Background and aims:Liver cirrhosis is a complex disease that may result in increased morbidity and mortality following bariatric surgery(BS).This study aimed to explore the outcome of BS in patients with unexpected cirrhosis,focusing on postoperative complications and the progression of liver disease. Methods:A retrospective study of bariatric patients with cirrhosis from four centers in China between 2016 and 2023 was conducted,with follow-up for one year after BS.The primary outcome was the safety of BS in patients with unexpected cirrhosis,while the secondary outcome was the metabolic efficacy of BS in this group postoperatively. Results:A total of 47 patients met the study criteria,including 46 cases of Child-Pugh class A cirrhosis and 1 case of Child-Pugh B.Pathological examination confirmed nodular cirrhosis in 21 patients(44.68％),pseudolobule formation in 1 patient(2.13％),lipedema degeneration with inflammatory cell infiltration in 3 patients(6.38％),and chronic hepatitis in 1 patient(2.13％).The average percentage of total weight loss was 29.73±6.53％at one year postoperatively.During the 30-day postoperative period,the complication rate was 6.38％,which included portal vein thrombosis,gastrointestinal bleeding,and intra-abdominal infection.Moreover,no cases of liver decompensation or mortality were reported during the follow-up period.The remission rates of comorbidities among 41 patients one year after surgery were as fol-lows:dyslipidemia 100％,type 2 diabetes 82.61％,hypertension 84.62％,and obstructive sleep apnea syndrome 85.71％. Conclusions:BS can be safely performed in patients with unexpected cirrhosis in the compensated stage of liver disease,with low postoperative morbidity and no mortality observed during one-year follow-up.

Objective:To investigate the long-term prognosis of liver transplantation (LT) recipients who received grafts from donors aged ≥80 years and the associated risk factors.Methods:Clinical and follow-up data of LT recipients from January 2002 to June 2023 were retrospectively analyzed using the United Network for Organ Sharing (UNOS) database. Donors were categorized into three groups : non-elderly donors (NED, age < 60 years), elderly donors (ED, age 60-79 years), and very elderly donors (VED, age ≥80 years). Propensity score matching (PSM) was used to reduce baseline selection bias among the groups. Survival rates were calculated using the Kaplan-Meier method, and differences among the groups were compared using the Log-Rank test. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent risk factors for overall survival (OS) in the VED group. Recipients were further subdivided into three age groups (<50 years, 50-69 years, and ≥70 years) to compare survival outcomes among NED, ED, and VED groups.Results:A total of 115, 089 LT recipients were included, comprising 95, 973 (83.4%) in the NED group, 18, 520 (16.1 %) in the ED group, and 596 (0.5 %) in the VED group. After 3∶3∶1 PSM, each group included 1, 623 recipients for NED and ED, and 541 for VED, with no significant differences in baseline data. The 10-year OS rates for NED, ED, and VED groups were 61.8%, 55.9%, and 47.8%, respectively, and the 10-year graft survival (GS) rates were 61.3 %, 53.8%, and 45.9 %, respectively, with all comparisons showing statistical significance ( P< 0.001). In recipients aged <70 years, the VED group had significantly lower OS and GS rates (49.0% and 47.1 %, respectively ) compared to the NED (63.7 % and 61.8%) and ED (57.7% and 55.2 %) groups ( P< 0.001 ). For recipients aged ≥70 years, there were no significant differences in 10-year OS and GS among the NED (47.2% and 48.7 %), ED (47.0 % and 48.7 %), and VED (40.0 % and 39.2 %) groups ( P= 0.992 and P= 0.996, respectively). Cox regression analysis identified cold ischemia time ≥8 hours ( HR=1.447, 95% CI: 1.088-1.923, P=0.011), pre-transplant ICU dependence ( HR=1.803, 95% CI: 1.176–2.765, P=0.007), and hepatitis B/C virus infection ( HR =1.432, 95% CI: 1.057-1.941, P=0.020) as independent risk factors for OS in the VED group. Conclusions:Liver grafts from VED grafts significantly reduce long-term OS and GS in recipients, except in those aged ≥70 years where prognosis is comparable to recipients of NED and ED grafts.. For the VED group, factors such as cold ischemia time ≥8 hours, pre-transplant ICU dependence, and hepatitis B/C virus infection markedly influence the prognosis.

Objective:To explore the role of ductular reaction in assessing the efficacy of liver transplantation.Method:From January 2015 to December 2020, he relevant clinical data were retrospectively reviewed for 100 recipients and their corresponding donors at Shulan (Hangzhou) Hospital. They were assigned into two groups of hepatic steatosis (HS group, 65 cases) and non-hepatic steatosis (non-HS group, 35 cases) according to whether or not receiving steatosis donated liver. Furthermore, based upon the occurrence of early allograft dysfunction (EAD), the participants were categorized into two groups of EAD (33 cases) and non-EAD (67 cases). The degree of bile duct reaction ductular reaction was defined by the percentage of staining area occupied by cytokeratin 19 (CK19) -positive bile duct cells in immunohistochemical-stained specimens. Donor of ductular reaction were compared between HS/non-HS and EAD/non-EAD groups. The risk factors for EAD were identified by univariate and multivariate Logistic regression analysis. Subgroup analysis was conducted based upon the level of ductular reaction (DR number) in donors (DR=0.4 as a threshold) and whether or not donors exhibited steatosis. The impact of DR was examined on the incidence of EAD and survival post-liver transplantation in steatosis donors.Result:The level of DR was higher in steatosis donor than that in non-steatosis donor [ (0.59%±0.385%) vs. (0.32%±0.194%), P<0.01]. And it was higher in EAD group than that in non-EAD group [ (0.72%±0.449%) vs. (0.38%±0.226%), P<0.01]. Multivariate logistic regression analysis showed that a high level of ductular reaction was an independent risk factor for EAD post-liver transplantation in donor. Subgroup analysis revealed that receiving a steatosis donor with low ductular reaction (DR<0.4%) had comparable levels of EAD occurrence and overall survival rate to receiving a non-steatosis donor. Conclusion:Steatosis with low ductular reaction donor may be safely applied for liver transplantation. And assessing donor injury based upon ductular reaction can effectively expand the clinical application of steatosis donors.

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

Objective:To explore the early and medium-long term outcomes of steatosis donor liver transplantation(LT)for an optimal clinical application.Methods:From January 2015 to December 2020, this retrospective cohort study was conducted jointly at Shulan (Hangzhou) Hospital, First Affiliated Hospital of Zhejiang University and First Hospital of Jilin University. The relevant clinicopathological and follow-up data were collected from 1535 LT recipients. For comparison, propensity score was utilized for case-control matching of steatosis and non-steatosis donor livers. According to presence or absence of liver steatosis, the recipients were divided into two groups of steatosis donor liver (n=243) and non-steatosis donor liver (n=1292). And 1∶1 propensity score matching was made for two groups. Then early and medium-long term outcomes of two groups were examined. Counts were described as absolute numbers. Kaplan-Meier method was employed for calculating survival time and plotting survival curve and Log-rank test for survival analysis. COX regression model was utilized for univariate and multivariate analyses. Based on basic metabolic disease pre-LT, steatosis donor liver recipients were divided into three subgroups: BMI ≥25 kg/m 2 with hypertension or diabetes (n=21), BMI<25 kg/m 2 and no hypertension or diabetes (n=130) and other recipients (n=92). A comparative study was performed for determining the prognosis of subgroups according to the different characteristics of recipient and donor liver. Results:No significant inter-group difference existed in 2-year survival post-LT ( P=0.174). However, significant inter-group difference in survival existed after 2 years post-LT ( P=0.004). And 3/5-year survival rate of steatosis donor liver was 66.4% and 44.2% respectively. Both were significantly lower than those of non-steatosis donor liver. Multivariate Cox regression analysis indicated that steatosis donor liver and male recipients were independent risk factors for prognosis >2 years survival post-LT( P=0.008, P=0.004). Subgroup analysis of steatosis liver donors showed that the prognosis of patients with BMI ≥25 kg/m 2 with hypertension or diabetes was significantly worse than other subgroups (BMI <25 kg/m 2 with no hypertension or diabetes and other recipients) <2 years survival post-LT ( P=0.029, P=0.043). Conclusions:Steatosis donor liver does not affect early survival of recipients, yet reduces medium-long term survival rate of recipients notably. In steatosis donor liver recipients, early survival rate declines markedly in recipients with preoperative BMI ≥25 kg/m 2 with hypertension or diabetes as compared with BMI <25 kg/m 2 with no hypertension or diabetes group.

Objective To study the effects of fingolimod (FTY720) on the sphingosine-1-phosphate (S1P) signaling pathway in osteoclasts.Methods Murine RAW 264.7 macrophages were induced into osteoclasts by dexamethasone and 1 α,25-(OH)2VitD3 and identified by tartrate resistant acid phosphatase Trp staining.After the osteoclasts were divided into 2 groups,the experimental group was treated with 400 ng/mL FTY720-P while the control group was not.The signal expression of extracellular signal-regulated kinase 1 (ERK1),caspase9 and protein kinase(PKC) in the downstream of S1 P pathway was detected at the gene and protein levels,and the expression of bone morphogenetic protein-2(BMP-2) and transforming growth factor-β1 (TGF-β1),which are closely related to bone reconstruction,was detected.Results The RAW264.7 cells were successfully induced into osteoclasts identified by trataric acid phosphatase staining kit (TRAP).The expression of S1PR1 in osteoclasts was higher than that in other S1PRs.After culture for 48 hours,the expression of PKC mRNA in the experimental group was significantly lower than that in the control group while the expression of BMP-2 mRNA and TGF-[β1 mRNA was significantly increased in the experimental group than in the control group (P ＜ 0.05).However,there were no significant differences in expression of ERK1 mRNA or caspase9 mRNA between the 2 groups(P ＞ 0.05).Conclusions FTY720-P can affect the expression of PKC signal in the downstream of osteoclasts by affecting S1P signaling pathway,mainly by binding to S1PR1 signal pathway,and can also promote the expression of TGF-[β1 and BMP-2 in osteoclasts,ultimately affecting the function of osteoclasts.

Objective To explore the effect of Lycium barbarum polysaccharide (LBP) on adiponectin (APN) expression and the mechanism of lowering blood-lipid and anti-inflammation in atherosclerotic (AS) mice.Methods C57BL/6J mice with normal feed were chosen as control group.Thirty-two ApoE-/-mice with high cholesterol diet were successfully established as AS models,and then the mice were randomly divided into model group and three LBP groups,which were feed with high,medium,and low dose of LBP.After feeding for four weeks,aortic blood and tissues were collected.Blood-lipid,inflammatory factors,endothelin-1 (ET-1),APN,AdipoR1,and AMPK pathway related protein expression were detected.Differentiated 3T3-L1 cells were divided into control group,LBP group,and LBP + BML-275 group.Triglyceride (TG),inflammatory factors,APN,AdipoR1,and AMPK pathway related protein expression was investigated.Results In mice,compared with the control group,typical AS pathomorphologic changes were found in aorta and the levels of TG,total cholesterol (TC),nitric oxide (NO),ET-1,interleukin-6 (IL-6),and tumor necrosis factor (TNF-α) in the model group were significantly increased,while the protein expression of HDL-C,APN,AdipoR1,PPARα,AMPKα,and p-AMPK-α and Acyl-CoA oxidase (ACO) mRNA expression was reduced.Compared with the model group,AS pathomorphologic state was obviously improved in aorta and the amount of TG,TC,NO,ET-1,IL-6,and TNF-α in LBP groups were markedly decreased,while the protein expression of HDL-C,APN,AdipoR1,PPARα,AMPKα,p-AMPKα,and ACO mRNA expression was up-regulated.These changes were all in a dose-dependent manner.In differentiated 3T3-L1 fat cells,compared with control group,LBP enhanced the expression of APN,AdipoR1,PPARα,AMPKα,p-AMPKα,and ACO,but decreased the amount of TG,IL-6,and TNF-α.Compared with LBP group,the levels of TG,IL-6 and TNF-α was notably increased in BML-275 group.Conclusion LBP up-regulates the expression of APN and AdipoR1,activates APN/AMPK pathway,plays a role in lowering blood-lipid and anti-inflammation,and thus relieves AS in mice.

Objective To observe the effects of Dahuangfuzi decoction on the intestine barrier functional of acute necrotizing pancreatitis in rats. Methods The 60 rats were randomly divided into sham operation group ( n = 19 ), ANP group ( n = 21 ), and Dahuangfuzi treatment group ( n = 20). The rats of ANP group were induced by injecting 1 ml/kg of 4% sodium taurocholate into the pancreatiobiliary duct, and jejunal fistula was esablished. The rats of treatment group received Dahuangfuzi decoction (2 ml, repeated at 4 and 8 h)through jejunum distal stoma tube 0. 5 h after ANP induction. The other 2 groups received same amount of normal saline. Blood sample was collected through abdominal aorta, 24 h after ANP induction, and the serum amylase, endotoxin, D-lactate, plasma diamine oxidase (DAO) were detected. Pancreas, small intestine tissue was harvested for pathologic examination, index of intestinal epithelial damage was measured and ultrastructural changes in small intestinal mucosa was observed. Results The expression of serum amylase, endotoxin,D-lactate, DAO in sham operation group was ( 152 ± 32 ) U/L, (6.95 ± 2.10) pg/L, ( 3.96 ± 1.08 ) μg/mland ( 14.26 ± 2.67 ) μg/ml, while the corresponding values were ( 1549 ± 93 ) U/L, (40.48 ± 3.41 ) pg/L,( 12.34 ± 1.23 ) μg/ml and ( 80.28 ± 3.54) μg/ml in ANP group, and they were (655 ± 49 ) U/L, ( 19.55 ±2.50) pg/L, (6.75 ± 1.36 ) μg/mland ( 20.69 ± 7.53 ) μg/ml in treatment group. The values in ANP group were significantly higher than those in sham operation group. The values in treatment group were significantly lower than those in ANP group, but significantly higher than those in sham operation group ( P ＜ 0.05 or P ＜0. 01 ). The thickness and height of intestinal mucosa in ANP group were ( 389.44 ± 29.87 )μm and ( 16.52 ±3.73) μm, which were significantly lower than those in treatment group [(501.95 ± 45.38 )μm, (27.82 ±5.17)] μm, and in sham operation group [( 658.72 ± 57.49 ) μm, ( 35.49 ± 6.43 )μm, Index of intestional epitholial donage in ANP group was 3.72 ± 0.65 which is significently higher than those in theatment (2.12 ±0.37 ) and in sham operation group (0.85 ± 0.24). The intestinal mucosa histological and ultrastructural changes in Dahuangfuzi treatment group were better than those in ANP group. Conclusions Dahuangfuzidecoction can significantly decrease the damage of intestine barrier function in ANP rats.

Objective To observe the clinical effect of Baiziyangxin decoction in treating children's viralmyocarditis and to explore its possible mechanism. Methods Sixty-two patients were randomly divided into a control group and a treatment group. The control group was treated with conventional western therapy (CWT), while the treatment group was treated with CWT plus Baiziyangxin decoction. The changes of myocardial enzymes before and after the treatment were observed. Results The total effective rate of the treatment group was 87.5%, while that of the control group was 70%. The difference of the total effective rate between the two groups was significant(P<0.05)., The treatment group was obviously superior to the control group in declining myocardial enzymes level. Conclusion Baiziyangxin decoction showed obvious effect in treating Children's Viralmyocarditis.

Objective To observe the clinical effects of Chaihu Gegen decoction in treating children's epidemic parotitis and to explore its possible mechanism. Methods Sixty five patients were randomly recruited into a control group and a treatment group. The control group was treated with conventional western therapy (CWT) , while the treatment group was treated with CWT plus Chaihu Gegen decoction and external application of Chinese medicine. The therapeutic effects in both groups were observed. Results The body temperature and the improvement time of clinical symptoms were obviously better in treatment group than the control group. The effective rate was 94.29% and 76.67% in the treatment group and the control group respectively. The difference between the two groups was significance (P<0.05). Conclusion It is effective to treat epidemic parotitis with Chaigu Gegen decoction combined with external treatment.