Background/Aims: Liver transplantation is the most effective treatment for the sickest patients with acute-on-chronic liver failure (ACLF). However, the influence of donor age on liver transplantation, especially in ACLF patients, is still unclear. Methods: In this study, we used the data of the Scientific Registry of Transplant Recipients. We included patients with ACLF who received liver transplantation from January 1, 2007, to December 31, 2017, and the total number was 13,857. We allocated the ACLF recipients by age intogroup I (donor age ≤17 years, n=647); group II (donor age 18–59 years, n=11,423); and group III (donor age ≥60 years, n=1,787). Overall survival (OS), graft survival, and mortality were com-pared among the three age groups and the four ACLF grades. Cox regression was also analyzed. Results: The 1-, 3-, and 5-year OS rates were 89.6%, 85.5%, and 82.0% in group I; 89.4%, 83.4%, and 78.2% in group II; and 86.8%, 78.4%, and 71.4% in group III, respectively (p<0.001).When we analyzed the different effects of donor age on OS with different ACLF grades, in groupsII and III, we observed statistical differences. Finally, the cubic spline curve told us that the relative death rate changed linearly with increasing donor age. Conclusions Donor age is related to OS and graft survival of ACLF patients after transplanta-tion, and poorer results were associated with elderly donors. In addition, different donor ages have different effects on recipients with different ACLF grades.

Background/Aims: Liver transplantation is the most effective treatment for the sickest patients with acute-on-chronic liver failure (ACLF). However, the influence of donor age on liver transplantation, especially in ACLF patients, is still unclear. Methods: In this study, we used the data of the Scientific Registry of Transplant Recipients. We included patients with ACLF who received liver transplantation from January 1, 2007, to December 31, 2017, and the total number was 13,857. We allocated the ACLF recipients by age intogroup I (donor age ≤17 years, n=647); group II (donor age 18–59 years, n=11,423); and group III (donor age ≥60 years, n=1,787). Overall survival (OS), graft survival, and mortality were com-pared among the three age groups and the four ACLF grades. Cox regression was also analyzed. Results: The 1-, 3-, and 5-year OS rates were 89.6%, 85.5%, and 82.0% in group I; 89.4%, 83.4%, and 78.2% in group II; and 86.8%, 78.4%, and 71.4% in group III, respectively (p<0.001).When we analyzed the different effects of donor age on OS with different ACLF grades, in groupsII and III, we observed statistical differences. Finally, the cubic spline curve told us that the relative death rate changed linearly with increasing donor age. Conclusions Donor age is related to OS and graft survival of ACLF patients after transplanta-tion, and poorer results were associated with elderly donors. In addition, different donor ages have different effects on recipients with different ACLF grades.

Background/Aims: Liver transplantation is the most effective treatment for the sickest patients with acute-on-chronic liver failure (ACLF). However, the influence of donor age on liver transplantation, especially in ACLF patients, is still unclear. Methods: In this study, we used the data of the Scientific Registry of Transplant Recipients. We included patients with ACLF who received liver transplantation from January 1, 2007, to December 31, 2017, and the total number was 13,857. We allocated the ACLF recipients by age intogroup I (donor age ≤17 years, n=647); group II (donor age 18–59 years, n=11,423); and group III (donor age ≥60 years, n=1,787). Overall survival (OS), graft survival, and mortality were com-pared among the three age groups and the four ACLF grades. Cox regression was also analyzed. Results: The 1-, 3-, and 5-year OS rates were 89.6%, 85.5%, and 82.0% in group I; 89.4%, 83.4%, and 78.2% in group II; and 86.8%, 78.4%, and 71.4% in group III, respectively (p<0.001).When we analyzed the different effects of donor age on OS with different ACLF grades, in groupsII and III, we observed statistical differences. Finally, the cubic spline curve told us that the relative death rate changed linearly with increasing donor age. Conclusions Donor age is related to OS and graft survival of ACLF patients after transplanta-tion, and poorer results were associated with elderly donors. In addition, different donor ages have different effects on recipients with different ACLF grades.

Background/Aims: Liver transplantation is the most effective treatment for the sickest patients with acute-on-chronic liver failure (ACLF). However, the influence of donor age on liver transplantation, especially in ACLF patients, is still unclear. Methods: In this study, we used the data of the Scientific Registry of Transplant Recipients. We included patients with ACLF who received liver transplantation from January 1, 2007, to December 31, 2017, and the total number was 13,857. We allocated the ACLF recipients by age intogroup I (donor age ≤17 years, n=647); group II (donor age 18–59 years, n=11,423); and group III (donor age ≥60 years, n=1,787). Overall survival (OS), graft survival, and mortality were com-pared among the three age groups and the four ACLF grades. Cox regression was also analyzed. Results: The 1-, 3-, and 5-year OS rates were 89.6%, 85.5%, and 82.0% in group I; 89.4%, 83.4%, and 78.2% in group II; and 86.8%, 78.4%, and 71.4% in group III, respectively (p<0.001).When we analyzed the different effects of donor age on OS with different ACLF grades, in groupsII and III, we observed statistical differences. Finally, the cubic spline curve told us that the relative death rate changed linearly with increasing donor age. Conclusions Donor age is related to OS and graft survival of ACLF patients after transplanta-tion, and poorer results were associated with elderly donors. In addition, different donor ages have different effects on recipients with different ACLF grades.

ObjectiveTo analyze the impact of diabetes-related deaths on the probability of premature mortality and life expectancy in Minhang District of Shanghai from 2004 to 2023, and to provide reference data for the optimization of targeted prevention and control strategies. MethodsAll death cases involving diabetes among the registered residents of Minhang District from 2004 to 2023 were collected. The probability of premature mortality and life expectancy was computed using the abridged life table method. The average annual percent change (AAPC) was calculated with Joinpoint 4.9.0.0. The Arriaga decomposition method was employed for statistical analyses of the influence of cause-specific and age-specific mortality related to diabetes on life expectancy. ResultsThe total number of diabetes-related mortality, crude mortality, and standardized mortality for both males and females in Minhang District from 2004 to 2023 exhibited an increasing trend (P<0.001). The primary causes of death among diabetes-related cases were cardiovascular disease (37.68%), diabetes mellitus (31.95%), and malignant tumor (17.80%). From 2004 to 2023, probability of premature mortality to diabetes-related diseases demonstrated a rising trend (P<0.001), contrasting with the declining trend observed in the overall population (P=0.001). Males showed a significant upward trajectory (P<0.001), while females displayed a stable pattern. Among the diseases exerting considerable influence, cardiovascular disease and malignant tumor revealed a marked increase over time (P<0.001), whereas diabetes mellitus maintained a stable trend; both factors negatively impacted the reduction in probability of premature mortality. From 2004 to 2023, diabetes-related mortality reduced life expectancy among residents by an average of 1.22 years (-49.89%), indicating a negative impact; the reduction was 1.41 years in males and 0.90 years in females. The age groups exhibiting greater negative contributions differed by genders, namely males aged 50‒54 years and females aged 70‒74 years. Cardiovascular disease, diabetes mellitus, and malignant tumor contributed significantly to this decline (-0.46 years, -0.42 years, -0.20 years, respectively), with male experiencing higher negative contributions than females. ConclusionIn Minhang District, the rising mortality associated with diabetes-related diseases negatively impact both the reduction of the probability of premature mortality and the increase in life expectancy. This trend is primarily attributed to the rapid escalation of mortality and younger age demographic of male residents, which warrants significant attention. It is recommended that, based on the enhancement of case management, efforts should be directed towards the targeted prevention and control of risk factors and high-risk populations.

Objective:To analyze the genetic variants of two consanguineous Chinese pedigrees affected with Hereditary prokallikrein (PK) and High molecular weight kininogen (HMWK) deficiency and explore their molecular pathogenesis.Methods:A PK deficiency pedigree (10 individuals from 4 generations) and a HMWK deficiency pedigree (6 individuals from 3 generations) which were admitted to the First Affiliated Hospital of Wenzhou Medical University on December 3, 2021 and June 16, 2022, respectively were selected as the study subjects. Clinical data of the two pedigrees were collected, and the related coagulation indexes of the probands and their family members were determined. Genomic DNA of the two pedigrees was extracted from peripheral blood samples. This study was approved by the First Affiliated Hospital of Wenzhou Medical University (Ethics No. KY2022-R193).Results:The plasma PK activity of proband A, a 29-year-old female, and her brother were extremely low (< 1.0%). Proband B was a 66-year-old male with extremely low plasma HMWK activity (< 1.0%). Genetic sequencing revealed that the proband A and her brother had both harbored a homozygous c. 417_418insCATTCTTA (p.Arg140Hisfs*3) insertional variant in exon 5 of the KLKB1 gene, with her grandmother, maternal grandmother, father, mother, sister and son all carrying heterozygous insertion variant, and her ancestor father and husband are both wild-type. Proband B had harbored a homozygous c. 460C>A (p.Pro154Thr) missense variant in exon 4 of the KNG1 gene, and his son carries a heterozygous missense variant. All other members of the pedigree are wild type. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variants were respectively rated as pathogenic (PVS1+ PM2_Supporting+ PM4) and likely pathogenic (PS4+ PM2_Supporting+ PP3+ PP4). Conclusion:The c. 417_418insCATTCTTA (p.Arg140Hisfs*3) variant of the KLKB1 gene and the c. 460C>A (p.Pro154Thr) variant of the KNG1 gene probably underlay the decreased PK and HMWK activities in the two pedigrees, respectively.

Objective To investigate age-and sex-related changes in choroid plexus(CP)volume in healthy adults,as well as its association with the volumes of other brain regions,and explore the relationship of CP volume changes with degenerative brain alterations.Methods A total of 320 healthy subjects aged between 18 and 85 years were prospectively recruited in Physical Examination Center of First Affiliated Hospital to Army Medical University during August 2023 and February 2024.These participants were randomly divided into 7.OT and 3.OT groups,with 160 people in each group.After all of them underwent sagittal three-dimensional structural MPRAGE scans of magnetic resonance imaging(MRI)at 3.OT or7.OT,FreeSurfer 6.0 segmentation software was employed to obtain the volumes of CP and other brain regions automatically.Spearman analysis was applied to analyze the correlation of CP volume with age.Independent sample t-test analysis was applied to analyze the differences in CP volume between genders.Partial correlation analysis was performed to analyze the correlation between CP volume and the volumes of other brain regions.Results A total of 311 subjects were included in the study.The results from both 3.OT and 7.OT MRI showed that CP volume was positively correlated with age(3.OT:r=0.462,P＜0.001;7.OT:r=0.539,P＜0.001).The males had significantly larger CP volume than the females(3.OT:1.4±0.47 vs 1.08±0.39 mL,P＜0.001;7.OT:2.43±0.68 vs 1.98±0.38 mL,P＜0.001).In addition,3.OT MRI revealed there was a significant positive correlation of CP volume with the volumes of white matter hyperintensities(WMH)and cerebrospinal fluid(P＜0.001),as well as a negative correlation with the volumes of gray matter,white matter,hippocampus and thalamus(P＜0.05).Conclusion CP volume is increased with ageing,with gender differences,independent of field strength and resolution.CP volume is correlated with WMH,hippocampus and other brain regions,suggesting that increment in CP volume is involved in age-related degenerative changes in the brain.Changes in CP volume might be regarded as a new imaging marker for the neurodegenerative changes.

Uncovering the risk factors of pulmonary hypertension and its mechanisms is crucial for the prevention and treatment of the disease.In the current study,we showed that experimental periodontitis,which was established by ligation of molars followed by orally smearing subgingival plaques from patients with periodontitis,exacerbated hypoxia-induced pulmonary hypertension in mice.Mechanistically,periodontitis dysregulated the pulmonary microbiota by promoting ectopic colonization and enrichment of oral bacteria in the lungs,contributing to pulmonary infiltration of interferon gamma positive(IFNγ+)T cells and aggravating the progression of pulmonary hypertension.In addition,we identified Prevotella zoogleoformans as the critical periodontitis-associated bacterium driving the exacerbation of pulmonary hypertension by periodontitis,and the exacerbation was potently ameliorated by both cervical lymph node excision and IFNγ neutralizing antibodies.Our study suggests a proof of concept that the combined prevention and treatment of periodontitis and pulmonary hypertension are necessary.

ObjectiveTo investigate the current situation of health communication carried out by medical institutions in Shanghai through new media platforms such as WeChat， Weibo， Toutiao， Douyin， Kuaishou， Bilibili and WeChat Videos， and to propose targeted measures. MethodsBased on the systematic collection of new media accounts of medical institutions in Shanghai， and through the combination of keyword screening and manual audit， health communication data of medical institutions on new media platforms were determined. ResultsData from 1 117 new media accounts of 162 medical institutions in Shanghai were collected， including 610 WeChat official accounts， 105 WeChat video accounts， 89 Weibo accounts， 18 Bilibili accounts， 198 Douyin accounts， 37 Toutiao accounts， and 60 Kuaishou accounts， totaling 111 853 posts. After keyword sorting and manual screening， a total of 66 761 health science posts were collected， with WeChat Official Accounts， Douyin， and Weibo having the top three highest number of posts. Video-based new media such as Douyin， WeChat Videos， Kuaishou， and Bilibili had a better communication impact than text and image-based new media like WeChat Official Accounts， Weibo， and Toutiao. Among them， Douyin and Toutiao were the best platforms for video and text-image-based new media， respectively. ConclusionMedical institutions in Shanghai recognize the importance of new media in health communication and have made full use of various media platforms to carry out health communication，having a certain impact on health education. In the future， medical institutions should choose appropriate platforms based on target audiences and content characteristics， fully leverage the advantages of various platforms， explore innovative communication strategies， promote the dissemination of health knowledge， and enhance the health literacy of the public.

Objective:To analyze the relationship between the level of erythrocyte sedimentation rate (ESR) and clinical manifestations, and to discuss the clinical significance of ESR in patients with SSc.Methods:Patients with SSc registered in Peking Union Medical College Hospital from January 2009 and May 2022 in the database of National Rheumatism Data Center (CRDC) were included. All patients fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for SSc. The clinical features and laboratory tests were analyzed. T test was used for analyzing the mea-surement data with normal distribution, and the results were expressed as mean±SD deviation. Wilcoxon signed-rank test or Wilcoxon rank sum test were used to analyze the measurement data that did not conform to normal distribution. The results were expressed as M ( Q1, Q3). The count data were compared with Chisquare test or Fisher's exact test. Binary logistic regression analysiswas used to analyze independent variables. P val-ue<0.05 was considered to be statistically significant. Results:A total of 308 SSc patients were enrolled in the single center of Peking Union Medical College Hospital, including 280 females (90.9%), with the average age of (47 ±12) years old. SSc patients with elevated ESR combined woth anemia were more common. Compared with normal ESR group, elevated ESR group had higher incidence of pulmonary interstitial disease (80.8% vs. 67.6%, χ2=5.89, P=0.015), pulmonary hypertension (31.7% vs. 21.1%, χ2=4.20, P=0.040) and myositis(26.9% vs. 15.7%, χ2=5.54, P=0.019). In laboratory tests, anemia is highly frequent in SSc patients with increased ESR. The increase in CK, hs-CRP, IgA and IgG were more common, and the val-ues of IgA and IgG were sta-tistically higher. In antibody tests, anti-dsDNA antibody, anti-RNP antibody, anti-SSA and anti-SSB antibodies positivity were higher, and anti-Scl70 antibody positivity was less common ( P<0.05). Multivariate regression analysis indicated elevated IgG [ B=1.733, OR(95% CI)=5.657(2.839, 11.272), P<0.001], anemia [ B=1.083, OR(95% CI)=2.952(1.376, 6.333), P=0.005)], positive anti-SSA antibody [ B=1.665, OR(95% CI)=5.287 (2.367, 11.809), P<0.001] were independent factors for SSc patients with elevated ESR are more common. IgG and positive anti-SSA antibody were strong risk factor for increased ESR. Conclusion:SSc patients with elevated ESR are more commonl with anemia, elevated IgG and positive anti-SSA anti-body, which may be related to disease activity. Long-term follow-up for these patients is helpful to guide clini-cal doctors′ treatment choices.