Objective To explore the risk factors for recurrence of intracranial ruptured cystic an-eurysm(ISA)in elderly patients after endovascular coil embolization and provide corresponding management strategies.Methods A retrospective analysis was conducted on 204 ISA patients 60 years old)receiving endovascular coiling in Bijie Branch of Zhejiang Provincial People's Hospi-tal from January 2017 to December 2023.According to the presence of aneurysm recurrence or not,they were divided into a recurrence group(32 cases)and a non-recurrence group(172 cases).The recurrent aneurysms included 10 cases of type Ⅰ,7 cases of type Ⅱ,13 cases of type Ⅲ,and 2 cases of type Ⅳ.Multivariate logistic regression analysis was used to identify the risk factors for arterial aneurysm recurrence,and ROC curve analysis was used to determine the predictive per-formance of our model.Results There was significant difference in the occlusion classes of Modi-fied Raymond-Roy Classification(MRRC)immediately after surgery between the recurrence group and the non-recurrence group(P=0.007).The recurrence group had obviously larger pro-portions of recurrent aneurysms with a maximum diameter of ≥10 mm,immediate MRRC occlu-sion classes Ⅱ～Ⅲb,and volume embolization ratio(VER)＜20％,and lower ratios of immediate MRRC occlusion class Ⅰ and using stent assisted techniques when compared with the non-recur-rent group(P＜0.05,P＜0.01).Multivariate logistic regression analysis indicated that maximum diameter of aneurysm ≥10 mm,postoperative MRRC occlusion class Ⅲb,and VER＜20％were independent risk factors for ISA recurrence(P＜0.05,P＜0.01).The patients with types Ⅲ andⅣ recurrent aneurysms had increased ratios of maximum diameter of aneurysm ≥10 mm and VER＜20％than those with types Ⅰ and Ⅱ(P＜0.05).The patients with recurrent type Ⅲ andⅣ aneurysms received endovascular treatment after recurrence.Conclusion Larger diameter of aneurysm,MRRC grade Ⅲb immediately after surgery,and lower VER are independent risk fac-tors for ISA recurrence in elderly patients undergoing coil embolization.In addition,it is recom-mended that the patients with recurrent type Ⅲ or Ⅳ aneurysms should undergo immediate re-treatment.

Background The job content of aircraft maintenance workers is complex, with high intensity and high requirements, and they are prone to work-related musculoskeletal disorders (WMSDs), but related research is relatively rare. Objective To investigate the positive rate of WMSDs among aircraft maintenance workers, evaluate ergonomic load, and analyze the risk factors of WMSDs. Methods We used a self-compiled questionnaire for WMSDs and the Quick Exposure Checklist (QEC) to investigate the basic situation, positive rate of WMSDs, and the ergonomic load of 2271 male maintenance workers in 6 departments of an aircraft maintenance company, including airline maintenance, overall overhaul, accessory/landing gear overhaul, engine overhaul, product customization, and power assist. We used a logistic regression model to analyze the risk factors of WMSDs in the neck, shoulder, hand/wrist, and lower back. Results The positive rate of WMSDs in the past 12 months was 70.4% (1598/2271) and the positive rate of WMSDs in different body parts ranged from 6.6% to 49.5%, with the top three parts of lower back, neck, and knee, respectively. There were statistically significant differences in the positive rate among different departments (P<0.05). The average QEC scores for neck, hand/wrist, and back (static) were moderate, while those for shoulder and back (dynamic) were high, and the body part specific positive rate of WMSDs increased with the increase of ergonomic load level. Working years (5-<10 years, ≥20 years), working with back flexed or twisted or side bent (moderately, excessively), high maximum force level exerted by one hand, and feeling difficult (sometimes, often) and stressful (moderately, very) while working were associated with higher risks of lower back pain (OR=1.486, 1.505; 2.151, 3.769; 1.637; 2.110, 2.407; 1.637, 1.794; P<0.05). Working years (15-<20 years, ≥20 years), working with head/neck bent or twisted (occasionally, continuously), feeling difficult (sometimes) and stressful (very) while working were associated with higher risks of neck pain (OR=1.731, 1.586; 3.732, 8.341; 1.633; 1.696; P<0.05). Working years (15-<20 years, ≥20 years), working with hands in a high position (at shoulder or above), very frequent shoulder/arm movements, feeling difficult (sometimes, often) and stressful (moderately, very) while working were associated with higher risks of shoulder pain (OR=1.587, 1.709; 1.299; 1.521; 1.643, 2.239; 1.659, 1.977; P<0.05). Working with wrist at deviated or bent angle, high repetition of similar movements, feeling difficult (sometimes, often) and stressful (moderately, very) while working were associated with higher risks of hand/wrist pain (OR=1.692; 1.670; 1.827, 2.884; 2.190, 2.625; P <0.05) . Physical exercise after work (≥3 times·week⁻¹) was associated with a lower risk of neck pain (OR=0.582, P<0.05). Shift workers were at a lower risk of shoulder pain and hand/wrist pain (OR=0.737 and 0.554, P<0.05). Conclusion The high positive rate of WMSDs symptoms among aircraft maintenance workers is related to individual, occupational ergonomic, and psychological factors, and active prevention and intervention should be taken.

Objective To explore the risk factors for recurrence of intracranial ruptured cystic an-eurysm(ISA)in elderly patients after endovascular coil embolization and provide corresponding management strategies.Methods A retrospective analysis was conducted on 204 ISA patients 60 years old)receiving endovascular coiling in Bijie Branch of Zhejiang Provincial People's Hospi-tal from January 2017 to December 2023.According to the presence of aneurysm recurrence or not,they were divided into a recurrence group(32 cases)and a non-recurrence group(172 cases).The recurrent aneurysms included 10 cases of type Ⅰ,7 cases of type Ⅱ,13 cases of type Ⅲ,and 2 cases of type Ⅳ.Multivariate logistic regression analysis was used to identify the risk factors for arterial aneurysm recurrence,and ROC curve analysis was used to determine the predictive per-formance of our model.Results There was significant difference in the occlusion classes of Modi-fied Raymond-Roy Classification(MRRC)immediately after surgery between the recurrence group and the non-recurrence group(P=0.007).The recurrence group had obviously larger pro-portions of recurrent aneurysms with a maximum diameter of ≥10 mm,immediate MRRC occlu-sion classes Ⅱ～Ⅲb,and volume embolization ratio(VER)＜20％,and lower ratios of immediate MRRC occlusion class Ⅰ and using stent assisted techniques when compared with the non-recur-rent group(P＜0.05,P＜0.01).Multivariate logistic regression analysis indicated that maximum diameter of aneurysm ≥10 mm,postoperative MRRC occlusion class Ⅲb,and VER＜20％were independent risk factors for ISA recurrence(P＜0.05,P＜0.01).The patients with types Ⅲ andⅣ recurrent aneurysms had increased ratios of maximum diameter of aneurysm ≥10 mm and VER＜20％than those with types Ⅰ and Ⅱ(P＜0.05).The patients with recurrent type Ⅲ andⅣ aneurysms received endovascular treatment after recurrence.Conclusion Larger diameter of aneurysm,MRRC grade Ⅲb immediately after surgery,and lower VER are independent risk fac-tors for ISA recurrence in elderly patients undergoing coil embolization.In addition,it is recom-mended that the patients with recurrent type Ⅲ or Ⅳ aneurysms should undergo immediate re-treatment.

ObjectiveTo identify the chemical components of Houpo Wenzhongtang in vivo and in vitro and to analyze the pharmacokinetic properties of the index components in rats with deficiency-cold of spleen and stomach. MethodThe chemical components of Houpo Wenzhongtang was analyzed and identified by ultra performance liquid chromatography-quadrupole-time-of-flight tandem mass spectrometry（UPLC-Q-TOF-MS/MS）. Six rats were randomly selected from 18 SD rats as the blank group， and the remaining rats were given lard and cold vinegar for a long time to construct a rat model with deficiency-cold of spleen and stomach. After successful modeling， the rats were randomly divided into the model group and Houpu Wenzhongtang group（13.5 g·kg^-1， calculated as crude drug）. The administration group was given the corresponding dose of Houpu Wenzhongtang by gavage， and the blank group and the model group were given the same amount of distilled water by gavage. Enzyme-linked immunosorbent assay（ELISA） were used to measure gastrin（GAS） and motilin（MTL） levels in each group. At the same time， plasma samples were collected at different time points after administration， and blood-entry prototype components and metabolites of Houpo Wenzhongtang were analyzed by UPLC-Q-TOF-MS/MS. On this basis， plasma concentrations of magnolol， honokiol， alpinetin and hesperidin in Houpo Wenzhongtang were determined by ultra performance liquid chromatography coupled with triple quadrupole/linear ion trap mass spectrometry（UPLC-QTRAP-MS/MS）， and the pharmacokinetic parameters were calculated using DAS 2.0 software. ResultA total of 79 chemical components， including 44 flavonoids and 11 lignans， were identified in Houpo Wenzhongtang. Meanwhile， 18 blood-entry prototype components and 27 metabolites were identified， the main metabolic pathways of metabolites were glucuronidation， sulfation， oxidation and hydrolysis， and phase Ⅰ and phase Ⅱ were the two primary forms of metabolism. Pharmacokinetic results showed that among the four index components， the time to peak（t_max） values of magnolol and honokiol were consistent and exhibited similar drug metabolism characteristics， the t_max of alpinetin was the shortest， and the absorption rate was the fastest， which had the earliest peak plasma concentration levels， and hesperidin had the shortest mean residence time（MRT_0-t） and the highest metabolic rate in rats. ConclusionThis study clarifies the blood-entry prototype components and their metabolites of Houpo Wenzhongtang in the rat model of deficiency-cold of spleen and stomach， and reveals the pharmacokinetic characteristics of the main active ingredients， which can provide a scientific basis for the study of pharmacodynamic material basis of this formula and its clinical application in treating the syndrome of deficiency-cold of spleen and stomach.

This report described one patient of giant polycystic liver and polycystic kidney involving iliac fossa. Preoperative computed tomography (CT) revealed a large polycystic kidney occupying partially iliac fossa space. A decompression of lower pole of original kidney was planned for placing transplanted kidney. During total liver resection plus orthotopic liver transplantation, right polycystic kidney could move up on its own and iliac fossa space was released for placing transplanted kidney smoothly. Polycystic kidney shrunk markedly post-operation. It provided references for surgical planning of combined liver-kidney transplantation for this type of disease.

Background/Aims: The shortage of donor liver hinders the development of liver transplantation. This study aimed to clarify the poor outcomes of functionally marginal liver grafts (FMLs) and provide evidence for the improvement of ischemia-free liver transplantation (IFLT) after FML transplantation. Methods: Propensity score matching was used to control for confounding factors. The outcomes of the control group and FML group were compared to demonstrate the negative impact of FMLs on liver transplantation patients. We compared the clinical improvements of the different surgical types. To elucidate the underlying mechanism, we conducted bioinformatic analysis based on transcriptome and single-cell profiles. Results: FMLs had a significantly greater hazard ratio (HR: 1.969, P=0.018) than did other marginal livers. A worse 90-day survival (Mortality: 12.3% vs. 5.0%, P=0.007) was observed in patients who underwent FML transplantation. Patients who received FMLs had a significant improvement in overall survival after IFLT (Mortality: 10.4% vs 31.3%, P=0.006). Pyroptosis and inflammation were inhibited in patients who underwent IFLT. The infiltration of natural killer cells was lower in liver grafts from these patients. Bulk transcriptome profiles revealed a positive relationship between IL-32 and Caspase 1 (R=0.73, P=0.01) and between IL-32 and Gasdermin D (R=0.84, P=0.0012). Conclusions FML is a more important negative prognostic parameter than other marginal liver parameters. IFLT might ameliorate liver injury in FMLs by inhibiting the infiltration of NK cells, consequently leading to the abortion of IL-32, which drives pyroptosis in monocytes and macrophages.

Objective:To investigate the predictive value of heparin binding protein(HBP) combined with pediatric sequential organ failure assessment(pSOFA) in children with sepsis.Methods:Children with sepsis admitted to PICU of Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University) from January 2021 to June 2022 were selected as study group,while those who underwent elective surgery for inguinal hernia and assessment of precocious puberty and short stature during the same period were selected as control group.All children with sepsis were divided into sepsis group and septic shock group according to their severity as well as survival group and death group according to prognosis.The study group was monitored for HBP on the 1st,3rd,and 7th day of admission,while the control group was monitored for HBP on the 1st day of admission.Patients in the sepsis group received pSOFA scores immediately after admission.The laboratory results and HBP concentrations were compared between groups，and a joint model was established in combination with pSOFA to observe its predictive performance in sepsis prognosis.Results:A total of 50 children with sepsis were included in study group，including 45 children with sepsis and five children with septic shock.There were 27 males and 23 females，aged 1 month～13 years（median age two years）.There were 7 deaths in this study，including two patients with sepsis and five patients with septic shock.The HBP concentration in the study group was significantly higher than that in the control group on the 1st day，and the HBP concentration in the group gradually decreased with the prolongation of hospital stay.The concentration of HBP on the first day of septic shock group was higher than that of sepsis group，and the difference was statistically significant（ P<0.001）.The concentration of HBP on the 1st day in the sepsis death group was significantly higher than that in the sepsis survival group（ P=0.023）.The receivor operator characteristic curve analysis showed that HBP and pSOFA had good predictive value for the death of children with sepsis，and the joint model of HBP and pSOFA（75.1×pSOFA-0.1×HBP）had the best predictive performance for the death of children with sepsis，but there was no significant difference with the pSOFA. Conclusion:The HBP level significantly increases in children with sepsis，and gradually decreases with the length of hospital stay，and HBP has great value in predicting the outcome of death in children with sepsis，and the combination of pSOFA could improve its predictive ability of death,but not better than pSOFA.

Objective:To investigate the cytopathic effect of amino acids 86-175 of rotavirus non-structural protein 4 (NSP4 86-175) on rat cardiomyocytes and the possible mechanism. Methods:Rat H9C2 cardiomyocytes were treated with NSP4 86-175 protein. Changes in the growth and morphology of the cells were observed. The activity of LDH in the cell culture medium was detected. Fluo-3AM was used to label intracellular free calcium ions and the concentrations of calcium ions in rat cardiomyocytes with and without NSP4 86-175 treatment were detected by confocal laser microscopy. The expression of Bax, Bcl-2, caspase-3, 78 kDa glucose-regulated protein (GRP78), C/EBP homologous protein (CHOP) and caspase-12 at mRNA level was detected by real-time PCR. The expression of caspase-3, caspase-8, caspase-9, GRP78, CHOP and caspase-12 at protein level was detected by Western blot. Results:Normal cardiomyocytes showed a typical myoblast-like morphology, presenting as spindle-shaped cells with clear boundaries. Obvious cytopathic effect, vacuolar degeneration, shriveled and rounded cells, and cell fragmentation were observed after the treatment with purified NSP4 86-175 protein. The activity of LDH in cell culture medium was enhanced by NSP4 86-175 protein. NSP4 86-175 protein also enhanced the fluorescence of the calcium ions in rat cardiomyocytes, promoted cell apoptosis, up-regulated the expression of apoptotic factors including caspase-3, caspase-8, caspase-9 and Bax-2, and increased the expression of classical markers of endoplasmic reticulum stress such as GRP78, CHOP and caspase-12. Conclusions:NSP4 86-175 had a cytopathic effect on rat cardiomyocytes, which might be related to the induced intracellular calcium overload, endoplasmic reticulum stress, apoptosis and necrosis. These results might be used as theoretical reference for further study on rotavirus infection and myocardial injury.

Objective:To explore the long-term preservation value and repair effect of normothermic machine perfusion (NMP) on clinically discarded kidneys.Methods:A case of clinical discarded donor kidney was collected, and NMP was carried out in vitro for 9 hours with recovered blood. The dynamic changes of renal appearance, blood gas and biochemistry analysis of perfusate and renal pathology were recorded. Results:In the second to fifth hour of NMP, the appearance of renal was pink and ex vivo normothermic perfusion assessment score (EVNP) was grade Ⅰ. While, the sixth hour and beyond of NMP, the appearance of kidney turned to dark red and EVNP was grade Ⅲ. The renal perfusion blood flow maintained above 150 ml/min in the first 6 hours and decreased significantly after that, and at the end, was only 50 ml/min. During the whole process of perfusion, urine output was maintained at about 100 ml/h. PO 2 remained above 100 mmHg in the first 5 hours of perfusion and from the 6th hour, was lower than 80 mmHg and continued to decline, and was close to 0 at the end of perfusion. The results showed that although the K + concentration changes in blood and urine in the first 5 hours of NMP had a good consistency, the lactic acid level had been rising. In addition, there was no significant change in the histopathology at the fourth hour of perfusion compared with that before zero-point puncture, and the fibrinous thrombus in glomeruli was improved compared with that before perfusion. However, at the sixth hour after perfusion and before the end of perfusion, the pathological changes of renal tissue were significantly worse. There were a large of thrombosis in glomerular blood vessels, renal tubular atrophy and acute tubular necrosis. Conclusions:NMP can realize the evaluation of extended criteria donors before transplantation, and it proves the feasibility and repair potential of NMP in kidney to a certain extent. At the same time, NMP also provides a new way to expand the source of donor kidney and to pre-treat organ in vitro.