BACKGROUND: Metabolic-associated fatty liver disease (MAFLD) is the predominant form of chronic liver disease worldwide. This study was designed to investigate the proportion and characteristics of MAFLD within the general Chinese population and to identify the contributory risk factors for liver fibrosis among MAFLD individuals. METHODS: The participants were recruited from a cohort undergoing routine health evaluations at the Third Hospital of Hebei Medical University between May 2019 and March 2023. The diagnosis of MAFLD was based on the established clinical practice guidelines. The fibrosis-4 index score (FIB-4) was employed to evaluate hepatic fibrosis, with a FIB-4 score of ≥1.3 indicating significant fibrosis. Binary logistic regression analyses were used to determine risk factors associated with significant hepatic fibrosis in MAFLD. RESULTS: A total of 22,970 participants who underwent comprehensive medical examinations were included in the analysis. The overall proportion of MAFLD was 28.77% (6608/22,970), with 16.87% (1115/6608) of these patients showing significant fibrosis as assessed using FIB-4. Independent risk factors for significant liver fibrosis in MAFLD patients were male (odds ratio [OR] = 0.676, 95% confidence interval [CI]: 0.558-0.821), hepatitis B surface antigen (HBsAg) positivity (OR = 2.611, 95% CI: 1.557-4.379), body mass index ≥23.00 kg/m 2 (OR = 0.632, 95% CI: 0.470-0.851), blood pressure ≥130/85 mmHg (OR = 1.885, 95% CI: 1.564-2.272), and plasma glucose ≥5.6 mmol/L (OR = 1.815, 95% CI: 1.507-2.186) (all P <0.001). CONCLUSIONS The proportion of MAFLD in an urban Chinese population is 28.77%. About 16.87% of MAFLD patients presented with significant liver fibrosis. Independent risk factors for significant liver fibrosis in MAFLD patients should be noticed.
Humans ; Male ; Female ; Liver Cirrhosis/pathology* ; Middle Aged ; Risk Factors ; Adult ; Fatty Liver/pathology* ; Aged ; China/epidemiology* ; Logistic Models ; Urban Population ; East Asian People

Objective:To construct a management model for equipment in operating room on the basis of multi-criteria decision analysis(MCDA)method,and optimize management strategies and implement dynamic management.Methods:The dynamic monitoring and management for the operation and management of equipment in operating room was realized through combined the process of multi-criteria decision-making and the data platform of equipment in operating room,and construct the MCDA's framework for equipment in operating room.A total of 40 used equipment from operating room at Beijing Friendship Hospital Affiliated to Capital Medical University during January and December 2023 were selected as the research objects.The conventional management method was applied in 20 equipment during January and June 2023,and the management model(MCDA management method)of equipment in operating room was applied in 20 equipment during June to December 2023.The operational qualities of equipment,failure rates and qualification rates of sampling,and the scores of management effectiveness between two kinds management methods were compared.A self-designed survey questionnaire for satisfaction was adopted to investigate the satisfactions of managers,who used equipment in operating room,for the equipment that received clinical managements of two kinds of management methods.Results:The average rate of opening equipment,the increased extent of average cost-benefit and the increased extent of average social benefit of these equipment in operating room were respectively(91.58±3.36)%,(7.02±1.69)%and(7.25±1.36)%in using MCDA management method,all of which were higher than those in using conventional management method.However,the average transferring rate of MCDA management method was(7.69±1.54)%,which was lower than that of conventional management method,and the differences of them were all statistically significant(t=19.466,9.732,14.558,20.969,P<0.05).The failure rate of the equipment in operating room,which were managed by the MCDA method,was lower than that of these equipment were managed by the conventional method,while the pass rate of random inspection of equipment were managed by the MCDA methods was higher than those were managed by the conventional method,and the differences were statistically significant(x2=10.157,7.619,P<0.05).The scores of safety performance,speed of maintenance,cleaning quality and the speed of replacing equipment of adopting MCDA management method were all higher than those of adopting conventional management method,and the differences were statistically significant(t=17.952,15.149,13.527,10.474,P<0.05).The satisfaction rates of the managers of using equipment for adopting MCDA management method in the rationality of the process of medical equipment,the feasibility of the system,and the effectiveness of quality were all higher than those for adopting conventional management method,and the differences were significant(x2=5.454,6.667,5.963,P<0.05).Conclusion:The management of management model based on MCDA method for equipment in operating room can enhance the operational quality and management level for equipment,and reduce the operating risk and the incidence of adverse events in equipment,and improve the satisfactions of managers in using equipment.

Objective To establish a method for the simultaneous determination of 16 cephalosporin antibiotics of the fourth generation in whole blood by ultra-high performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS),including representative drugs such as cefalexin,cefuroxime axetil,cefetamet pivoxil,ceftizoxime,cefodizime,cefteram pivoxil,cefpodoxime proxetil,cefditoren pivoxil,cefminox sodium,cefoperazone,cefpirome,cefoxitin,cefamandole nafate,cefquinome sulfate,cefpiramide,and ceftiofur.Methods Whole blood was pretreated with acetonitrile for protein precipitation and then determined by ultra-high performance liquid chromatography-triple quadrupole mass spectrometry.The liquid phase used a Hypersil GOLD? C18 column(2.1 mm ×100 mm,1.9 μm).The organic phase was 0.1％formic acid methanol solution,and the aqueous phase was 0.1％formic acid aqueous solution(containing 10 mmol/mL ammonium formate)for gradient elution.Detection was performed in electrospray positive ionization mode with selected reaction monitoring(SRM).Results The 16 drugs showed good linearity within their respective concentration ranges,with R2 values all greater than 0.99.Limits of detection for cefminox sodium and cefpiramide were 50 and 20 ng/mL,respectively,and for the remaining 14 drugs were all lower than 5 ng/mL.The relative standard deviations(RSDs)of intra-day and inter-day precisions at four spiked concentrations for the 16 drugs were all no higher than 10％(n=5).Accuracy ranged within±15％for mosg drugs,except for cefamandole nafate,ceftiofur,and cefetamet pivoxil at the lower limit of quantification,which showed accuracy within±20％.Extraction recoveries exceeded 80％for all compounds.Conclusion This method has high detection sensitivity,rapid speed,and good repeatability for the simultaneously determination of 16 cephalosporin antibiotics in whole blood.

Objective To establish a method for the simultaneous determination of 16 cephalosporin antibiotics of the fourth generation in whole blood by ultra-high performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS),including representative drugs such as cefalexin,cefuroxime axetil,cefetamet pivoxil,ceftizoxime,cefodizime,cefteram pivoxil,cefpodoxime proxetil,cefditoren pivoxil,cefminox sodium,cefoperazone,cefpirome,cefoxitin,cefamandole nafate,cefquinome sulfate,cefpiramide,and ceftiofur.Methods Whole blood was pretreated with acetonitrile for protein precipitation and then determined by ultra-high performance liquid chromatography-triple quadrupole mass spectrometry.The liquid phase used a Hypersil GOLD? C18 column(2.1 mm ×100 mm,1.9 μm).The organic phase was 0.1％formic acid methanol solution,and the aqueous phase was 0.1％formic acid aqueous solution(containing 10 mmol/mL ammonium formate)for gradient elution.Detection was performed in electrospray positive ionization mode with selected reaction monitoring(SRM).Results The 16 drugs showed good linearity within their respective concentration ranges,with R2 values all greater than 0.99.Limits of detection for cefminox sodium and cefpiramide were 50 and 20 ng/mL,respectively,and for the remaining 14 drugs were all lower than 5 ng/mL.The relative standard deviations(RSDs)of intra-day and inter-day precisions at four spiked concentrations for the 16 drugs were all no higher than 10％(n=5).Accuracy ranged within±15％for mosg drugs,except for cefamandole nafate,ceftiofur,and cefetamet pivoxil at the lower limit of quantification,which showed accuracy within±20％.Extraction recoveries exceeded 80％for all compounds.Conclusion This method has high detection sensitivity,rapid speed,and good repeatability for the simultaneously determination of 16 cephalosporin antibiotics in whole blood.

Objective:To construct a management model for equipment in operating room on the basis of multi-criteria decision analysis(MCDA)method,and optimize management strategies and implement dynamic management.Methods:The dynamic monitoring and management for the operation and management of equipment in operating room was realized through combined the process of multi-criteria decision-making and the data platform of equipment in operating room,and construct the MCDA's framework for equipment in operating room.A total of 40 used equipment from operating room at Beijing Friendship Hospital Affiliated to Capital Medical University during January and December 2023 were selected as the research objects.The conventional management method was applied in 20 equipment during January and June 2023,and the management model(MCDA management method)of equipment in operating room was applied in 20 equipment during June to December 2023.The operational qualities of equipment,failure rates and qualification rates of sampling,and the scores of management effectiveness between two kinds management methods were compared.A self-designed survey questionnaire for satisfaction was adopted to investigate the satisfactions of managers,who used equipment in operating room,for the equipment that received clinical managements of two kinds of management methods.Results:The average rate of opening equipment,the increased extent of average cost-benefit and the increased extent of average social benefit of these equipment in operating room were respectively(91.58±3.36)%,(7.02±1.69)%and(7.25±1.36)%in using MCDA management method,all of which were higher than those in using conventional management method.However,the average transferring rate of MCDA management method was(7.69±1.54)%,which was lower than that of conventional management method,and the differences of them were all statistically significant(t=19.466,9.732,14.558,20.969,P<0.05).The failure rate of the equipment in operating room,which were managed by the MCDA method,was lower than that of these equipment were managed by the conventional method,while the pass rate of random inspection of equipment were managed by the MCDA methods was higher than those were managed by the conventional method,and the differences were statistically significant(x2=10.157,7.619,P<0.05).The scores of safety performance,speed of maintenance,cleaning quality and the speed of replacing equipment of adopting MCDA management method were all higher than those of adopting conventional management method,and the differences were statistically significant(t=17.952,15.149,13.527,10.474,P<0.05).The satisfaction rates of the managers of using equipment for adopting MCDA management method in the rationality of the process of medical equipment,the feasibility of the system,and the effectiveness of quality were all higher than those for adopting conventional management method,and the differences were significant(x2=5.454,6.667,5.963,P<0.05).Conclusion:The management of management model based on MCDA method for equipment in operating room can enhance the operational quality and management level for equipment,and reduce the operating risk and the incidence of adverse events in equipment,and improve the satisfactions of managers in using equipment.

ObjectiveTo explore the effect of Tanreqing injection combined with Ceftazide on the clinical efficacy， lung function， and laboratory inflammatory index of patients suffering from phlegm heat obstructing lung syndrome in acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. MethodFrom June 2021 to June 2023， 76 patients diagnosed with phlegm heat obstructing lung syndrome in AECOPD were enrolled in the respiratory and critical medical department of Jieshou Hospital of Traditional Chinese Medicine. They were randomly divided into a control group and an observation group with 38 cases each. The control group used Ceftazidime intravenous drip and other conventional oxygen inhalation and antispasmodic treatment measures of western medicine. The observation group received Tanreqing injection intravenous drip based on the treatment of the control group， with a course of 10 days. The changes of laboratory indicators such as hs-CRP， calcitonin （PCT）， and interleukin-6 （IL-6） before and after treatment were analyzed， and the improvement of forced expiratory volume in the first second （FEV₁）， forced vital capacity （FVC）， one second rate （FEV₁/FVC）， assessment and improvement of the British Medical Research Society’s dyspnea index （mMRC）， self-evaluation test of chronic obstructive pulmonary disease patients （CAT）， and traditional Chinese medicine syndrome score was compared. In addition， the total effective rate between the two groups after treatment was compared. ResultAfter treatment， the hs-CRP， PCT， IL-6， FEV₁， FVC， FEV₁/FVC， mMRC， CAT scores， and traditional Chinese medicine syndrome evaluation of both groups improved （P<0.01）. After treatment， compared with the control group， the observation group showed more significant improvements in hs-CRP， PCT， IL-6， FEV₁， FVC， FEV₁/FVC， mMRC， CAT scores， and traditional Chinese medicine syndrome evaluation， and the difference was statistically significant （P<0.05，P<0.01）. The total clinical effective rate of the control group was 86.84% （33/38）， while that of the observation group was 94.74% （36/38）. The therapeutic effect of the observation group was better than that of the control group （χ²=8.471， P<0.05）. ConclusionTanreqing injection combined with Ceftazidime has obvious efficacy in the treatment of phlegm heat obstructing lung syndrome in AECOPD， which is better than the treatment of Ceftazidime antibiotics alone. It can reduce the risk of acute exacerbation， alleviate clinical symptoms， and delay the decline of lung function.

Objective To establish and validate a prediction model for gastric cancer lymph node metastasis based on four machine learning (ML) algorithms. Methods A retrospective analysis was conducted on clinical data of 531 patients who underwent radical gastrectomy. The patients were randomly divided into training set (399 patients) and test set (132 patients) in a ratio of 3 to 1. Univariate analysis was used to screen for variables associated with gastric cancer lymph node metastasis, and Logistic regression, random forest, K-nearest neighbor algorithm, and support vector machine algorithm models were established to rank the importance of variables. All ML algorithm models were validated in the test set, and receiver operating characteristic (ROC) curves were plotted. The optimal ML algorithm model was determined based on the area under the curve (AUC), sensitivity, specificity, and accuracy. A nomogram model was constructed based on the variable importance ranking of the optimal ML algorithm model. The discrimination, calibration, and clinical applicability of the nomogram model were evaluated using ROC curves, calibration curves, and decision curves. Results The results of the comparison of the four ML algorithm models showed that the random forest model was the optimal algorithm model. The accuracy, sensitivity, and specificity of the random forest model in the training set were 72.7%, 69.9%, and 75.0%, respectively, with an AUC of 0.803. The accuracy, sensitivity, and specificity of the random forest model in the test set were 64.4%, 66.7%, and 62.5%, respectively, with an AUC of 0.751. A nomogram model was constructed based on the variables of the random forest algorithm model. The ROC curve showed that the AUCs of the nomogram model in the training set and test set were 0.721 and 0.776, respectively. Calibration curves and decision curves showed that the nomogram model had good calibration and clinical applicability in both the training set and test set. Conclusion The random forest model is the optimal algorithm model among the four ML algorithm models. The nomogram model based on the random forest model can accurately predict the risk of gastric cancer lymph node metastasis, thereby better guiding clinical diagnosis and treatment decisions.

OBJECTIVE To investigate the improvement effect and mechanism of different extracts from Tylophora yunnanensis on non-alcoholic steatohepatitis （NASH）. METHODS Normal human liver LO2 cells were induced to steatosis by free fatty acid， then were divided into normal group， model group， silybin group （100 μmol/mL）， T. yunnanensis ethanol extracts （TYS） group （50 μg/mL）， T. yunnanensis ethyl acetate extracts （TYSA） group （50 μg/mL）， and T. yunnanensis n-butanol extracts （TYSB） group （50 μg/mL）. After 24 hours of drug intervention， the deposition of lipid droplets was observed in LO2 cells in each group. The contents of total cholesterol （TC）， triacylglycerol （TG）， malondialdehyde （MDA） and glutathione （GSH）， the activities of aspartate transaminase （AST）， alanine transaminase （ALT） and superoxide dismutase （SOD）， the mRNA expressions of Kelch-like ECH-associated protein 1（ Keap1）， nuclear factor E2-related factor 2（ Nrf2） and heme oxygenase 1（ HO- 1） were detected. NASH rat model was induced by a high-fat diet， and then divided into normal group， model group， silybin group （12.6 mg/kg）， TYS group （80 mg/kg）， TYSA group （80 mg/kg） and TYSB group （80 mg/kg）， with six rats in each group. The liver indexes of rats in each group were calculated after 6 weeks of drug intervention. The liver histopathological changes were observed， and the contents of TC， TG， HDL-C and LDL-C， AST and ALT activities in serum， the contents of MDA and GSH， SOD activities in liver tissue were detected. RESULTS Compared with model group， TYS， TYSA and TYSB could reduce lipid droplet deposition， intracellular TC， TG and MDA contents， AST and ALT activities， and increase SOD activity， GSH content， and Keap1， Nrf2， HO-1 mRNA expression levels in LO2 cells after steatosis to varying degrees， with some differences being statistically significant （P＜0.05）. They also significantly improved liver injury in NASH model rats， reduced their liver indexes， TC， TG， LDL-C and MDA contents， AST and ALT 1-042） activities， and increased HDL-C （except for TYS and TYSB）， GSH contents and SOD activity， with TYSA having the most significant effect （P＜0.05）. CONCLUSIONS TYS， TYSA and TYSB have a certain improvement effect on NASH， among which TYSA has the most obvious effect. Its mechanism of action may be related to upregulating the Keap1/Nrf2/HO-1 signaling pathway and inhibiting oxidative stress

Objective:To investigate the value of delta radiomics based on longitudinal changes of dynamic contrast enhanced MRI (DCE-MRI) in predicting pathological complete response (pCR) after neoadjuvant therapy (NAT) for breast cancer.Methods:The clinicopathological and imaging data of 117 patients with breast cancer confirmed by surgical pathology from April 2019 to November 2021 at Jiangxi Cancer Hospital were analyzed retrospectively. All patients were female with 23?74 (48±10) years old. The patients were randomly divided into training (81 cases) and test sets (36 cases) at the ratio of 7∶3 according to the number of random seeds in the software. All patients underwent DCE-MRI before and after early NAT (2 courses). The maximum diameter relative regression value of breast tumors before and after early NAT (D%) was calculated and used to construct a conventional imaging model. The delta radiomic features were extracted based on pre-NAT and early-NAT (2 courses) DCE-MRI and selected by redundancy analysis and least absolute shrinkage and selection operator algorithm. A ten-fold cross-validation method was used to construct the delta radiomic model and Radscore was calculated for each patient. All patients were classified into pCR group and non-pCR group according to the surgical pathology after NAT. Significant clinicopathological variables were selected by univariate analysis and stepwise regression method. They were integrated with D% and Radscore to build the combined model and nomogram. The model performance in predicting pCR after NAT in breast cancer was evaluated by the receiver operating characteristic curve and the area under the curve (AUC), and the clinical utility of the models was compared by using clinical decision curves.Results:The combined model had the best diagnostic performance among the three models, with an AUC of 0.90 in the training set and 0.87 in the test set. The Radscore had the highest weight in the nomogram. In the training set, the diagnostic performance of the combined model and delta radiomics model were better than that of the conventional imaging model ( Z=?3.48, P=0.001; Z=2.54, P=0.011). The clinical decision curves showed an overall greater clinical benefit of the combined model compared with the conventional imaging model and delta radiomic model. Conclusions:The addition of significant clinicopathological variables and Radscore of delta radiomic model which represents the longitudinal changes in tumor heterogeneity to the conventional imaging model may improve the predictive ability of pCR. The delta radiomic may serve as a noninvasive biomarker for early prediction of NAT response.

OBJECTIVE To study the improvement effects of different polar parts fro m total f lavonoids of Scutellaria amoena on non-alcoholic fatty liver disease （NAFLD）model rats. METHODS The total flavonoids of S. amoena （SAF）were extracted by reflux extraction with ethanol ，suspended with water ，and then extracted with ethyl acetate and n-butanol in order to obtain the extraction parts of SAF （recorded as SAFA and SAFB respectively ）. Thirty-six rats were randomly divided into normal group （n＝ 6）and modeling group （n＝30）. Modeling group was given high-lipid diet to induce NAFLD model. After modeling ，modeling group was randomly divided into model group （normal saline ），fenofibrate group （positive control ，20 mg/kg），SAF group （300 mg/kg），SAFA group （300 mg/kg）and SAFB group （300 mg/kg）；they were given relevant intragastical administration ，once a day，for consecutive 6 weeks. After last administration ，the liver index was calculated ；the levels of total cholesterol （TC）， triacylglycerol（TG），aspartate transaminase （AST），alanine transaminase （ALT），high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C） in serum ，the levels of superoxide dismutase （SOD），glutathione peroxidase （GSH-Px），malondialdehyde（MDA），interleukin-1β（IL-1β），IL-6 and tumor necrosis factor-α（TNF-α）in liver tissue were detected；the pathomorphological changes of liver tissue were observed. RESULTS Compared with normal group ，the liver index ， the levels of TC ，TG，AST，ALT，LDL-C，MDA，IL-1β， IL-6 and TNF-α in serum/liver tissue of model group were all increased significantly （P＜0.05）， while the levels of HDL-C，SOD and GSH-Px were all decreased significantly （P＜0.05）. Compared with model group ，except there was no statistical significance in the serum levels of HDL-C and ALT in SAFA group （P＞0.05），above indexes in serum/liver tissue of rats in groups of polar parts from total flavonoids of S. amoena were significantly improved （P＜0.05）；inflammatory cell infiltration and fatty vacuoles in liver tissue were significantly improved. Compared with SAF group and SAFA group ，the levels of TC，TG，AST，MDA，IL-6 and TNF-α were decreased significantly in SAFB group（P＜0.05），while the level of SOD was increased significantly （P＜0.05）；pathomorphological changes of liver tissue were improved more significantly. CONCLUSIONS Each polar part from total flavonoids of S. amoena can improve NAFLD by regulating oxidative stress and inhibiting the secretion of inflammatory factors. The n-butanol polar part has more obvious effect .