ObjectiveTo investigate the differences in clinicopathological features and prognosis between patients with drug-induced vanishing bile duct syndrome （VBDS） and those with VBDS induced by autoimmune liver disease， and to summarize the key points for clinical differentiation. MethodsA total of 67 patients who were diagnosed with VBDS by liver biopsy in The First Affiliated Hospital of Soochow University and Wuxi Fifth People’s Hospital from January 2018 to June 2024 were enrolled as subjects， among whom 18 had drug-induced VBDS （D-VBDS group） and 49 had VBDS induced by autoimmune liver disease （A-VBDS group）. Related data were collected， including general information， clinical symptoms and signs， laboratory markers， liver pathomorphological features， and prognosis. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsAmong the 67 VBDS patients， female patients accounted for a higher proportion （80.60%）， and the patients aged 40 — 59 years accounted for 55.22%； there were 18 patients （26.87%） with D-VBDS and 49 patients （73.13%） with A-VBDS. Yellow urine （83.58%） was the most common clinical symptom in VBDS patients， followed by fatigue （64.18%）， poor appetite （64.18%）， jaundice of the sclera （62.69%）， abdominal distension （23.88%）， pruritus （23.88%）， nausea and vomiting （20.90%）， and fever （13.43%）. Compared with the D-VBDS group， the A-VBDS group had a significantly higher degree of plasma cell infiltration and a significantly lower degree of canalicular bile plugs （χ²=14.186， 6.568， both P<0.05）. Compared with the A-VBDS group， the D-VBDS group had significantly higher peak levels of alanine aminotransferase， total bilirubin， direct bilirubin， and indirect bilirubin （Z=-2.546， -2.957， -2.628， -2.772， all P<0.05）. Compared with the D-VBDS group， the patients in the A-VBDS group were more likely to develop liver cirrhosis （χ²=4.682， P=0.030）. ConclusionThe levels of alanine aminotransferase and bilirubin and liver pathomorphological features are objective indicators for differentiating D-VBDS from A-VBDS， and they are of great importance for clarifying diagnosis and determining the degree of liver injury. Patients with A-VBDS are more likely to develop liver cirrhosis.

Severe liver disease is frequently accompanied by prolonged prothrombin time or international normalized ratio， thrombocytopenia， and abnormal fibrinogen level， which have traditionally been interpreted as hypocoagulability and a bleeding tendency. Recent studies have shown that hemostatic abnormalities in liver disease do not simply result from deficiency of procoagulant factors， but represent a fragile rebalanced hemostatic state shaped by multiple mechanisms including parallel reductions in procoagulant factors and natural anticoagulants， platelet and fibrinolytic abnormalities， imbalance of the von Willebrand factor/a disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13 axis， and endothelial activation. This article reviews the key mechanisms of rebalanced hemostasis in severe liver disease， the limitations of conventional coagulation markers， coagulation features across different disease states， and their implications for clinical management. Clinical decision-making should shift from correcting abnormal laboratory values to identifying destabilization of the inflammation-endothelium-coagulation-fibrinolysis network， with individualized assessment based on disease stage and the risk of bleeding/thrombosis.

Objective:To evaluate the efficacy and safety of regional citrate anticoagulation (RCA) during plasma exchange (PE) in pediatric patients.Methods:We conducted a retrospective analysis of 12 critically ill children admitted to the Pediatric Intensive Care Unit (PICU) of Jinan Children's Hospital, who underwent 28 PE sessions with RCA between December 2023 and August 2024. Clinical records were reviewed to assess bleeding events, extracorporeal circuit performance, and changes in arterial blood gas parameters, serum total calcium (Ca tot), and activated clotting time before and after treatment. Results:No patients exhibited signs of increased bleeding. In one case, the procedure was discontinued prematurely due to elevated venous pressure. A significant decrease in ionized calcium (Ca ion) was observed 0.5 hours post-treatment. At the end of PE, pH, HCO 3?, base excess (BE), lactate, PaCO 2, Ca tot, and Na + levels increased, while K + and Ca ion levels decreased, with all changes being statistically significant. Four hours post-treatment, pH, HCO 3?, BE, PaCO 2, and Na + remained elevated, whereas Ca ion, lactate, and K + returned to baseline. By 12–15 hours post-treatment, all parameters—including pH, HCO 3?, BE, PaCO 2, Na +, K +, Ca ion, and lactate—had normalized, showing no significant differences from pre-treatment levels. Conclusions:RCA provides effective extracorporeal anticoagulation during pediatric PE without increasing bleeding risk. However, metabolic complications—primarily metabolic alkalosis—are common. These disturbances typically resolve spontaneously and do not lead to severe adverse events. While no ideal anticoagulant for PE has yet been established, RCA remains a safe and effective option, particularly for pediatric patients at higher risk of bleeding.

The aim of this research was to investigate the mechanism of chelidonine on H2 O2-in-duced inflammatory injury in porcine intestinal epithelial cells(IPEC-J2)through transcriptome sequencing.IPEC-J2 cells in the logarithmic growth phase were divided into the blank group(K group),H2O2 group(S group)and chelidonine group(L group),with three replicates in each group.Total RNA was isolated from each group for the purpose of constructing a sequencing li-brary.The assembled data underwent functional annotation,differential gene analysis,as well as GO and KEGG enrichment analyses.qPCR was used to confirm the expression of key differentially expressed genes(DEGs),and ELISA was utilized to assess the effect of chelidonine on the permea-bility of IPEC-J2 cells.The results indicated that the sequencing data met the necessary criteria and demonstrated a strong correlation between samples.The GO functional annotation results suggest that the intervention effects of chelidonine involve biological processes such as oxidative stress re-sponse and G2/M phase transition regulation of the mitotic cycle,and are closely associated with molecular functions,such as transmembrane transport activity.The KEGG enrichment analysis indicates that following H2 O2 treatment,DEGs in IPEC-J2 cells are predominantly enriched in the p53 signaling pathway,the coagulation cascade,the FoxO signaling pathway,and various other sig-naling pathways.Following pretreatment with chelidonine,the DEGs exhibit significant enrichment in several signaling pathways related to inflammation,including the TNF signaling pathway,syn-aptic vesicle cycle,and IL-17 signaling pathway.The results of qPCR were consistent with the se-quencing results.Chelidonine has also been found to effectively inhibit LDH release,elevate GLN content,and decrease DOA content.In conclusion,it can be seen that chelidonine can reduce cell permeability and alleviate H2 O2-induced inflammatory injury in IPEC-J2 cells by modulating in-flammation-related pathways such as the TNF signaling pathway.

Objective To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application.Methods and Results Recommendations were formulated based on literature review and expert group discussion,and consensus was reached following expert consultation.The consensus recommendations are comprehensive,covering the entire treatment procedures from preoperative assessment and preparation,surgical operation process,postoperative management and traditional Chinese medicine treatment to individualized treatment planning.The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain,reduced the use of opioid drugs,and significantly improved the quality of life and enhanced immune function of the patients.Postoperative follow-up suggested good treatment tolerance among the patients without serious complications.Conclusion The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy.The combined treatment has a high clinical value with a good safety profile for management of cancer pain.

Objective To explore the correlation between central venous oxygen saturation(ScvO2)-re-lated indexes at different time points and the occurrence of low cardiac output syndrome(LCOS)after con-genital heart disease(CHD)correction surgery.Methods A total of 73 children who underwent CHD correc-tion surgery in this hospital from July 1st,2021 to July 1st,2024 were selected as the research subjects.The clinical data,preoperative conditions,and postoperative conditions of the children were collected.The ScvO2 and arterial lactate(Lac)levels of the children at different time points(the 1st,6th,12th,and 24th hours after surgery)were monitored,and the ScvO2/Lac at different time points and the change rate of ScvO2 in different time periods were calculated.The correlation between ScvO2-related indexes and LCOS after CHD correction surgery was analyzed.Results ScvO2 at the 6th hour after surgery,ScvO2 at the 12th hour after surgery,Sc-vO2/Lac at the 12th hour after surgery,the change rate of ScvO2 from the 1st to the 24th hour after surgery,the change rate of ScvO2 from the 6th to the 12th hour after surgery,and the change rate of ScvO2 from the 12th to the 24th hour after surgery were independent influencing factors of LCOS occurrence after CHD cor-rection surgery(P＜0.05).There was a negative correlation between ScvO2 at the 12th hour after surgery,ScvO2/Lac and LCOS occurrence after CHD correction surgery(r=-0.543,-0.523,P＜0.05).The area under the curve(AUC)of ScvO2 at the 12th hour after surgery for predicting LCOS occurrence after CHD correction surgery was 0.938(95％CI:0.865-1.000);the AUC of ScvO2/Lac at the 12th hour after surgery for predicting LCOS occurrence after CHD correction surgery was 0.922(95％CI:0.851-0.994).Conclusion ScvO2 and ScvO2/Lac at the 12th hour after surgery have good predictive potential for LCOS occurrence af-ter CHD correction surgery.

OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Objective:To evaluate the efficacy of intraoperative sliding CT assisted deep brain stimulation of subthalaminal nucleus (STN-DBS) in short-term motor improvement and its influencing factors in patients with Parkinson's disease (PD) under general anesthesia.Methods:The cohort consisted of 48 PD patients accepted STN-DBS in Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University from June 2021 to June 2023, including 21 patients accepted STN-DBS under general anesthesia and 27 patients accepted STN-DBS under local anesthesia. STN-DBS was performed in the CT operating room and intraoperative CT was used to confirm the electrode position. Regular program-controlled follow-up for over one year in Out-patient Clinic was applied after discharge. Operation time, complications, stimulus-related adverse events, unified Parkinson's disease rating scale (UPDRS)-Ⅲ score and UPDRS-Ⅲ improvement rate at medicine-off (Med-off) stage/DBS-on stage 1 year after operation, and UPDRS-Ⅲ score and UPDRS-Ⅲ improvement rate at medicine-on (Med-on) stage/DBS-on stage 1 year after operation, and levodopa equivalent daily dose (LEDD) and LEDD reduction were compared between the two groups. Spearman rank correlation analysis or Pearson correlation analysis were used to investigate the correlation between short-term motor improvement ([UPDRS-Ⅲ score at Med-off stage before operation-UPDRS-Ⅲ score at Med-off stage/DBS-on stage 1 year after operation]/UPDRS-Ⅲ score at Med-off stage before operation×100%) and clinical data in PD after STN-DBS under general anesthesia.Results:The operation time of general anesthesia group was (1.9±0.5) h, and that of local anesthesia group was (2.6±0.8) h, with significant difference ( P<0.05). During the 1-year follow-up, no significant difference in incidence of adverse reactions, UPDRS-Ⅲ score improvement rate at Med-on and Med-off stages, LEDD and LEDD reduction was noted between the two groups ( P>0.05). In the general anesthesia group, the short-term motor improvement after STN-DBS was negatively correlated with age or gender ( P>0.05), but positively correlated with maximum improvement rate of preoperative UPDRS-Ⅲ score ( r=0.840, P<0.001). Conclusion:For patients who cannot tolerate local anesthesia, DBS under general anesthesia is also safe and effective.

Objective:To investigate the characteristics of β and γ oscillations in Parkinson's disease (PD) patients with levodopa-induced dyskinesia (LID).Methods:Seventeen patients with advanced idiopathic PD received subthalamic nucleus deep brain stimulation (STN-DBS) from August 2019 to June 2021 at Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University were enrolled; 11 patients were without LID before surgery (PD group) and 6 patients were with LID before surgery (LID group). Preoperative electrophysiological data of the STN, including Area under power spectral density (PSD-AUC), burst amplitude and duration of β and γ oscillations, were compared between the two groups.Results:PSD-AUC of β oscillation at 25-35 Hz in the PD group (60.39±1.00) was significantly increased compared with that in the LID group (54.33±0.55), whereas the PSD-AUC of γ oscillation at 65-85 Hz in the LID group (97.31±1.84) was significantly increased compared with that in the PD group (41.52±7.42, P<0.05). The aburst mplitude and duration of β oscillation in the PD group were significantly increased compared with those in the LID group ([8.52±1.00] au] vs. [1.09±0.13] au, [13 344±2 069] ms vs. [1 442±128] ms, P<0.05), while the burst amplitude and duration of γ oscillation in the LID group were significantly higher than those in the PD group ([5.03±0.55] au vs. [0.14±0.01] au, [12 276±5 011] ms vs. [1 741±233] ms, P<0.05). Conclusion:The imbalance of β-γ oscillations in the STN is associated with LID pathophysiology.

In China, most patients with hepatocellular carcinoma (HCC) have progressed to the middle and advanced stages when they are diagnosed, so early-stage diagnosis is a significant key to improving the prognosis. Tumor diameter significantly correlates with the prognosis of patients with small hepatocellular carcinoma (sHCC), which is further classified as early-stage HCC (eHCC) and advanced HCC (pHCC). The "fast in and fast out" enhancement pattern is a typical feature of liver cancer imaging (CECT/CEMRI/CEUS); yet, eHCC with a diameter of <2 cm frequently exhibits hypovascularity. Hepatocyte-specific enhanced MRI (EOB-MRI) displays a unique hepatobiliary-specific phase (HBP) hypointensity, along with atypical manifestations such as lipid-containing nodules, T2 hyperintensity, and restricted diffusion. HBP is a functional radiographic imaging feature for cancerous nodules in cirrhosis. EOB-MRI can significantly increase the hypovascularity detection rate of eHCC in conjunction with serologic markers like alpha-fetoprotein. With a focus on the dynamic changes in hypovascular hypointense nodules in HBP (including diameter size, APHE, DWI, and other parameters), it is recommended that high-risk cirrhotic cohorts undergo routine monitoring (EOB-MRI follow-up every three months) to diagnose early-stage eHCC, based on the existing evidence-based medicine. This recommendation in clinical practice guidelines provides a crucial strategy that can markedly enhance patients' five-year survival rates.