Objective To investigate the values of systemic inflammatory response index(SIRI),systemic immunoinflammatory index(SII),neutrophil count/lymphocyte count(NLR),platelet count/lymphocyte count(PLR)and lymphocyte count/monocyte count(LMR)in prediction of the severity of acute pancreatitis(AP)at early stage.Methods The clinical data on 666 AP patients admitted to the department of hepatobiliary surgery,the First Affiliated Hospital of Anhui University of Science and Technology,from January 2020 to November 2023 were retrospectively analyzed.The patients were divided into a mild group(MAP group,mild acute pancreatitis)and a non-mild group(non-MAP group,including moderate to severe acute pancreatitis).Blood routine and biochemical indicators were collected at admission and 24 hours after admission.The differences in SIRI,SII,NLR,PLR and LMR between the two groups were compared,so were the values of these five indexes in prediction of non-MAP.Results Of the 666 AP patients,507 were in the MAP group and 159 in the non-MAP group.In the non-MAP group,C-reactive protein(CRP),SIRI,SII,and NLR were higher than those in the MAP group 24 hours after admission,while LMR was lower than that in the MAP group,and the differences were statistically significant(P<0.05).CRP(HR=1.008,95%CI:1.004～1.012,P<0.05)and SIRI(HR=1.216,95%CI:1.029～1.436,P<0.05)were identified as the risk factors for the severity of AP.The ROC curve showed that the AUC and sensitivity of SIRI for predicting non-MAP 24 hours after admission were 0.718 and 75.00%,respectively,higher than those of SII,CRP,NLR,and LMR.Both SIRI and CRP had AUC values greater than 0.7,and the combined AUC was 0.788(0.738～0.837),the sensitivity was 86.00%and the specificity was 81.44%.Conclusions SIRI can be used as a predictor of disease severity in early AP patients,and combined with CRP can improve the predictive value.

Objective The aim of this study was to compare the effect of injection of indocyanine green(ICG)through peripheral vein and gallbladder in laparoscopic cholecystectomy(LC)of difficult gallbladder.Methods Patients with difficult gallbladder who underwent LC by the same surgical team from May to October 2023 in the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Anhui University of Science and Technology were divided into three groups according to A random number table.Group A was injected ICG through peripheral vein before operation,group B was injected ICG through gallbladder during operation,and group C was the control group.The differences of operation time,intraoperative blood loss,hospitalization time,hospitalization cost and postoperative complications among the three groups were compared,and the effects of fluorescence mode cholangio-gram in group A and group B were compared.One-way analysis of variance was used to compare the normal distri-bution of the measurement data among groups,and LSD-t test was used to compare the two groups.The counting data was compared by chi-square test.The Boferroni test was appied to compare the two groups.Results There were no differences in length of stay,hospitalization cost and postoperative complications among the three groups(P＞0.05).The operative time and intraoperative blood loss of group A and group B were lower than those of group C(P＜0.05),but there was no difference between group A and group B(P＞0.05).The total imaging rate of the first three tubes of free gallbladder triangle(early stage)in group A was 41.67%,which was significantly lower than that in group B(63.89%)(P＜0.05).Conclusion ICG is beneficial for the identification of extrahepatic bile duct structures during LC of difficult gallbladder,and ICG injection through the gallbladder is helpful for the early identification of extrahepatic bile duct.

Objective:To explore the effects of online mindfulness-based stress reduction(MBSR)on the anxiety and depression status,and quality of life in the caregivers of patients with severe mental disorders.Methods:Ninety-three caregivers for patients with schizophrenia or bipolar disorder,who were hospitalized in Yunnan Provincial Mental Hospital in March 2021,were enrolled and randomly divided into control group(n=47)and MBSR intervention group(n=46).Both groups received basic health education and rehabilitation skill training,while the intervention group received additional online MBSR for 8 weeks.The anxiety and depression status,and the quality of life of the caregivers were evaluated by Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS)and the 36-item Short Form Health Survey(SF-36)before and 8 weeks after intervention,respectively.Results:Thirteen caregivers dropped out of the study,and 80 subjects(40 in each group)were included in the final analysis.At the baseline,there were no significant differences in SAS,SDS and SF-36 scores between two groups(all P>0.05).Compared with the baseline,SAS and SDS scores in the intervention group significantly decreased after 8 weeks of intervention(both P<0.01)and were significantly lower than those in the control group(both P<0.01).There were no significant changes in the control group(all P>0.05).Except the physiological function dimension,the total score and the scores of each dimension of SF-36 in the intervention group were significantly increased after 8-week intervention(all P<0.05),and were significantly higher than those in the control group(all P<0.01).There were no significant changes in the control group before and after intervention(all P>0.05).Conclusion:Online MBSR can reduce the anxiety and depression levels,improve the quality of life in the caregivers of patients with severe mental disorders.

Objective:To investigate the value of preoperative C-reactive protein to albumin ratio (CAR) in predicting microvascular invasion (MVI) and early postoperative recurrence of hepatocellular carcinoma(HCC).Methods:A retrospective cross-sectional study was conducted to analyze the clinical data of 190 patients with hepatocellular carcinoma who underwent radical resection in the First Affiliated Hospital of Anhui University of Science and Technology and the First Affiliated Hospital of Anhui Medical University from January 2020 to April 2022. The patients were divided into MVI group ( n=57) and non-MVI group ( n=133) according to whether there was microvascular invasion in postoperative pathology. The systemic inflammatory response index (SIRI), systemic immunoinflammatory index(SII), fibrinogen to albumin ratio (FAR) and CAR were calculated. 190 patients were followed up for 2 years after surgery. 86 patients had a recurrence, of whom 45 were in the MVI group and 41 were in the non-MVI group. SIRI, SII, FAR and CAR of the two groups were observed. And the value of SIRI, SII, FAR and CAR in predicting MVI and early postoperative recurrence was determined by receiver operating characteristic(ROC) curve. Univariate and multifactorial analysis of MVI risk factors in HCC. Quantitative data data consistent with normal distribution were represented by ( ± s), and independent sample t test was used for comparison between groups. Quantitative data that did not conform to normal distribution were represented by quartile M( Q1, Q3), and comparison between groups was performed by Mann-Whitney U test. Qualitative data were compared using chi-square test. Multivariate Logistic regression analysis was used for multivariate analysis. Results:There were 86 patients with early recurrence after operation, the recurrence rate was 45.26%. Among them, 45 cases (78.95%) recurred in MVI group and 41 cases (30.83%) in non-MVI group. There were 9 deaths (15.79%) in MVI group and 5 deaths (3.76%) in non-MVI group. There were differences in recurrence and death between MVI group and non-MVI group ( P<0.05). CAR was better than SIRI, SII and FAR in predicting MVI of hepatocellular carcinoma ( P<0.05). The area under ROC curve (AUC), sensitivity and specificity of CAR were 0.651, 70.20% and 60.20%, respectively, and the best predictive value was 0.01. CAR was an independent risk factor for MVI ( OR=1.068, 95% CI: 0.819-1.393, P<0.05). CAR was better than SIRI, SII and FAR in predicting early postoperative recurrence ( P<0.05). AUC, sensitivity and specificity of CAR were 0.641, 55.40% and 73.80%, and the predicted value was 0.01. Conclusion:Preoperative CAR is a risk factor for MVI in HCC, which can predict the occurrence of MVI and early recurrence after operation.

Objective:To study the factors influencing repeatedly hospitalization in patients with acute pancreatitis (AP), and to analyse the predictive value of triglyceride for repeated hospitalization.Methods:The clinical data of 1 958 patients with AP treated at the First Affiliated Hospital of Anhui University of Science and Technology from January 2012 to April 2022 were analyzed. Of 1 733 AP patients who were enrolled, there were 1 000 males and 733 females, with mean ± s. d age being (49.4±16.4) years. Patients were grouped based on their ID numbers to determine their number(s) of hospitalization. Those who were admitted only once were included in the initial hospitalization group ( n=1 030), and those who were admitted twice or more were included in the repeated hospitalization group ( n=703). The factors influencing repeated hospitalization were analyzed by univariate analysis and multivariate logistic regression analysis. The predictive value of triglyceride for repeated hospitalization was evaluated by receiver operating characteristic (ROC) curve. Results:Multivariate logistic regression analysis showed that hypertriglyceridemia ( OR=1.445, 95% CI: 1.144-1.825, P=0.002) and biliary causes ( OR=3.184, 95% CI: 1.978-5.125, P<0.001) were independent risk factors for repeated hospitalization. When triglyceride <10.9 mmol/L, the prediction of AP patients without repeated hospitalization was 90.6%. The area under the ROC curve was 0.589, and the Yoden index was 0.170. Conclusion:Hypertriglyceridemia was risk factor for repeat hospitalization in AP patients and the efficacy of triglyceride in predicting repeat hospitalization in AP patients was good.

Objective To investigate the clinical utility of indocyanine green (ICG) fluorescence imaging in difficult laparoscopic cholecystectomy (LC). Methods The clinical data of LC patients from October 2021 to December 2021 in the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. Based on whether ICG fluorescence imaging was used and whether gallbladder difficulties were detected, the patients were divided into four groups: ICG common gallbladder (Group A), ICG difficult gallbladder (Group B), common gallbladder (Group C), and difficult gallbladder (Group D). The operative time, intraoperative bleeding, length of hospital stay, hospitalization cost and postoperative complications were compared. Comparison of normally distributed continuous data between groups was performed by t test. Comparison of categorical data between groups was performed using the chi-square test or Fisher's exact probability method. Results The operative time, intraoperative bleeding, length of hospital stay, hospitalization cost and intraoperative complications in group A were comparable to those in Group C (all P > 0.05). The operative time and intraoperative bleeding were (75.41±12.96) min and (18.27±6.97) mL in group B, vs (106.78±19.21) min and (23.99±8.43) mL in group D, respectively, and the differences were statistically significant (all P < 0.05), while the length of hospitalization, hospitalization cost and postoperative complications in group B were comparable to those in group D (all P > 0.05). Conclusion The benefits of ICG fluorescence imaging during LC in patients with the common gallbladder are not obvious. However, in difficult gallbladder cases, ICG fluorescence imaging can improve biliary tract exposure and reduce operation time and intraoperative bleeding.

Despite complications were significantly reduced due to the popularity of percutaneous coronary intervention (PCI) in clinical trials, reperfusion injury and chronic cardiac remodeling significantly contribute to poor prognosis and rehabilitation in AMI patients. We revealed the effects of HSP47 on myocardial ischemia-reperfusion injury (IRI) and shed light on the underlying molecular mechanism. We generated adult mice with lentivirus-mediated or miRNA (mi1/133TS)-aided cardiac fibroblast-selective HSP47 overexpression. Myocardial IRI was induced by 45-min occlusion of the left anterior descending (LAD) artery followed by 24 h reperfusion in mice, while ischemia-mediated cardiac remodeling was induced by four weeks of reperfusion. Also, the role of HSP47 in fibrogenesis was evaluated in cardiac fibroblasts following hypoxia-reoxygenation (HR). Extensive HSP47 was observed in murine infarcted hearts, human ischemic hearts, and cardiac fibroblasts and accelerated oxidative stress and apoptosis after myocardial IRI. Cardiac fibroblast-selective HSP47 overexpression exacerbated cardiac dysfunction caused by chronic myocardial IRI and presented deteriorative fibrosis and cell proliferation. HSP47 upregulation in cardiac fibroblasts promoted TGFβ1-Smad4 pathway activation and Smad4 deubiquitination by recruiting ubiquitin-specific peptidase 10 (USP10) in fibroblasts. However, cardiac fibroblast specific USP10 deficiency abolished HSP47-mediated fibrogenesis in hearts. Moreover, blockage of HSP47 with Col003 disturbed fibrogenesis in fibroblasts following HR. Altogether, cardiac fibroblast HSP47 aggravates fibrosis post-myocardial IRI by enhancing USP10-dependent Smad4 deubiquitination, which provided a potential strategy for myocardial IRI and cardiac remodeling.

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive hereditary mitochondrial disease, which is mainly characterized by gastrointestinal and neurological system involvement. This article reports a rare case of MNGIE which presented as chronic diarrhea. The purpose is to improve the understanding of MNGIE.

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive hereditary mitochondrial disease, which is mainly characterized by gastrointestinal and neurological system involvement. This article reports a rare case of MNGIE which presented as chronic diarrhea. The purpose is to improve the understanding of MNGIE.

Objective:To explore the influence of the timing of the drainage tube removal on the clinical pathway after radical resection of papillary thyroid carcinoma.Methods:The clinical data of 64 patients with radical resection of papillary thyroid carcinoma discharged to the department of general surgery, First Affiliated Hospital of Anhui University of Science and Technology from December 2019 to May 2020 were retrospectively analyzed. There were 14 males and 50 females, aged (45.8 ± 11.7) years and ranging from 23 to 73 years. According to the amount of postoperative drainage fluid, decide whether to extubate and divide the patient into a study group and a control group, there were 37 cases in the study group and 27 cases in the control group. The extubation indication in the study group was 24 hours of drainage fluid volume <20 mL, the control group was 24 hours of drainage fluid volume <10 mL. The differences in operation time, intraoperative blood loss, tumor diameter, number of lymph node dissection, extubation time, postoperative complications, hospitalization cost, postoperative hospitalization time, total hospitalization time, and clinical path completion rate were compared between the two groups. The measurement data of normal distribution were expressed as mean±standard deviation ( Mean± SD), and the t test was used for comparison between groups, the measurement data of non-normal distribution were measured by M ( P25, P75), and the Mann-Whitney U test were used for comparison between groups.Counting data were expressed as percentages(%), and chi-square test was used in comparison between groups. Results:There were no significant difference between the two groups in the operation time, total intraoperative blood loss, tumor diameter, number of lymph node dissections, postoperative complications and hospitalization costs( P>0.05). The extubation time, postoperative hospitalization time, hospitalization time and clinical path completion rate of the study group were 2.9(2.5, 3.5) d、3.0(3.0, 3.5) d、7.0(7.0, 8.5) d and 70.3% (26/37), vespectively. In the control group, they were 4.5(3.8, 5.5) d、5.0(4.0, 6.0) d、11.0(10.0, 13.0) d and 11.1% (3/27), respectively. The difference between the two groups were statistically significant ( P<0.05). Conclusion:After radical resection of papillary thyroid cancer, taking the 24 h drainage volume <20 mL as the timing of extubation does not increase the incidence of postoperative complications, which can significantly shorten the extubation time, postoperative hospitalization time and total hospitalization time and improve clinical path completion rate.