Hepatic encephalopathy and malnutrition due to hyperammonemia often interact with each other, forming a vicious circle in patients with cirrhosis. In addition, hepatic encephalopathy and malnutrition have a high incidence in patients with cirrhosis, which seriously affects the quality of life and prognosis. Therefore, identifying whether malnutrition is present in patients with cirrhosis combined with hepatic encephalopathy is crucial for providing appropriate interventions.This article reviews the pathogenesis, nutritional assessment methods, and nutritional management of malnutrition in patients with liver cirrhosis combined with hepatic encephalopathy.

Objective:To investigate the protective effect of Dendrobium officinale polysaccharides(DOP)on intestinal mucosal barrier damage,and to elucidate the possible mechanism.Methods:Ten female C57BL/6 mice,aged 5 months,were selected as young group;twenty femal C57BL/6 mice,aged 15 months,were randomly divided into aged group and DOP treatment group(200 mg·kg-1,DOP group),with 10 mice in each group.The mice in DOP group were administrated with DOP by gavage.The body mass,food intakes and hanging time of the mice in various groups were detected.HE staining was used to observe the pathomorphology of intestinal and spleen tissues of the mice in various groups.Immunohistochemical staining was used to detect the expressions of intestinal atresin 1(ZO-1)and Mucin 2(MUC2)in intestinal tissue of the mice in various groups.The intestinal baterial metabolite medium(IBMM)were prepared to intervene the Caenorhabditis elegans(C.elegans),and the C.elegans were randomly divided into Young-IBMM group,Aged-IBMM group,and DOP-IBMM group.Immuno-fluorescence method was used to analyze the intestinal lipofuscin accumulation levels on the 1st day and the 12th day of the C.elegans in various groups.Brilliant blue staining was used to assess the intestinal leakage on the 1st day and the 12th day of C.elegans in various groups.The Caco-2 cells were randomly divided into Young-IBMM,Aged-IBMM and DOP-IBMM groups,and Western blotting method was used to detect the expression levels of ZO-1,Occludin,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),phosphorylated myosin light chain(p-MLC),myosin light chain kinase(MLCK)proteins in the Caco-2 cells in various groups.Results:Compared with young group,the body mass of the mice in aged group was increased(P＜0.05),the amount of food intake was decreased(P＜0.05),and the hanging time was decreased(P＜0.05);compared with aged group,the body mass of the mice in DOP group was significantly decreased(P＜0.01),the amount of food intake was increased(P＜0.05),and the hanging time was significantly extended(P＜0.01).The HE staining results showed that compared with young group,the thickness of intestinal mucosa of the mice in aged group became thinner,the goblet cells were reduced,the intestinal villi were disordered with different lengths,a large amount of hemosiderin was found on the surface of the spleen,the cell components in the red medullary were reduced,and the lymphatic sheath and lymphatic nodes around the intra-white pulp artery remained or almost disappeared;compared with aged group,the thickness of the intestinal mucosa of the mice in DOP group was increased,the goblet cells were increased,the length of the intestinal villi was consistent and neatly arranged,the overall function of the red pulp of the spleen was improved,and the components of the white pulp were increased.The immunohistochemical staining results showed that compared with young group,the expression levels of ZO-1 and MUC2 proteins in intestinal tissue of the mice in aged group were significantly decreased(P＜0.05 or P＜0.001);compared with aged group,the expression levels of ZO-1 and MUC2 proteins in the intestinal tissue of the mice in DOP group were significantly increased(P＜0.05 or P＜0.001).The immuno-fluorescence analysis showed that compared with Young-IBMM group,the intestinal lipofuscin accumulation level of C.elegans in Aged-IBMM group was significantly increased(P＜0.001);compared with Aged-IBMM group,the intestinal lipofuscin accumulation level of C.elegans in DOP-IBMM group was significantly reduced(P＜0.001).The brilliant blue staining showed that compared with Young-IBMM group,the bright blue dye leaked into the whole body of C.elegans from intestinal tissue in Aged-IBMM group,and the intestinal structure became blurred and was difficulted to be observed;compared with Aged-IBMM group,the leakage of bright blue dye of C.elegans in DOP-IBMM was reduced.The Western blotting results showed that compared with Young-IBMM group,the expression levels of TNF-α,IL-6,p-MLC,and MLCK proteins in the Caco-2 cells in Aged-IBMM group were significantly increased(P＜0.01 or P＜0.001),and the expression levels of ZO-1 and Occludin proteins were significantly decreased(P＜0.05 or P＜0.01);compared with Aged-IBMM,the expression levels of TNF-α,IL-6,p-MLC and MLCK proteins in the Caco-2 cells in DOP-IBMM group were significantly decreased(P＜0.01),and the expression levels of ZO-1 and Occludin proteins were significantly increased(P＜0.05 or P＜0.01).Conclusion:DOP has an ameliorating effect on intestinal mucosal barrier damage in the aged mice,and its mechanism may be related to the improvement of intestinal barrier damage by regulating intestinal bacterial metabolites,inhibiting the p-MLC/MLCK signal pathway,restoring the expression of tight junction complexes,and reducing the level of intestinal inflammation.

Objective To screen key differentially expressed genes in head and neck squamous cell carcinoma(HNSCC)and analyze their prognostic value,based on biological information from gene expression omnibus(GEO)and the cancer genome atlas(TCGA)databases.Methods HNSCC mRNA expression data(GSE74530)were downloaded from the GEO database as a test dataset,and differentially expressed genes(DEGs)were identified.The biological function of DEGs in HNSCC was investigated by gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis.HNSCC mRNA expression data were obtained from the TCGA database as a validation dataset to preliminarily verify the expression of DEGs in HNSCC tissues and normal tissues.Seven up-regulated DEGs variants were analyzed using the cBioPortal database,and their effects on the survival of HNSCC patients were evaluated by the Kaplan-meier method and COX regression analysis.The co-expressed genes of ATP6V1C1 were analyzed by the cBioPortal database.Results A total of 1 432 differential genes were screened from HNSCC tissue and paracancerous tissue in the GSE74530 test dataset,among which 7 of the 10 most significant genes were up-regulated,respectively:MMP1,WDR66,PTPRZ1,TEAD4,RBM38,ATP6V1C1 and CBLB were downregulated by CGNL1,LOC100506990 and ADH1B.GO and KEGG enrichment analysis showed that HNSCC tissue differential genes were mainly enriched in lymphocyte migration and extracellular matrix regulation pathways.The TCGA dataset confirmed that 7 upregulated DEGs were highly expressed in HNSCC.cBioPortal analysis showed that the proportion of ATP6V1C1 gene changes was the highest among the 7 up-regulated genes,and the overall survival rate of patients with high expression of ATP6V1C1 gene decreased significantly.Correlation analysis showed that BIRC5 was the most closely related gene to ATP6V1C1.Conclusion MMP1,WDR66,PTPRZ1,TEAD4,RBM38,ATP6V1C1 and CBLB were highly expressed in HNSCC patients,among which ATP6V1C1 was the most significant,and its expression level was associated with poor prognosis in HNSCC patients.ATP6V1C1 is expected to be a biomarker for early diagnosis and prognosis of HNSCC,providing a new idea for clinical diagnosis and treatment.

Objective To screen key differentially expressed genes in head and neck squamous cell carcinoma(HNSCC)and analyze their prognostic value,based on biological information from gene expression omnibus(GEO)and the cancer genome atlas(TCGA)databases.Methods HNSCC mRNA expression data(GSE74530)were downloaded from the GEO database as a test dataset,and differentially expressed genes(DEGs)were identified.The biological function of DEGs in HNSCC was investigated by gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis.HNSCC mRNA expression data were obtained from the TCGA database as a validation dataset to preliminarily verify the expression of DEGs in HNSCC tissues and normal tissues.Seven up-regulated DEGs variants were analyzed using the cBioPortal database,and their effects on the survival of HNSCC patients were evaluated by the Kaplan-meier method and COX regression analysis.The co-expressed genes of ATP6V1C1 were analyzed by the cBioPortal database.Results A total of 1 432 differential genes were screened from HNSCC tissue and paracancerous tissue in the GSE74530 test dataset,among which 7 of the 10 most significant genes were up-regulated,respectively:MMP1,WDR66,PTPRZ1,TEAD4,RBM38,ATP6V1C1 and CBLB were downregulated by CGNL1,LOC100506990 and ADH1B.GO and KEGG enrichment analysis showed that HNSCC tissue differential genes were mainly enriched in lymphocyte migration and extracellular matrix regulation pathways.The TCGA dataset confirmed that 7 upregulated DEGs were highly expressed in HNSCC.cBioPortal analysis showed that the proportion of ATP6V1C1 gene changes was the highest among the 7 up-regulated genes,and the overall survival rate of patients with high expression of ATP6V1C1 gene decreased significantly.Correlation analysis showed that BIRC5 was the most closely related gene to ATP6V1C1.Conclusion MMP1,WDR66,PTPRZ1,TEAD4,RBM38,ATP6V1C1 and CBLB were highly expressed in HNSCC patients,among which ATP6V1C1 was the most significant,and its expression level was associated with poor prognosis in HNSCC patients.ATP6V1C1 is expected to be a biomarker for early diagnosis and prognosis of HNSCC,providing a new idea for clinical diagnosis and treatment.

Hepatic encephalopathy and malnutrition due to hyperammonemia often interact with each other, forming a vicious circle in patients with cirrhosis. In addition, hepatic encephalopathy and malnutrition have a high incidence in patients with cirrhosis, which seriously affects the quality of life and prognosis. Therefore, identifying whether malnutrition is present in patients with cirrhosis combined with hepatic encephalopathy is crucial for providing appropriate interventions.This article reviews the pathogenesis, nutritional assessment methods, and nutritional management of malnutrition in patients with liver cirrhosis combined with hepatic encephalopathy.

Primary adrenal small cell neuroendocrine carcinoma is clinically rare. This article reported a patient, who was diagnosed as primary adrenal small cell neuroendocrine carcinoma complicated with renal vein cancer thrombus, and underwent laparoscopic left adrenal + left kidney + left renal vein tumor embolectomy.The carcinoma relapsed after 19 months of follow-up after surgery. The patient and his family refused further treatment.

Background/Aims: Lyon consensus differentiates acid exposure time (AET) as physiological, borderline, and pathological. Mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPWi) are believed to increase diagnostic yield of gastroesophageal reflux disease (GERD) and correlate with symptom outcome of proton pump inhibitor (PPI) treatment. We aim to explore the clinical characteristics and the correlation of pH-impedance parameters with PPI response in Chinese patients with different AET levels. Methods: We retrospectively investigated 177 patients with typical reflux symptoms who received esophageal function tests. The demographics, GERD questionnaire scores, the proportion of esophagitis and PPI responders, and manometric and pH-impedance parameters were compared among patients with AET < 4%, 4-6%, and > 6%. In patients with AET ≥ 4%, manometric and pH-impedance parameters were compared between PPI responders and non-responders. Results: Among 177 patients, 69 (39.0%) had AET 4-6%, and 53 (29.9%) had AET > 6%. The demographics, esophagogastric junction type, and occurrence of ineffective esophageal motility were similar between patients with AET 4-6% and > 6%, but different from AET < 4%. MNBI and PSPWi were different among different AET levels, but similar between PPI responders and non-responders in patientswith AET ≥ 4%. Conclusions It is reasonable to set 4% as a threshold to define pathological AET in Chinese patients. MNBI and PSPWi could identify GERD patients, but may not correlate with PPI response of Chinese GERD patients.

Objective To investigate the application of pedicled tunica vaginalis flap cover new urethra in redo and second-stage hypospadias repair.Methods Retrospective analysis was performed in 45 redo hypospadias repair cases,aged from 1 year 3 months to 9 years 4 months (median 5 years 3month).All patients were divided into urethral dehiscence after hypospadias repair (group A) and the second stage surgery of two-stage hypospadias repair (group B) based on medical history.According to the site of dehiscence,the group A were further divided into midshaft urethral dehiscence (A1) and glans and distal urethral dehiscence with urethral opening located on midshaft (A2).After new urethra was completed,the appropriate size of the pedicledtunica vaginalis flap was transferred to cover the new urethra.Results There was no scrotal hematoma occurred in all 45 cases,and somecomplications occurred,including scrotal swelling in 1 case,high-riding testicle in 2 cases,penile clockwise torsion in 1 case,urethrocutaneous fistula in 6 cases.All the 45 cases were followed up for 1 to 4 years,with mean of 1.8 years.One more urethrocutaneous fistula occurred in group A2 and 1 more urethrocutaneous fistula with urethral stricture occurred in group B.There was no penile curvature and urethral diverticulum occurred in all cases.Conclusions Pedicled tunica vaginalis flap could be used as waterproofing layer to cover new urethra in redo hypospadias repair and presented a low incidence rate of postoperative complications.