly higher in extreme obesity group(all P<0.05).No statistically significant differences in height,BMD,BMD z-score,25-hydroxy-vitamin D,blood sugar,calcium,phosphorus,alkaline phosphatase,or rate of puberty development were observed between the two groups(all P>0.05).The results of the Spearman correlation analysis showed that the BMI z-score,body fat index,muscle mass index,and fat-free BMI were pos-itively correlated with the BMD z-scores of all participants and in girls(all P<0.05).In boys,the BMD z-score was positively correlated with muscle mass index and fat-free mass index(both P<0.05).The results of multiple linear regression analysis of BMD z-scores and body composition showed that in boys and the simple obesity group,body fat percentage and body fat index were independent influencing factors of BMD z-scores(both P<0.05).Conclusion Higher body fat percentage and body fat index may be adverse factors influencing BMD in school-stage children with obesity.Meanwhile,the BMD of school-age children with obesity increased with an increase in fat-free mass index.

Objective To investigate the influencing factors of bone mineral density(BMD)in school-stage children with different degrees of obesity and their relationship with body composition.Methods A total of 271 obese children aged 6-12 years who underwent pediatric health checkups in our hospital between October 2018 and December 2023 were selected.The children were divided into two groups according to their degree of obesity:a simple obesity group(n=171)and an extreme obesity group(n=100).All children were examined for metabolic indicators,body composition,BMD,and abdominal ultrasonography.Comparisons of various indicators between the two groups were made using the independent samplesttest,Mann-Whitney Utest,or chi-square test.The relationship between BMD and body composition was analyzed using multiple linear regression and Spearman correlation analyses.Results Compared with simple obesity group,the body weight,body mass index(BMI)z-score,body fat index,muscle mass index,fat-free body mass index,body fat percentage,waist-to-hip ratio,fasting insulin level,insulin resistance index,uric acid,and fatty liver incidence were significantly higher in extreme obesity group(all P<0.05).No statistically significant differences in height,BMD,BMD z-score,25-hydroxy-vitamin D,blood sugar,calcium,phosphorus,alkaline phosphatase,or rate of puberty development were observed between the two groups(all P>0.05).The results of the Spearman correlation analysis showed that the BMI z-score,body fat index,muscle mass index,and fat-free BMI were pos-itively correlated with the BMD z-scores of all participants and in girls(all P<0.05).In boys,the BMD z-score was positively correlated with muscle mass index and fat-free mass index(both P<0.05).The results of multiple linear regression analysis of BMD z-scores and body composition showed that in boys and the simple obesity group,body fat percentage and body fat index were independent influencing factors of BMD z-scores(both P<0.05).Conclusion Higher body fat percentage and body fat index may be adverse factors influencing BMD in school-stage children with obesity.Meanwhile,the BMD of school-age children with obesity increased with an increase in fat-free mass index.

Downhill esophageal varices (DEV) is a rare cause of upper gastrointestinal bleeding. It is different from ascending esophageal varices caused by portal hypertension, and caused by obstruction of the superior vena cava. It can be secondary to an indwelling central venous catheter. It is very dangerous when DEV is complicated with upper gastrointestinal bleeding,and there is no unified treatment strategy at present. We report a case of hemodialysis patient with left upper limb swelling for 6 months and intermittent hematemesis for 3 months. Combined with gastroscopy and CT venography, the patient was considered to have DEV rupture and hemorrhage. The patient was discharged after comprehensive treatment including closure of internal arteriovenous fistula, ligation of bleeding points of esophageal varices, recanalization of superior vena cava, and "culprit" vein embolization. There was no recurrence after half a year of follow-up. This case is helpful for clinicians to improve the recognition on this disease and explore the experience of diagnosis and treatment.

Objective:To evaluate the regeneration and biomechanical property recovery of semitendinosus tendon(ST)/gracilis tendon(GT) after anterior cruciate ligament(ACL) reconstruction using shear wave elastorgraphy (SWE) combined with high-frequency ultrasound(HFUS).Methods:Twenty-five patients who underwent ST/GT autograft reconstruction after ACL rupture at the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2020 to June 2022 were prospectively enrolled. All patients underwent HFUS, SWE and flexion strength assessment at pre-operation and 1, 3, 6, 12, 24 months postoperatively. The morphology, length, cross-sectional area and SWE of ST/GT and flexion strength of knee were recorded at each time point. Repeated measures analysis of variance was employed to compare the cross-sectional area and elasticity value of regenerated ST/GT at different time points. Spearman correlation analysis was used to investigate the relationship between the elasticity value of regenerated ST/GT and flexion strength.Results:The regeneration rates of ST/GT after being harvested for ACL reconstruction were 88% and 92%. The length of the regenerated ST/GT were shorter than before operation(both P<0.05). Repeated measures analysis of variance revealed significant differences in the cross-sectional area of regenerated ST/GT, both in terms of time effect and inter-group effect ( F=27.264, 28.980; both P<0.001), but no significant difference was observed in the interaction effect ( F=0.670, P=0.652). The cross-sectional area of regenerated ST/GT was the largest at 3 months postoperatively ( P<0.05), and restored to the preoperative level at 12 and 24 months postoperatively (both P>0.05). Repeated measures analysis of variance showed that the elasticity values of the regenerated ST/GT were significantly different in terms of time effect, group effect, and interaction effect ( F=265.402, 33.015, 11.475; all P<0.001). The elasticity of regenerated ST/GT post-operation gradually increased over time. The flexion strength level of knee gradually improved post-operation(χ 2=34.83, P<0.001). The elasticity values of the regenerated ST and GT showed significant positive correlations with the flexion strength ( rs=0.755, 0.761; both P<0.001). Conclusions:HFUS discovers that most of ST/GT can be regenerated after being harvested for ACL reconstruction. The flexion strength and elasticity value of regenerated tendon recover gradually with time. It is suggested that the SWE can predict the recovery of biomechanical property of regenerated ST/GT.

OBJECTIVE To conduct the pharmacoeconomic evaluation of empagliflozin in the treatment of heart failure with reduced ejection fraction （HFrEF），and to provide evidence-based reference for rational drug use and medical and healthy decision-making. METHODS A Markov model was used to perform a cost-effectiveness analysis of the regimen of empagliflozin in the treatment of HFrEF ，and to evaluate the cost and effectiveness of standard treatment plan plus empagliflozin （empagliflozin group）vs. standard treatment plan （standard treatment group ）. Clinical parameters were obtained from the EMPEROR-Reduced study；cost and utility data came from the published literatures. The cycle of the model was 1 month and the simulation time was 20 years. Single-factor sensitivity analysis and probability sensitivity analysis were performed to validate the results of cost-effectiveness analysis. RESULTS Compared with the standard treatment group ，each additional quality-adjusted life year in the empagliflozin group cost 37 995.94 yuan more ，which was less than China ’s 1 time GDP per capita in 2020（72 447 yuan）. The results of single factor sensitivity analysis showed that steady-state hospitalization rate of 2 groups was the most important factor affecting the incremental cost-effectiveness ratio . The results of probability sensitivity analysis showed that when the willingness-to-pay threshold （WTP）was 1 time GDP per capita in 2020（72 447 yuan），the probability of empagliflozin group with cost-effectiveness advantage was 58.8％；when the WTP was 3 times GDP per capita in 2020（217 341 yuan），the probability of empagliflozin group with cost-effectiveness advantage was 63.8％. CONCLUSIONS Compared with standard treatment plan alone，standard treatment plan plus empagliflozin is more cost-effective in the treatment of HFrEF. However ，the economic probability is not high.

Objective:To explore the status of HBV infection, immune response to hepatitis B vaccine and its influencing factors of one-year old children born to HBV infected mothers in real world.Methods:In this cross-sectional study, eligible mothers infected with chronic HBV and children who completed standard vaccination against hepatitis B vaccine and hepatitis B immunoglobulin injection were selected. Clinical biochemical, virological measurements, data of antiviral therapy and complications during pregnancy and childbirth were collected by HIS(Hospital Information System)system and LIS (Laboratoty Information Management System) system. At one year of age, the children were tested for HBsAg, HBsAb and HBV DNA in venous blood specimens.Results:A total of 1 302 eligible mothers and children were collected, including 600 in high viral load group (mothers’ HBV DNA≥2×10 5 IU/ml) and 702 in low viral load group (mothers’ HBV DNA<2×10 5 IU/ml). In high viral load group, 587 patients received antiviral drugs in the middle or late trimester (Treated group) and 13 patients did not receive antiviral drugs (Untreated group). No chronic HBV infection occurred in children of low viral load group, and in 5 cases (0.83%) the infection occurred in high viral load group. In the five HBV infected children, 3 cases (0.51%) were in the treated group, and 2 cases (15.38%) in untreated group. The failure rate of mother-to-child blocking in low viral load group was significantly lower than that in high viral load group ( χ2=5.87, P=0.015), and it was significantly lower in treated group than that in untreated group ( χ2=29.195, P=0.001). The percentages of HBsAb level <10 mIU/ml, 10- <100 mIU/ml and ≥100 mIU/ml in 1 297 children without HBV infection were 1.15%, 15.65% and 83.19%, respectively. Univariate and multivariate logistic regression analysis showed that maternal total bilirubin level and hypothyroidism during pregnancy were correlated with HBsAb level at 1 year of age ( χ2=29.003, P <0.05). Conclusions:Antiviral drugs taken during pregnancy by pregnant women with high HBV viral load can significantly reduce mother-to-child transmission of HBV. Follow-up on the response of children born to HBV-infected mothers to hepatitis B vaccine should be enhanced after birth.

Immune cell infiltration is of great significance for the diagnosis and prognosis of cancer. In this study, we collected gene expression data of non-small cell lung cancer (NSCLC) and normal tissues included in TCGA database, obtained the proportion of 22 immune cells by CIBERSORT tool, and then evaluated the infiltration of immune cells. Subsequently, based on the proportion of 22 immune cells, a classification model of NSCLC tissues and normal tissues was constructed using machine learning methods. The AUC, sensitivity and specificity of classification model built by random forest algorithm reached 0.987, 0.98 and 0.84, respectively. In addition, the AUC, sensitivity and specificity of classification model of lung adenocarcinoma and lung squamous carcinoma tissues constructed by random forest method 0.827, 0.75 and 0.77, respectively. Finally, we constructed a prognosis model of NSCLC by combining the immunocyte score composed of 8 strongly correlated features of 22 immunocyte features screened by LASSO regression with clinical features. After evaluation and verification, C-index reached 0.71 and the calibration curves of three years and five years were well fitted in the prognosis model, which could accurately predict the degree of prognostic risk. This study aims to provide a new strategy for the diagnosis and prognosis of NSCLC based on the classification model and prognosis model established by immune cell infiltration.
Algorithms ; Carcinoma, Non-Small-Cell Lung ; diagnosis ; physiopathology ; Humans ; Lung Neoplasms ; diagnosis ; physiopathology ; Machine Learning ; Prognosis

OBJECTIVETo analyze the clinical phenotypes of a pedigree affected with periodic paralysis and explore its molecular basis.

METHODSClinical data and peripheral blood samples of the pedigree were collected. The proband and his father both complained of periodic paralysis and dysmorphic features. The exome of the proband was screened using Roche NimbleGen probes, and the results were confirmed by Sanger sequencing. Suspected mutations were subjected to bioinformatic and gene-disease correlation analysis.

RESULTSA c.653G>A (p.R218Q) mutation of the KCNJ2 gene was detected in both the proband and his father. Bioinformatics analysis suggested it to be pathogenic.

CONCLUSIONThe clinical manifestation of the pedigree was suggestive of Andersen-Tawil syndrome. KCNJ2 c.653G>A (p.R218Q) was the pathogenic mutation in this pedigree.

Objective To observe the effect of excretory/secretory products from Trichinella spiralis adult worms(AES)on cecal ligation and puncture(CLP)?induced sepsis in mice. Methods Forty?eight BALB/c mice were randomly divided into 3 groups:a sham operation group(PBS+sham group,Group A),a CLP?induced sepsis group(PBS+CLP group,Group B)and an AES treatment group(AES+ CLP group,Group C). The mice of each group were intraperitoneally injected with 25 μg of AES or PBS only as a control in a total volume of 200μl. Eight mice from each group were selected randomly for survival analy?sis of 96 hours. The other 8 mice in each group were observed for pathological changes in the lung,liver and kidney tissues by HE staining 12 h after CLP,and then determined for the detection of cytokines including TNF?α,IL?1β,IL?6,IL?10 and TGF? βin the sera by ELISA. Results The difference among the survival rates of mice in the 3 groups was statistically significant (χ2=21.16,P<0.05). Compared to Group A(100%),the survival rate of mice in Group B(0)decreased significantly(P<0.05),and also the pathological damage degrees in the lung,liver and kidney tissues of the mice in Group B increased signifi?cantly after CLP. Compared with the mice in group B,the survival rate of those in Group C(70%)increased significantly(P<0.05),and the pathological damage degrees in the lung,liver and kidney tissues of the mice in Group C decreased significantly after the treatment with AES. The differences among the levels of pro?inflammatory cytokines TNF?α(F=27.11,P<0.05),IL?1β(F=18.75,P<0.05)and IL?6(F=100.93,P<0.05)in the sera of the mice in the three groups were statistically signifi?cant. Compared with the mice in Group A,the levels of the 3 cytokines of those in Group B increased significantly(all P <0.05). However,after the treatment with AES,the levels of the pro?inflammatory cytokines of those in Group C decreased signifi?cantly(all P<0.05). The differences among the levels of immunoregulatory cytokines IL?10(F=10.88,P<0.05)and TGF?β(F=11.37,P<0.05)in the sera of the mice in the three groups were also statistically significant. Compared with the mice in Group B,the levels of IL?10 and TGF?β of those in Group C were higher after treatment with AES(both P<0.05). Conclu?sion T. spiralis AES has a therapeutic potential for alleviating sepsis induced by CLP in mice.