Hepatic encephalopathy （HE） is a major complication of liver cirrhosis associated with a poor prognosis， imposing a heavy burden on patients， families， and the healthcare system. In recent years， although significant advances have been made in the diagnosis and management strategies for HE， many issues remain to be resolved. In 2026， the American College of Gastroenterology released a clinical guideline on HE， covering recommendations on the diagnosis， management， and prevention of HE， which provides guidance for clinical practice. This article gives an excerpt of the recommendations and key views from this guideline.

Objective:To explore the correlation between quantitative parameters based on SUV acquired by dynamic SPECT/CT imaging of parotid glands and pathological grading of labial gland in patients with primary Sj?gren syndrome (pSS).Methods:Seventy-two patients (6 males, 66 females, age (51.5±13.8) years) with confirmed pSS diagnosed at Hebei General Hospital between August 2022 and March 2024 were prospectively included. The clinical data and pathological grading information from labial gland biopsies were analyzed. Dynamic SPECT/CT imaging of the parotid glands was performed, and quantitative parameters based on SUV were obtained using Q-metrix software: SUV max, SUV mean, uptake volume of parotid glands (UVP) and total parotid uptake (TPU) pre/post-acid stimulation, as well as the differences in quantitative parameters before and after acid stimulation (ΔSUV max, ΔSUV mean, ΔUVP, and ΔTPU). The independent-sample t test or Mann-Whitney U test was performed to evaluate the differences in parameters between patients with pathological grade 1-2 and those with pathological grade 3-4. Spearman rank correlation was used to analyze the correlation between quantitative parameters and pathological grading. The performance of quantitative parameters in distinguishing pathological grade 1-2 from grade 3-4 was assessed using ROC curve analysis with Delong test. Results:The SUV max pre/post-acid stimulation in patients with pathological grade 1-2 ( n=30) were higher than those in patients with grade 3-4 ( n=42) (36.38(27.81, 44.17) vs 15.45(10.77, 24.51), Z=-5.51, P<0.001(pre-acid stimulation); 21.53(16.93, 26.21) vs 11.33(7.32, 15.89), Z=-5.27, P<0.001 (post-acid stimulation)). SUV mean, UVP and TPU pre/post-acid stimulation in patients with pathological grade 1-2, as well as ΔSUV max, ΔSUV mean and ΔTPU, were all significantly higher ( Z values: from -4.73 to -3.04, t values: 6.39, 4.50, all P<0.01). Moreover, these parameters were negatively correlated with the pathological grading ( rs values: from -0.66 to -0.36, all P<0.05). No significant difference in ΔUVP was observed between patients with pathological grade 1-2 and those with grade 3-4 ( Z=-1.05, P=0.293), and ΔUVP showed no correlation with pathological grading ( rs=-0.13, P=0.297). Among all parameters, SUV max pre/post-acid stimulation and TPU pre-acid stimulation exhibited better diagnostic performance in differentiating pathological grade 1-2 from grade 3-4, with AUC values of 0.883, 0.866, and 0.888, respectively. Delong test showed that those 3 AUC values were all higher than AUC values of SUV mean, UVP post-acid stimulation and ΔUVP (all AUC<0.800; Z values: 2.09-4.65, all P<0.05). Conclusion:The quantitative parameters of parotid glands based on SUV acquired by dynamic SPECT/CT can reflect the damage degree of parotid glands in patients with pSS, providing novel quantitative analytical tools for the functional diagnosis and assessment of pSS.

Objective:To explore the correlation between quantitative parameters based on SUV acquired by dynamic SPECT/CT imaging of parotid glands and pathological grading of labial gland in patients with primary Sj?gren syndrome (pSS).Methods:Seventy-two patients (6 males, 66 females, age (51.5±13.8) years) with confirmed pSS diagnosed at Hebei General Hospital between August 2022 and March 2024 were prospectively included. The clinical data and pathological grading information from labial gland biopsies were analyzed. Dynamic SPECT/CT imaging of the parotid glands was performed, and quantitative parameters based on SUV were obtained using Q-metrix software: SUV max, SUV mean, uptake volume of parotid glands (UVP) and total parotid uptake (TPU) pre/post-acid stimulation, as well as the differences in quantitative parameters before and after acid stimulation (ΔSUV max, ΔSUV mean, ΔUVP, and ΔTPU). The independent-sample t test or Mann-Whitney U test was performed to evaluate the differences in parameters between patients with pathological grade 1-2 and those with pathological grade 3-4. Spearman rank correlation was used to analyze the correlation between quantitative parameters and pathological grading. The performance of quantitative parameters in distinguishing pathological grade 1-2 from grade 3-4 was assessed using ROC curve analysis with Delong test. Results:The SUV max pre/post-acid stimulation in patients with pathological grade 1-2 ( n=30) were higher than those in patients with grade 3-4 ( n=42) (36.38(27.81, 44.17) vs 15.45(10.77, 24.51), Z=-5.51, P<0.001(pre-acid stimulation); 21.53(16.93, 26.21) vs 11.33(7.32, 15.89), Z=-5.27, P<0.001 (post-acid stimulation)). SUV mean, UVP and TPU pre/post-acid stimulation in patients with pathological grade 1-2, as well as ΔSUV max, ΔSUV mean and ΔTPU, were all significantly higher ( Z values: from -4.73 to -3.04, t values: 6.39, 4.50, all P<0.01). Moreover, these parameters were negatively correlated with the pathological grading ( rs values: from -0.66 to -0.36, all P<0.05). No significant difference in ΔUVP was observed between patients with pathological grade 1-2 and those with grade 3-4 ( Z=-1.05, P=0.293), and ΔUVP showed no correlation with pathological grading ( rs=-0.13, P=0.297). Among all parameters, SUV max pre/post-acid stimulation and TPU pre-acid stimulation exhibited better diagnostic performance in differentiating pathological grade 1-2 from grade 3-4, with AUC values of 0.883, 0.866, and 0.888, respectively. Delong test showed that those 3 AUC values were all higher than AUC values of SUV mean, UVP post-acid stimulation and ΔUVP (all AUC<0.800; Z values: 2.09-4.65, all P<0.05). Conclusion:The quantitative parameters of parotid glands based on SUV acquired by dynamic SPECT/CT can reflect the damage degree of parotid glands in patients with pSS, providing novel quantitative analytical tools for the functional diagnosis and assessment of pSS.

Combined with teaching practice, this study summarizes the teaching contents, methods and effect evaluation of pathological technology for professional postgraduates majoring in pathology. According to the basic conditions of postgraduates, the pathological technology training program has been formulated, student-centered heuristic teaching is carried out by using diversified teaching methods such as flipped classroom, interactive theoretical teaching is carried out by using the intelligent teaching platform, and practical teaching is carried out by using the problem-based learning mode, aiming to improve the theoretical literacy and practical level of pathological technology of professional postgraduates majoring in pathology, improve their clinical research thinking, and lay a foundation for clinical pathological diagnosis and scientific research in the future.

Objective:To analyze the clinical characteristics and prognostic value of prostate-specific antigen (PSA) dynamic features in patients with metastatic castration resistant prostate cancer (mCRPC) received abiraterone acetate (AA) therapy.Methods:The data of 89 patients with mCRPC who received AA therapy from January 2017 to June 2021 in Shanghai Tongji Hospital were retrospectively reviewed. The age of patients was (75.7 ± 8.3) years old, median PSA before AA was 56.88 (19.31, 143.75) ng/ml. The PSA dynamic features included PSA nadir (PSAN) and PSAN time. PSAN was defined as the lowest value of PSA after treatment, and PSAN time was defined as time to PSAN after AA treatment. PSAN was divided into 3 groups: PSAN1 (<0.1 ng/ml), PSAN2 (0.1- 4.0 ng/ml) and PSAN3 (>4.0 ng/ml) groups. PSA response was defined as a maximum PSA decline rate ≥50%, and no PSA decline after treatment was defined as primary resistance. Cox regressions adjusted to clinical factors were performed to evaluate the influence of PSA dynamic features on patients' radiographic progression-free survival (rPFS) and overall survival (OS). Log-rank test was used to evaluate the survival time of patients in different PSAN groups. Receiver operator characteristic (ROC) curve and area under the curve (AUC) were performed to analyze the predictive value of PSA dynamic features on survival outcomes of patients.Results:The follow-up time was 17 (12, 23) months, and 75 (84.3%) patients showed PSA responses. The median PSAN was 1.82 (0.01, 11.70) ng/ml, median PSAN time was 5.0(3.0, 9.5)months. Multivariate Cox regression indicated that PSAN was an independent risk factor for rPFS ( PSAN2: HR=5.308, P=0.017; PSAN3: HR=13.209, P<0.001), and PSAN time ≥ 5 months( HR=0.309, P<0.001)was an independent protective factor for rPFS. Also, the PSAN3 was an independent risk factor for OS( HR=9.459, P=0.048). Log-rank test indicated that the rPFS of PSAN1 group (median not reached) was significantly longer than PSAN2 [median 13.0(95% CI 8.2-17.8) months, P=0.001] and PSAN3 [8.0 (95% CI 4.1-11.9) months, P<0.001] groups. ROC curve and AUC showed that PSAN had a higher predictive value in rPFS outcomes compared with T stage, metastatic disease volume, and Eastern Cooperative Oncology Group (ECOG) score (0.82 vs. 0.69, 0.68, 0.53, P<0.05). PSAN had a higher predictive value in OS outcomes than metastatic disease volume and ECOG(0.83 vs. 0.63, 0.58, P<0.05). Conclusions:Lower PSAN needs longer PSAN time. PSAN is an independent risk factor for rPFS and OS, and PSAN time is an independent protective factor for rPFS.

Objective To observe the 18F-FDG PET/CT manifestations of primary systemic anaplastic large cell lymphoma(ALCL).Methods A total of 21 patients with primary systemic ALCL were enrolled,and PET/CT manifestations were observed.Results Among 21 cases of ALCL,there were 15 cases of ALK+and 6 cases of ALK-.Affected lymph nodes in multiple site were observed in 19 cases,mainly located in the neck(n=13),mediastinum(n=12 cases)or retroperitoneum(n=12),while single site affected lymph node was notice in 2 cases.Extranodal organs/site involvements were found in 12 cases,including 6 cases of soft tissue(such as skin,muscles,etc.),4 cases of bone,14 cases of organs,including 4 cases of lung,3 cases of liver,2 cases of pancreas,2 cases of kidney,2 cases of gastrointestinal tract and 1 case of thyroid.Among 21 cases of ALCL,19 with irregular lymph node morphology and fused into clusters,17 with uniform density,3 with necrosis and 1 with calcification.All ALCL lesions in 21 cases showed hypermetabolism,the maximum standard uptake value(SUVmax)and the mean standard uptake value(SUVmean)of the affected lymph node was 17.04±9.94 and 9.96±6.15,respectively,while the metabolic tumor volume(MTV)and total lesion glycolysis(TLG)of all lesions was 92.54(67.61,249.21)cm3 and 723.46(419.78,1 461.17)g,respectively.The maximum diameter of the affected lymph node was not significantly correlated with SUVmax nor SUVmean(both P＞0.05),but positively correlated with MTV and TLG of all lesions(r=0.696,0.767,both P＜0.001).Ann Arbor staging was positively correlated with the maximum diameter,SUVmax and SUVmean of the affected lymph node,also MTV and TLG of all lesions(r=0.467,0.458,0.702,0.780,0.664,all P＜0.05).Conclusion 18F-FDG PET/CT manifestations of primary systemic ALCL were characteristic,with significant changed metabolic parameters,including SUVmax,SUVmean,MTV and TLG.

OBJECTIVE： To establish the method for the rapidly non-destructive quality control of Liuwei dihuang capsule. METHODS： AOTF-NIR spectrometry was adopted. Taking 80 batches of Liuwei dihuang capsule produced by a manufacturer in recent three years as samples， HPLC chromatogram was adopted to determine the contents of loganin， morroniside， paeonol， paeoniflorin and ursolic acid； the content of water was determined according to general principles stated in 2015 edition of Chinese Pharmacopeia （part Ⅰ）. Taking 70 batches of samples as correction set， the partial least square method and the cross-validation algorithm were used to establish the NIR quantitative model of 6 indexes in Liuwei dihuang capsules with the Unscrambler quantitative analysis software. Taking residual 10 batches of samples as validation set， external validation was conducted for the model. RESULTS： The correlation coefficients （R2） of internal and external validation of loganin， morroniside， paeonol， paeoniflorin， the content of water quantitative model were all greater than 0.9； the correction of standand deviation （RMSEC） were 0.372 8， 0.025 4， 0.263 3， 0.288 5， 0.186 7 and 0.037 7； the prediction of standard deviation （RMSEP） were 0.462 2， 0.077 5， 0.472 1， 0.634 9， 0.293 4 and 0.206 9； the external verification showed that mean deviations of preclicted value to actual value were 6.04％， 6.05％， 5.87％， 6.97％， 5.62％ and 4.83％， with the mean deviation less than 10％.CONCLUSIONS：The established method can achieve rapidly non-destructive analysis Liuwei dihuang capsule.