Objective:To investigate the clinical value of multiparameteric quantitative ultrasound combined with a non-invasive prediction model for assessing high-risk steatohepatitis.Methods:One hundred and ninety-four cases with metabolic-associated fatty liver disease (MAFLD) who underwent liver biopsy in Huashan Hospital, Fudan University, from June 2021 to September 2022 were selected. Shear wave elastography (SWE), shear wave dispersion (SWD) imaging, and attenuation imaging (ATI) examinations were conducted in all patients before biopsy. High-risk steatohepatitis was defined as a total activity score of ≥4 in patients with steatohepatitis, hepatocellular ballooning, and liver lobular inflammation based on pathological hepatic steatosis, inflammatory activity, and fibrosis scoring system (SAF), and fibrosis stage≥F2. Binary logistic regression analysis was used to identify the factors influencing high-risk steatohepatitis. A predictive model for diagnosing high-risk steatohepatitis was constructed using R language. The DeLong test was used to compare the area under the curve between groups. Measurement data was compared between groups using the t-test or rank-sum test, and count data were compared between groups using the χ2 test. Results:There were 46 cases (23.7%) with high-risk steatohepatitis. The quantitative ultrasound parameters included elastic modulus ( OR=2.958, 95% CI: 1.889-4.883, P<0.001), dispersion coefficient ( OR=1.786, 95% CI: 1.424-2.292, P<0.001) and attenuation coefficient ( OR=42.642, 95% CI: 3.463-640.451, P=0.004). Serological indexes of fasting blood glucose ( OR=1.196, 95% CI: 1.048-1.392, P=0.011), alanine aminotransferase ( OR=1.012, 95% CI: 1.006-1.019, P<0.001), aspartate aminotransferase ( OR=1.027, 95% CI: 1.014-1.042, P<0.001), γ-glutamyl transferase ( OR=1.008, 95% CI: 1.001-1.017, P=0.041) and HDL cholesterol ( OR=0.087, 95% CI: 0.016-0.404, P=0.003) were the factors influencing its progression. The AUCs of elastic modulus, dispersion coefficient, attenuation coefficient, multiparametric ultrasound model, serological index model, and ultrasound combined with serology model for the diagnosis of high-risk steatohepatitis were 0.764, 0.758, 0.634, 0.786, 0.773 and 0.825, respectively. The results of the DeLong test showed that the ultrasound combined with the serological model was significantly better than the serological index model and the elastic modulus, dispersion coefficient, and attenuation coefficient alone ( P=0.024, 0.027, 0.038 and <0.001). Conclusion:The combination of multiparametric quantitative ultrasound is helpful for the non-invasive diagnosis of high-risk steatohepatitis and possesses great clinical significance.

Objective To explore the value of serum stearoyl sphingosine(C18∶1-Cer)and 1-stearoyl-sn-glycero-3-phospho-choline(LPC 18∶0)levels in pregnant women's serum samples during pregnancy in predicting gestational diabetes mellitus(GDM).Methods The clinical data and laboratory indicators of 126 pregnant women were retrospectively analyzed.The sub-jects were divided into GDM group(n=66)and control group(n=60)according to the GDM diagnosis results.Mass spec-trometry was used to detect the serum C18∶1-Cer and LPC18∶0 levels of the subjects in early and mid pregnancy.Logistic re-gression analysis was used to screen out the risk factors for GDM.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of C18∶1-Cer,LPC18∶0 and their combination for GDM.Results Compared with the control group,the serum C18∶1-Cer and LPC18∶0 levels of the subjects in the GDM group were significantly increased in early(18.92±2.77ng/ml vs 23.47±4.18ng/ml,41.32±17.55ng/ml vs 88.08±16.02ng/ml)and mid pregnancy(23.14±4.10ng/ml vs 18.76±4.05ng/ml,84.60±14.53ng/ml vs 40.50±17.79ng/ml),and the differences were statistically significant(t=7.127,15.637;-5.984,2.174,all P＜0.05)C18∶1-Cer was positively correlated with fasting plasma glucose(FPG),fasting plasma insulin(FPI),homeostasis model assessment of insulin resistance(HOMA-IR),glycated hemoglobin(HbA1c)and triglyceride(TG)(r=0.458,0.209,0.317,0.223,0.219,all P<0.05).LPC18.0 was positively correlated with FPG,FPI,HOMA-IR,HbA1c,total cholesterol(TC)and TG(r= 0.715,0.426,0.580,0.465,0.232,0.372,all P<0.05).Logistic regression analysis results showed that C18∶1-Cer[OR(95%CI):1.522(1.136～2.039),P<0.05]and LPC18:0[OR(95%CI):1.198(1.102～1.302),P<0.001]were independent risk factors for GDM.ROC curve analysis results showed that the area under the curve(AUC)of serum C18∶1-Cer,LPC18∶0 and the combination of the two indicators were 0.819,0.971 and 0.986,respectively.The predictive performance of the combination of the two indicators was better than that of the single detection.Conclusion Serum C18∶1-Cer and LPC18∶0 in early pregnancy were closely related to the occurrence of GDM.C18∶1-Cer combined with LPC 18∶0 has a certain predictive value for the early diagnosis of GDM.

Objective To investigate the regulatory effects of exosome microRNA-3614-5p(miR-3614-5p)derived from mesenchymal stem cells on the progression of preeclampsia(PE)in model rats and its related mechanisms.Methods Thirty-six SD rats(24 females and 12 males)were housed in cages at a female-to-male ratio of 2∶1 for natural conception.Twenty-four pregnant rats were randomly divided into sham group(sham group),PE model group(PE group)and exosome miR-3614-5p group(PE+exo group),with 8 rats in each group.The PE model was established by subcutaneous injection of 100 mg/kg NG-nitro-L-arginine methyl ester in PE group.PE model was constructed in PE+exo group.Meanwhile,160 μ g/ml exosome suspension(0.5 ml/individual/day)was intraperitoneally injected on the 14th day for 6 consecutive days,and the experiment lasted for 21 days.Sham group was given an equal amount of normal saline.Blood pressure and urinary protein concentration were measured on days 0,7,14 and 21 of pregnancy.The levels of miR-3614-5p,B lymphoblastoma-2(Bcl-2)and Bcl-associated X protein(Bax)mRNA were detected by RT-qPCR.The activity of Caspase-3,the levels of reactive oxygen species(ROS)and the content of malondialdehyde(MDA),glutathione(GSH)and ferrous ion(Fe2+)were detected by ELISA.Western blot was used to analyze the protein levels of the iron death-related protein glutathione peroxidase 4(GPx4)and solute carrier family 7 member 11(SLC7A11).Results Compared with the sham group,the expression of miR-3614-5p in the placental tissues(0.43±0.05 vs 1.01±0.07)and peripheral blood(0.51±0.07 vs 1.01±0.12)of rats in the PE group was down-regulated,with significant differences(t=19.070,10.180,all P＜0.01).Compared with supernatant liquid phase,miR-3614-5p in exosomes derived from MSCs was enriched.Compared with sham group,the diastolic blood pressure(175.43±6.02 mmHg vs 113.26±5.11 mmHg),systolic blood pressure(123.57±5.63 mmHg vs 82.63±5.26 mmHg)and urinary protein content(175.48±13.21 mg/ml vs 67.65±5.76 mg/ml)of rats in PE group were increased on the 21st day with statistical significante between groups(t=22.606,16.440,23.168,all P＜0.01).Compared with PE group,diastolic blood pressure(124.57±5.33 mmHg vs 175.43±6.02 mmHg),systolic blood pressure(89.76±3.88 mmHg vs 123.57±5.63 mmHg)and urinary protein content(97.69±7.23 mg/ml vs 175.48±13.21 mg/ml)in PE+exo group were decreased,and the differences between groups were significant(t=18.493,13.557,16.713,all P＜0.01).Compared with sham group,Caspase-3 activity(238.56％±13.22％vs 100.12％±5.93％),Bax level(3.18±0.71 vs 1.01±0.11),ROS level(387.65％±25.98％vs 100.51％±5.89％),MDA content(33.21±3.17 nmol/mg vs 14.83±2.69 nmol/mg)and Fe2+concentration(38.77±6.53 nmol/ml vs 17.51±3.15 nmol/ml)in placenta tissue of PE group were increased,while Bcl-2 level(0.47±0.08 vs 1.01±0.12),GSH content(4.12±1.22 nmol/mg vs 9.76±0.93 nmol/mg),GPX4 protein(0.48±0.06 vs 1.01±0.24)and SLC7A11 protein(0.51±0.11 vs 1.01±0.11)levels were decreased(t=6.459～32.863,all P＜0.01);Caspase-3 activity(117.35％±8.67％vs 238.56％±13.22％),Bax level(1.13±0.45 vs 3.18±0.71),ROS level(128.73％±14.37％vs 387.65％±25.98％),MDA content(18.13±3.89 nmol/mg vs 33.21±3.17 nmol/mg)and Fe2+concentration(19.05±3.45 nmol/ml vs 38.77±6.53 nmol/ml)in placental tissues of PE+exo group were decreased,while Bcl-2 level(1.04±0.11 vs 0.47±0.08),GSH content(7.86±1.07 nmol/mg vs 4.12±1.22 nmol/mg),GPX4 protein(0.98±0.14 vs 0.48±0.06)and SLC7A11 protein(1.11±0.09 vs 0.51±0.11)levels were increased compared with PE group,with significant differences between groups(t=6.093～29.633,all P＜0.01).Conclusion In the placental tissues and peripheral blood of PE rats,miR-3614-5p was down-regulated.Exosomes overexpressing miR-3614-5p derived from MSCs suppressed PE progression in rats by inhibiting ferroptosis.These results suggested that exosomes miR-3614-5p derived from MSCs may be a novel potential biomarker for PE treatment.

Objective To observe the optimal target areas for shear wave velocity(SWV)evaluation on stages of chronic kidney disease(CKD)in different sides(left,right),different parts(upper pole,middle part and lower pole)and different tissue(renal cortex,renal medulla,renal sinus)of kidney.Methods Sixty-five CKD patients(130 kidneys)were retrospectively collected.SWV were compared between different sides,among different parts and tissue of kidney.The optimal regions for evaluating CKD stages were screened.Results No significant difference of SWV was found between left and right kidneys in same parts for same tissue(all P＞0.05),while significant differences of SWV of the same tissue were noticed among upper pole,middle part and lower part of kidney on the same side(all P＜0.05),i.e at upper pole＞at middle part＞at lower pole.Significant differences of SWV were also observed among renal cortex,medulla and sinus of kidney in the same side and parts(all P＜0.05),and the sinus had the highest SWV.Intraclass correlation coefficient analysis showed that the repeatability of the measurements of SWV was the best at the middle part of kidney.Besides,significant differences of SWV were found between renal cortex and medulla at the middle part of kidney among patients with stages 1,2,3 and 4-5 CKD(all P＜0.05),while the highest SWV were observed in patients with 4-5 stage CKD(all P＜0.05).SWV of renal cortex and medulla at middle part were positively correlated with CKD stages(both P＜0.01),the area under the curve of them for evaluating stage of CKD was 0.802 and 0.774,respectively.Conclusion The optimal target areas for SWV evaluation on stages of CKD were renal cortex and medulla at middle part of kidney.

Objective:To compare the correlation and differences between invasive blood pressure(IBP)and noninvasive blood pressure(NBP)monitoring at three different levels of systolic blood pressure(SBP), diastolic blood pressure(DBP)and mean arterial pressure(MAP)in elderly hypertensive patients with atherosclerosis of the extremities during perioperative anesthesia.Methods:156 elderly patients were prospectively admitted to the Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, for peripheral vascular stenosis interventions between December 2018 and December 2021.Their IBP and NBP were measured simultaneously during the perioperative anesthesia period.Then the correlation and consistency between IBP and NBP were analyzed via the Pearson correlation coefficient, Bland-Altman plots, and the receiver operating characteristic curve(ROC curve).Results:A total of 156 elderly patients were enrolled, including 108 men(69.2%)and 48 women(30.8%), with a mean age of 72.2±7.6.Pearson correlation analysis revealed that there was a significant positive correlation between IBP and NBP.The correlation coefficient was 0.993 for invasive systolic blood pressure(ISBP)and non-invasive systolic blood pressure(NSBP), 0.808 for invasive diastolic blood pressure(IDBP)and non-invasive diastolic blood pressure(NDBP), and 0.853 for invasive mean arterial pressure(IMAP)and non-invasive mean arterial pressure(NMAP)( P<0.001 for all). Bland-Altman analysis showed that the mean deviation of ISBP and NSBP was(20.3±6.5)mmHg(95% CI: 19.18-21.38)(1 mmHg=0.133 kPa), the mean deviation of IDBP and NDBP was(3.8±9.7)mmHg(95% CI: 2.13-5.41), and the mean deviation of IMAP and NMAP was(12.7±11.0)mmHg(95% CI: 10.83-14.55). The correlation coefficient of ISBP-NSBP deviation with ISBP was 0.856, the correlation coefficient of IDBP-NDBP deviation with IDBP was 0.206, and the correlation coefficient of IMAP-NMAP deviation with IMAP was 0.583( P<0.05 for all). When ISBP≥137 mmHg, the sensitivity of an ISBP-NSBP deviation ≥20 mmHg was 96.3%, the specificity was 96.4%, and the area under the ROC curve was 0.970(95% CI: 0.934-1.000). When ISBP≥158 mmHg, the sensitivity and specificity of a predicted ISBP-NSBP deviation≥25 mmHg were 97.4% and 78.8%, respectively, and the area under the ROC curve was 0.876(95% CI: 0.820-0.933); When ISBP≥208 mmHg, the sensitivity and specificity of a predicted ISBP-NSBP deviation≥30 mmHg were 100% and 98.5%, respectively, and the area under the ROC curve was 0.985(95% CI: 0.964-1.000). Conclusions:There is a good agreement between IBP and NBP in elderly hypertensive patients with peripheral atherosclerosis during perioperative anesthesia.The magnitude of the deviation between the two is significantly and positively correlated with the level of blood pressure, suggesting that we should appropriately choose the method of blood pressure measurement in the perioperative period to correctly evaluate the blood pressure of these elderly patients.

Objective: To observe the clinical efficacy of Tuina (Chinese therapeutic massage) plus oxiracetam in treating mild vascular dementia (VD) and seek its underlying mechanism. Methods: Ninety-six patients with mild VD were randomized into an observation group and a control group, with 47 cases in the observation group and 49 cases in the control group. The control group received oral oxiracetam capsules for treatment, and the observation group was given additional Tuina treatment. Before and after treatment, the mini-mental state examination (MMSE) was adopted to assess the patient's cognitive function; the activities of daily living (ADL) scale was used to evaluate their ability to conduct daily activities; changes in the serum inflammatory factors and oxidative stress indicators were also detected. Results: After treatment, the serum content of malondialdehyde (MDA) decreased in both groups (P<0.05) and was lower in the observation group than in the control group (P<0.05); the serum contents of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) increased in both groups (P<0.05) and were higher in the observation group than in the control group (P<0.05); the serum contents of interleukin (IL)-1, tumor necrosis factor (TNF)-α, IL-6, and IL-8 declined in both groups (P<0.05) and were lower in the observation group than in the control group (P<0.05). After the intervention, the levels of systolic velocity (Vs) and mean velocity (Vm) of the middle cerebral artery elevated, and the pulsatility index (PI) dropped in patients in the two groups, showing significant intra-group differences (P<0.05); the levels of Vs and Vm in the observation group were higher than those in the control group, and the PI was lower in the observation group than in the control group, showing significant between-group differences (P<0.05). The MMSE and ADL scores increased in both groups after the intervention (P<0.05) and were higher in the observation group than in the control group (P<0.05). Conclusion: In the treatment of mild VD, Tuina plus oxiracetam can improve the cerebral blood supply, ADL, and cognitive function; the mechanism may be associated with the reduction of oxidative stress damages and inflammatory reactions.

Objective To evaluate the accuracy of aortic valve velocity time integral(VTI)in as-sessing fluid responsiveness during general anesthesia in elderly patients.Methods Forty-four elderly pa-tients of both sexes,aged 65-80 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,with New York Heart Association classⅠorⅡ,undergoing elective surgery with general anesthesia in our hospi-tal from February 2018 to August 2018,were enrolled in this study.All the patients underwent tracheal in-tubation after general anesthesia induction,and then volume expansion was carried out(6％hydroxyethyl starch 250 ml was intravenously infused for 30 min).The heart rate(HR),mean arterial pressure(MAP),VTI and stroke volume(SV)were recorded before and after volume expansion,and ΔHR,ΔMAP,ΔVTI and ΔSV were calculated.Patients were divided into 2 groups according to ΔSV: response group(R group,ΔSV≥15％)and non-response group(NR group,ΔSV＜15％).The receiver operating characteristic curve(with the area under the standard ΔSV curve was 1)was used to analyze the ΔHR,ΔMAP and ΔVTI,and the Youden index at its best was calculated.The Person test was used to analyze the correlation between ΔVTI and ΔSV.Results There were 25 cases in R group and 19 cases in NR group.Compared with group NR,ΔHR was significantly decreased,and ΔVTI and ΔSV were increased in group R(P＜0.05).The area under the ROC curve of ΔHR,ΔMAP and ΔVTI in assessing fluid responsiveness was 0.509(95％confidence interval 0.314-0.689,P＝0.415),0.558(95％confidence interval 0.379-0.737,P＝0.515)and 0.905(95％confidence interval 0.812-0.999,P＜0.01),respectively.When Youden index was at its best,ΔVTI was 15.28％,with the sensitivity 88.0％and specificity 94.7％.There was a positive correlation between ΔSV and ΔVTI(r＝0.936,P＜0.05).Conclusion ΔVTI can accurately assess the fluid responsiveness during general anesthesia in elderly patients.

Objective: To evaluate the accuracy of aortic valve velocity time integral (VTI) in assessing fluid responsiveness during general anesthesia in elderly patients. Methods: Forty-four elderly patients of both sexes, aged 65-80 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, with New York Heart Association classⅠ or Ⅱ, undergoing elective surgery with general anesthesia in our hospital from February 2018 to August 2018, were enrolled in this study.All the patients underwent tracheal intubation after general anesthesia induction, and then volume expansion was carried out (6% hydroxyethyl starch 250 ml was intravenously infused for 30 min). The heart rate (HR), mean arterial pressure (MAP), VTI and stroke volume (SV) were recorded before and after volume expansion, and ΔHR, ΔMAP, ΔVTI and ΔSV were calculated.Patients were divided into 2 groups according to ΔSV: response group (R group, ΔSV≥15%) and non-response group (NR group, ΔSV<15%). The receiver operating characteristic curve (with the area under the standard ΔSV curve was 1) was used to analyze the ΔHR, ΔMAP and ΔVTI, and the Youden index at its best was calculated.The Person test was used to analyze the correlation between ΔVTI and ΔSV. Results: There were 25 cases in R group and 19 cases in NR group.Compared with group NR, ΔHR was significantly decreased, and ΔVTI and ΔSV were increased in group R (P<0.05). The area under the ROC curve of ΔHR, ΔMAP and ΔVTI in assessing fluid responsiveness was 0.509 (95% confidence interval 0.314-0.689, P=0.415), 0.558 (95% confidence interval 0.379-0.737, P=0.515) and 0.905 (95% confidence interval 0.812-0.999, P<0.01), respectively. When Youden index was at its best, ΔVTI was 15.28%, with the sensitivity 88.0% and specificity 94.7%.There was a positive correlation between ΔSV and ΔVTI (r=0.936, P<0.05). Conclusion ΔVTI can accurately assess the fluid responsiveness during general anesthesia in elderly patients.

Objective To explore the relationship between ultrasonic appearances of epididymal spermatic granuloma and its pathologic characteristics. Methods The sonographic features of 32 cases of epididymal spermatic granuloma confirmed by pathology were retrospectively analyzed. Results A total of 34 epididymal spermatic granuloma nodules in 32 cases included 4 located in caput epididymidis and 30 located in cauda epididymidis,and maximum diameter of nodules were about 0.5-2.3 cm.Sonographic and pathologic appearances of nodules were: ① mostly low echo type,21 nodules mostly showed the obscure boundary and quite abundant blood flow signals,early granulomas formed with interstitial fibrosis inapparently under-microscope; ② inhomogeneous echo type,12 nodules mostly showed the barely clear boundary and blood flow signals from small amount to abundant amount,granulomas of different maturites distributed dispersedly with interstitial fibrosis of varying degrees under-microscope or single giant lesions formed;③mostly high echo type,1 nodule showed the obscure boundary and inapparent blood flow signals, center of the nodules distributed by a large amount of dense fibrous tissue under-microscope. Anechoic ethmoid sinus seen in 29 nodules was section of dilated epididymal ductus.Dotted strong echoes seen in 6 nodules were calcification of sperms in dilated epididymal ductus and necrotic tissue. Conclusions Ultrasonic appearances of epididymal spermatic granuloma are closely related to its pathologic characteristics.To recognize both relations contributes to improve the diagnostic value of ultrasound.

OBJECTIVE:To establish a method for the determination of related substances in anastrozole. METHODS:HPLC was performed on the column of Welch Materials XB C18 with mobile phase of acetonitrile-water(35:65,V/V)at a flow rate of 1.0 mL/min,detection wavelength was 210 nm,column temperature of 25 ℃,and the injection volume was 20 μL. RESULTS:Only one impurity(impurity A)was detected in anastrozole,the linear range was 0.1-1.6 μg/mL(r=0.9996);limit of quantitation was 0.1 μg/mL,limit of detection was 0.02 μg/mL;RSDs of precision,stability and reproducibility tests were lower than 2%;recovery was 98.95%-105.29%(RSD%=1.78%,n=9). CONCLUSIONS:The method is simple,accurate,and can be used for the determination of related substances in anastrozole.