Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Objective To construct radiomics-semantic models to predict the treatment resistance of chemoradiotherapy in brain gliomas based on MRI and clinical data of multicenter patients.Methods Among 2 108 brain gliomas patients from five medical institutions,132 patients had residual gliomas after surgery.The clinical risk factors and multimodal MRI were collected.All patients were divided into training set(n=95)and validation set(n=37).The treatment response of gliomas after standardized chemoradiotherapy were divided into resistant and non-resistant types.The semantic features of MRI were evaluated by two radiologists.Three different segmentation regions of interest(ROI)were delineated to extract radiomics features.And that three groups of radiomics models were con-structed based on different sequence MRIs.The radiomics model with the best predictive efficacy in each group was selected and combined with MRI semantic features,three radiomics-semantic models(combined models)were established.Finally,a MRI semantic model,three groups of radiomics models and three combined models were developed.Results Comparisons between the different models showed that the radiomics-semantic model based on pre-operative T2-fluid attenuated inversion recovery(FLAIR)sequence,had the best predictive efficacy,the area under the curve(AUC)in the training and validation sets were 0.866[95％confidence interval(CI)0.790-0.942]and 0.810(95％CI 0.667-0.952),respectively.The radiomics-semantic model based on postoperative T1 WI sequence performed the second best,with the AUC of the training and validation sets being 0.812(95％CI 0.726-0.898)and 0.711(95％CI 0.541-0.881),respectively.Conclusion The combined models based on MRI radiomics and semantic features are able to predict the treatment resistance of chemoradiotherapy in brain gliomas patients,and may be used as an important basis for optimizing treatment.

Aim To explore the mechanism by which the compound Chaijin Jieyu formula(CCJJY)regulates the TLR4/NLRP3 signaling pathway to inhibit central oxidative stress and improve hippocampal synaptic plasticity damage in depression.Methods SD rats were randomly divided into the control group,chronic unpredictable mild stress group,sleep deprivation group,chronic unpredictable mild stress combined with sleep deprivation group,positive drug group(venlafax-ine+melatonin),low-dose group of CCJJY,medium dose group of CCJJY,and high-dose group of CCJJY,with nine rats in each group.Except for the control group,a rat model of depression complicated with in-somnia was established using chronic unpredictable mild stress combined with sleep deprivation.Depres-sion-like and sleep behaviors in rats were evaluated through weight,food intake,water maze,and pento-barbital sodium tests.ELisa was used to detect ROS,AANAT,and HPLC-EC was used to detect 5-HT con-tent,while Western blot/RT-PCR was used to detect the expression of IL-1β,TLR4,NLRP3,PSD-95,and SYN related proteins and mRNA.HE and Golgic stai-ning were used to observe the pathological changes in the third ventricle,hippocampus,and neuronal synap-ses.Results Compared with the control group,the depression-like behaviors of the model group rats were significant.The expression of IL-1β,TLR4,and NL-RP3 in the hippocampus increased,while the expres-sion of PSD-95 and SYN decreased.Activation of NL-RP3 inflammasomes led to "sleeve like" pathological changes in the third ventricle,with hippocampal neu-rons undergoing apoptosis and significant damage to neuronal synaptic plasticity.Compared with the model group,after intervention with CCJJY,the expression of ROS,IL-1β,TLR4,and NLRP3 decreased,while the expression of AANAT,5-HT,PSD-95,and SYN in-creased.Pathological damage to the third ventricle and hippocampal neurons was repaired.Conclusion The CCJJY improves hippocampal synaptic plasticity dam-age in depression by regulating the TLR4/NLRP3 sig-naling pathway to inhibit central oxidative stress.

In recent years,the incidence and mortality rates of hepatocellular carcinoma in China have gradually become close to each other,reflecting persistent limitations in current diagnostic and therapeutic strategies.Given the close association between hepatocellular carcinoma development and the progression of precancerous lesions,the expert panel released the first edition of the Multidisciplinary Experts Consensus on Diagnosis and Treatment of Precancerous Lesions of Hepatocellular Carcinoma in 2020 and updated it in 2023,aiming to advance early-intervention strategies and improve overall patient survival rates.This article provides an in-depth interpretation of the key imaging diagnostic points outlined in the consensus,aiming to offer radiologists at all levels with a robust reference for early identification and diagnosis of hepatocellular carcinoma precancerous lesions,thereby facilitating critical support for timely patient intervention and treatment.

As a globally prevalent malignancy with high morbidity and mortality rates,hepatocellular carcinoma has demonstrated significant potential in prognostic prediction and therapeutic evaluation through its imaging manifestations.This article focuses on the potential correlations between current imaging characteristics of hepatocellular carcinoma and its prognosis,emphasizing the importance of adopting and promoting a standardized imaging terminology system.It illustrates specific examples of imaging features associated with prognosis,reviews recent research hotspots and advancements in hepatocellular carcinoma prognosis.The aim is to offer precise prognostication,diagnosis and treatment strategies for patients with hepatocellular carcinoma.

In clinical practice,the diagnosis of hepatocellular carcinoma primarily relies on imaging findings.For cases with atypical imaging features or insufficient diagnostic specificity,pathological analysis remains essential.With the advancement of precision medicine,research focus has expanded from pure diagnostic evaluation to therapeutic efficacy prediction.Imaging-based prognostic biomarkers have emerged as a key research frontier in hepatocellular carcinoma management.Although accurate diagnosis remains paramount,current investigations increasingly prioritize the identification of biomarkers for treatment response prediction and outcome stratification.Recent studies demonstrate that radiological characteristics not only reflect tumor heterogeneity but also carry prognostic implications for hepatocellular carcinoma.These imaging biomarkers enable non-invasive outcome prediction and provide objective evidence to optimize therapeutic decision-making.This comprehensive review summarizes MRI-derived imaging features associated with hepatocellular carcinoma prognosis,aiming to guide personalized treatment strategies and ultimately improve survival outcomes for hepatocellular carcinoma patients.

Objective To investigate the mechanism of action of the nuclear factor erythroid 2-related factor 2(Nrf2)/solute carrier family 7 member 11(SLC7A11)/glutathione peroxidase 4(GPX4)signaling pathway in non-alcoholic fatty liver disease(NAFLD),and to explore the mechanism of Gegen QinLian Decoction for the treatment of NAFLD,using in vivo and in vitro experiments.Methods Rats were fed with high-fat chow for 24 weeks to induce NAFLD,and were then divided randomly into normal(C),model(M),high-,medium-,and low-dose Gegen QinLian Decoction(GGQLT-H,GGQLT-M,GGQLT-L),and metformin(Met)groups.From week 25 onwards,the rats were administered the corresponding drugs by gavage for 2 weeks according to the grouping,until sampling.Levels of the oxidative stress markers malondialdehyde(MDA)and glutathione(GSH)in the liver tissues were measured in each group using biochemical kits and ferrous iron(Fe2+)in rat liver tissues was detected using a Fe2+kit.Nrf2,heme oxygenase-1(HO-1),SLC7A11,glutathione synthetase(GSS),GPX4,and acyl coenzyme A synthetase 4(ACSL4)mRNA levels in rat liver tissues were measured by reverse transcription quantitative polymerase chain reaction.For cellular experiments lipid acc umulation was induced in HepG2 hepatocellular carcinoma cells using 1 mmol/L free fatty acid,to mimic the NAFLD in vitro model.Different concentrations of Gegen QinLian Decoction and metformin-containing serum were added for treatment.Lipid accumulation was detected in the cells in each group by Oil red O staining.The MDA and GSH contents of HepG2 cells in the different groups were determined using appropriate kits,and the ferrous contents were detected using a cell-specific ferrous kit.Expression levels of Nrf2,HO-1,SLC7A11,GSS,GPX4,and ACSL4 mRNA was detected in each group of cells using reverse transcription quantitative polymerase chain reaction.Results In the animal experiments,MDA and Fe2+liver levels were significantly higher in the M group than in the C group,while GSH levels were significantly lower(P＜0.01).GGQLT-H,GGQLT-M and Met groups showed significantly reduced MDA and Fe2+and elevated GSH levels compared with the M group(P＜0.01,P＜0.05).High-and medium-dose Gegen QinLian Decoction and metformin increased Nrf2,HO-1,GSS,and GPX4 mRNA and decreased ACSL4 mRNA expression levels(P＜0.01,P＜0.05).In cellular experiments,lipid droplets were significantly increased in the HepG2 cell M group compared with those in the C group,and lipid droplets were significantly reduced by Gegen QinLian Decoction and metformin.MDA and Fe2+levels were significantly increased and GSH levels were significantly decreased in the HepG2 M group compared with the levels in the C group(P＜0.01),while all doses of Gegen QinLian Decoction and metformin significantly decreased MDA and Fe2+levels(P＜0.01)and increased the GSH content(P＜0.01,P＜0.05).Nrf2,GSS,GPX4,and SLC7A11 mRNA expression levels in the GGQLT-H group,Nrf2,HO-1,and SLC7A11 in the GGQLT-L group,HO-1,SLC7A11,and GSS in the GGQLT-M group,and GSS,Nrf2,and HO-1 in the Met group were all significantly increased compared with the findings in the M group(P＜0.01,P＜0.05).ACSL4 mRNA expression levels were significantly decreased in the GGQLT-M and GGQLT-L groups and the Met group(P＜0.01,P＜0.05).Conclusions Gegen QinLian Decoction can improve NAFLD by inhibiting ferroptosis,and its mechanism may he related to regulation of the Nrf2/SLC7A 11/GPX4 signaling pathway.

Objective To explore the incidence and its influencing factors of transient severe motion(TSM)in the arterial phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI.Methods The databases of China National Knowledge Network(CNKI),VIP,Wanfang,PubMed,and Embase were searched for studies on the incidence and influencing factors of TSM,and the search time was from the establishment of the databases to October 2024.Meta-analysis was performed via Stata 17.0 software.Results A total of 30 papers(33 studies)were finally included,totaling 12 565 patients.Meta-analysis results showed that the incidence of TSM in the arterial phase of Gd-EOB-DTPA enhanced MRI was 13.0％.The risk factors for TSM included age[odds ratio(OR)=1.03;95％confidence interval(CI)1.02-1.05;P＜0.001),chronic obstructive pulmonary disease(COPD)(OR=4.21;95％CI 1.76-10.09;P=0.001),and moderate-to-severe pleural effusion(OR=3.34;95％CI 1.69-6.63;P=0.001),while a previous usage history of Gd-EOB-DTPA(OR=0.56;95％CI 0.39-0.81;P=0.002)was a protective factor of TSM.Conclusion The incidence of TSM in the arterial phase of Gd-EOB-DTPA enhanced MRI is relatively high.Age,COPD,moderate-to-severe pleural effusion are risk factors for TSM,while the previous usage history of Gd-EOB-DTPA is a protective factor for TSM.

Purpose To investigate the independent risk factors for early recurrence of solitary hepatocellular carcinoma after radiofrequency ablation based on gadoxetic acid disodium(Gd-EOB-DTPA)-enhanced MRI combined with clinical features.Materials and Methods Clinical and imaging data of hepatocellular carcinoma patients who underwent radiofrequency ablation at the First Affiliated Hospital of Henan University of Chinese Medicine from January 2019 to June 2022 were retrospectively collected.All patients underwent preoperative Gd-EOB-DTPA-enhanced MRI and were followed up for up to two years post-surgery.Univariate and multivariate Cox proportional hazards regression were performed to identify independent risk factors for recurrence after radiofrequency ablation.Results A total of 58 patients were finally included,including early recurrence group(n=22)and non-early recurrence group(n=36).Multivariate Cox regression analysis revealed that preoperative alpha-fetoprotein(AFP)levels(HR=1.103,95%CI 1.008-1.206,P=0.033),arterial-phase irregular margin enhancement(HR=4.647,95%CI 1.527-14.110,P=0.007),peritumoral arterial-phase enhancement(HR=11.575,95%CI 3.575-37.478,P=0.001)and peritumoral hepatobiliary phase hypointensity(HR=5.058,95%CI 1.129-22.668,P=0.034)were independent risk factors for early recurrence.The area under the curve for AFP combined with arterial-phase irregular margin enhancement,peritumoral arterial-phase enhancement and peritumoral hepatobiliary phase hypointensity were 0.896,0.842 and 0.860,with accuracy rates of 81.0%,84.5%and 82.8%,respectively.Conclusion Preoperative serum AFP levels,arterial-phase irregular margin enhancement,peritumoral arterial-phase enhancement and peritumoral hepatobiliary phase hypointensity are independent risk factors for early recurrence after radiofrequency ablation in hepatocellular carcinoma patients.The combination of AFP and any of these MRI features significantly improves predictive efficacy.

Objective:To compare the effects of remimazolam and propofol sedation on pulmonary ventilation in patients undergoing fiberoptic bronchoscopy.Methods:In this randomized controlled trial, 90 American Society of Anesthesiologists Physical Status classification Ⅰ to Ⅲ patients, aged 18-70 yr, with a body mass index of 18-30 kg/m 2, scheduled for elective fiberoptic bronchoscopy and/or treatment under sedation at the Endoscopy Center of the Fourth Affiliated Hospital of Soochow University between November 2021 and December 2022, were divided into 2 groups ( n=45 each) using a random number table: remimazolam group (group R) and propofol group (group P). After intravenous injection of sufentanil 0.1 μg/kg, an initial dose of remimazolam 0.075 mg/kg and propofol 0.9 mg/kg was intravenously injected in group R and group P, respectively. When necessary, additional single doses of remimazolam 0.025 mg/kg or propofol 0.3 mg/kg were administered until the bispectral index value reached 60–80 and the Modified Observer′s Assessment of Alertness/Sedation score was ≤3 (successful sedation). Electrical impedance tomography was conducted immediately after entering the operating room, immediately after successful sedation, immediately after completion of bronchoscopy the procedure, and immediately upon awakening to calculate the tidal impedance variation, center of ventilation, and global inhomogeneity index. The time to successful sedation, emergence time, the lowest SpO 2 during sedation, and occurrence of adverse events such as respiratory depression, injection pain, hypotension, hypertension, tachycardia, bradycardia and dizziness were recorded. Results:Compared with group P, the tidal impedance variation was significantly increased immediately after the procedure, the global inhomogeneity index was decreased immediately after the procedure and upon awakening, the emergence time was prolonged, the lowest SpO 2 was elevated, and the incidence of hypotension and injection pain was decreased in group R ( P<0.05). Conclusions:Compared with propofol sedation, remimazolam sedation has a smaller impact on pulmonary ventilation in patients undergoing fiberoptic bronchoscopy.