Objective:To study the clinicopathological features of Sjogren′s syndrome (SS) with liver injury and to improve the understanding of this disease.Methods:Forty-nine patients with SS complicated with liver injury were collected from Beijing Ditan Hospital, Capital Medical University from October 2008 to January 2022. All patients underwent ultrasound-guided liver biopsy, and all specimens were stained with HE. The histopathologic characteristics were observed and the pathologic indexes were graded. Immunohistochemical stains for CK7, CK19, CD38, MUM1 and CD10 were performed by EnVision method; and special histochemical stains for reticulin, Masson′s trichrome, Rhodanine, Prussian blue, periodic acid Schiff (PAS) and D-PAS stains were conducted .Results:The age of patients ranged from 31 to 66 years, including 3 males and 46 females. SS combined with drug-induced liver injury was the most common (22 cases, 44.9%), followed by autoimmune liver disease (13 cases, 26.5%, including primary biliary cholangitis in eight cases, autoimmune hepatitis in 3 cases, and PBC-AIH overlap syndrome in 2 cases), non-alcoholic fatty liver disease (NAFLD, 9 cases, 18.4%) and other lesions (5 cases, 10.2%; including 3 cases of nonspecific liver inflammation, 1 case of liver amyloidosis, and 1 case of porto-sinusoidal vascular disease). Among them, 28 cases (57.1%) were associated with obvious interlobular bile duct injury, mainly in SS combined with PBC group and drug-induced liver injury group. Twenty-three cases (46.9%) were associated with hepatocyte steatosis of varying degrees. In SS with autoimmune liver disease group, ISHAK score, degree of fibrosis bile duct injury, bile duct remodeling, lymphocyte infiltration of portal area, and plasma cell infiltration, MUM1 and CD38 expression; serum ALP and GGT, IgM; elevated globulin; positive AMA, proportion of AMA-M2 positive and IgM positive were all significantly higher than those in other groups(all P<0.05). Serum ALT, direct bilirubin and SSA positive ratio in SS combined with drug liver group were significantly higher than those in other groups(all P<0.05). The serum total cholesterol level in SS combined with PBC group ( P=0.006) and NALFD group ( P=0.011) were significantly higher than those in other groups ( P<0.05). Conclusions:The pathologic manifestations of SS patients with liver injury are varied. The inflammatory lesions of SS patients with autoimmune liver disease are the most serious, and the inflammatory lesions of SS patients with non-alcoholic fatty liver disease and non-specific inflammation are mild. Comprehensive analysis of liver histopathologic changes and laboratory findings is helpful for the diagnosis of SS complicated with different types of liver injury.

Objective:To evaluate the efficacy of calaglitzin combined with Degu insulin Liraglutide and pioglitazone metformin in the treatment of obese type 2 diabetes mellitus (T2DM) .Methods:Ninety-nine obese T2DM patients admitted to our hospital from Apr. 2021 to Jun. 2023 were divided into 2 groups according to different treatment methods. The control group ( n=52) were treated with Delgu insulin liraglutide and pioglitazone metformin; the observation group ( n=47) were treated with cagaglizin on the basis of the control group, and both groups were treated for 8 weeks. The therapeutic effect of the two groups was compared. Results:The effective rate of observation group was 95.74% (45/47), higher than that of control group 82.69% (43/52) ( P<0.05). After eight weeks of treatment, the levels of FPG (7.96±0.74) mmol/L, 2hPBG (8.36±1.02) mmol/L and BMI (24.63±1.51) kg/m 2 in the observation group were higher than those in the control group ( P<0.05). After 8 weeks of treatment, HOMA-IR (2.41±0.56) of observation group was lower than that of control group (2.84±0.61), GIR (5.63±0.97) mg·kg -1·min -1 was higher than that of the control group (5.17±0.95) mg·kg -1·min -1 ( P<0.05). After eight weeks of treatment, the levels of TG (4.22±0.43) mmol/L, TC (2.15±0.21) mmol/L and ApoB (1.18±0.14) mmol/L in the observation group were higher than those in the control group (2.49±0.26) mmol/L, (4.69±0.47) mmol/L and (1.45±0.19) mmo l/L ( P<0.05). The incidence of adverse reactions in the observation group was 8.51% (4/47), lower than that in the control group (5.77% (3/52) ( P>0.05) . Conclusion:Taking calaglitzin in combination with Delgu insulin liraglutide and pioglitazone metformin can significantly reduce insulin resistance, increase the sensitivity of peripheral tissues to insulin, reduce blood glucose level and BMI level, and the drug safety is reasonable.

Objective:To explore the mechanism of zoledronic acid (ZOL) affects osteogenic differentiation and bone formation through the regulation of sirtuin 3 (SIRT3) / P53 expression.Methods:Bone marrow mesenchymal stem cells (BMSCs) were induced to differentiate into osteogenic cells, the expression of SIRT3 in the cells was detected, and the targeting regulation relationship between SIRT3 and P53 was analyzed. The intracellular expressions of SIRT3 and P53 were intervened and ZOL was used to treat the cells. MTT method, Western blot method and kit were used to detect cell viability, osteogenesis-related genes Osteoprotegerin (OPG), runt-related transcription factor 2 (Runx2) expression, alkaline phosphatase (ALP) activity and alizarin red S (ARS) staining, respectively. Ovariectomy (OVX) was used to construct a rat model and explore the effect of ZOL on the progression of osteoporosis (OP) in vivo.Results:ZOL promoted osteogenic differentiation of BMSCs. The expression of SIRT3 was down-regulated in the serum of OP patients (0.78±0.23) compared with that of healthy subjects (1.00±0.26 vs. 0.78±0.23. t=3.85, P<0.001). During the osteogenic differentiation of BMSCs, the expression level of SIRT3 gradually increased with the prolonged induction of osteogenesis. Compared with the p53 protein expression and BMSCs activity in the control group, SIRT3 knockout could increase the expression level of p53 protein (0.59±0.05 vs. 1.01±0.11. t=6.02, P=0.004) but inhibited the activity of BMSCs (100.00±8.41 vs. 51.26±5.59. t=8.36, P=0.001). After ZOL treatment, the inhibitory effect of SIRT3 on cell viability (49.61±5.11 vs. 87.61±7.31. t=7.38, P=0.002) and osteogenesis was relieved, and the level of P53 was inhibited (1.10±0.10 vs. 0.69±0.04. t=6.59, P=0.003). P53 overexpression partially offseted the effects of ZOL on cell viability (84.61±6.52 vs. 66.54±5.47. t=3.68, P=0.021) and osteogenesis. Compared with the sham surgery group, the OVX group showed inhibition of osteogenesis in rats, and ZOL treatment significantly improved osteogenic inhibition. ZOL treatment increased the expression level of SIRT3 protein in bone tissue of OVX rats, but inhibited the expression level of P53. Conclusion:ZOL promoted osteogenic differentiation and bone formation of BMSCs by promoting the ubiquitination and degradation of P53 by SIRT3.

Objective To observe the impact of ultrasonic image quality on the consistency of artificial intelligence(Al)assisted diagnosis system and manual measurements of biological indicators of developmental dysplasia of hip(DDH).Methods Hip ultrasonic data of 75 DDH and 345 non-DDH children were retrospectively analyzed,and the quality of ultrasonic images were subjectively scored.An evaluation model of ultrasonic image quality was constructed based on 140 ultrasonic images acquired from 140 cases(group A,containing 25 DDH and 115 non-DDH)using entropy weighting method,the weight of anatomic structures and impact factors related to DDH were obtained.The comprehensive image quality scores of other ultrasonic images acquired from 280 cases(group B,including 50 DDH and 230 non-DDH)were calculated,and the images in group B were classified into grade A,B and C in descending order.The consistency of AI and manual measurements of DDH biological indicators in group B was assessed.Results The weight of each anatomic structure and impact factors of DDH obtained with the model were as follows:The lower edge of iliac branch＞ilium＞glenoid labrum＞bony margin＞femoral head＞motion artifacts.In group B,grade A was observed in 67(9 DDH and 58 non-DDH),grade B was found in 160(26 DDH and 134 non-DDH),while grade C was noticed in 53(15 DDH and 38 non DDH)images.Except for β,femoral head coverage(FHC)and femoral head length diameter,the consistencies between AI and manual measurements of other indicators of DDH were grade A＞B＞C.In group B,AI and manual measurements were more consistent in DDH than in non-DDH cases.Conclusion Ultrasonic image quality affected the consistency between AI and manual measurements of biological indicators of DDH.When image quality was not good enough,further attention should be paid to measurement of FHC and sizes of femoral head.

Objective:To evaluate the diagnostic value of the 18F-prostate specific membrane antigen (PSMA)-1007 PET/CT in seminal vesicle invasion (SVI) of prostate cancer. Methods:Clinical and pathological materials of 88 patients (age: 51-84 years) who underwent radical prostatectomy (RP) between May 2019 and December 2021 in the First Affiliated Hospital of Xi′an Jiaotong University were analyzed retrospectively. All patients underwent 18F-PSMA-1007 PET/CT examination for primary staging before surgery. The diagnostic efficiency of 18F-PSMA-1007 PET/CT in SVI was obtained using postoperative pathological results as the " gold standard" and ROC curve was drawn. Furthermore, univariate and multivariate logistic regression analyses were used to screen the influencing factors for 18F-PSMA-1007 PET/CT prediction of SVI. Results:The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 18F-PSMA-1007 PET/CT in diagnosing SVI were 79.55%(70/88), 72.73%(16/22), 81.82%(54/66), 57.14%(16/28) and 90.00%(54/60), respectively. The ROC AUC was 0.77. Results of univariate logistic regression showed that total prostate specific antigen (tPSA), primary SUV max, Gleason score, International Society of Urological Pathology (ISUP) grade group were associated with 18F-PSMA-1007 PET/CT prediction of SVI. Results of multivariate logistic regression showed that Gleason score (odds ratio ( OR)=2.04, 95% CI: 1.19-3.50, P=0.009) was a predictor of SVI in prostate cancer. Conclusion:18F-PSMA-1007 PET/CT has certain diagnostic value in SVI of prostate cancer, and combining with Gleason score can improve the diagnostic efficiency.

The increasing prevalence of the aging population, and inadequate and uneven distribution of medical resources, have led to a growing demand for telemedicine services. Gait disturbance is a primary symptom of neurological disorders such as Parkinson's disease (PD). This study proposed a novel approach for the quantitative assessment and analysis of gait disturbance from two-dimensional (2D) videos captured using smartphones. The approach used a convolutional pose machine to extract human body joints and a gait phase segmentation algorithm based on node motion characteristics to identify the gait phase. Moreover, it extracted features of the upper and lower limbs. A height ratio-based spatial feature extraction method was proposed that effectively captures spatial information. The proposed method underwent validation via error analysis, correction compensation, and accuracy verification using the motion capture system. Specifically, the proposed method achieved an extracted step length error of less than 3 cm. The proposed method underwent clinical validation, recruiting 64 patients with Parkinson's disease and 46 healthy controls of the same age group. Various gait indicators were statistically analyzed using three classic classification methods, with the random forest method achieving a classification accuracy of 91%. This method provides an objective, convenient, and intelligent solution for telemedicine focused on movement disorders in neurological diseases.
Humans ; Aged ; Parkinson Disease/diagnosis* ; Aging ; Algorithms ; Gait ; Lower Extremity

Retrospective analysis.To report a child with synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome admitted to the Department of Pediatric Nephrology and Rheumatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University in March 2020.A 14-year-old boy presented to hospital due to acne for more than 2 months, fever for more than 50 days, and hip pain for 2 weeks.The patient was diagnosed and treated as acne combined with infection and arthritis in other hospitals for more than 2 months without remission.He was initially diagnosed as juvenile idiopathic arthritis, acne combined with infection on admission.The disease was aggravated even after medications of anti-infection and anti-inflammatory drugs.After multidisciplinary consultation, the patient was diagnosed as SAPHO syndrome.The patient recovered from medications of Celecoxib, Sulfasalazine, recombinant human tumor necrosis factor receptorⅡ: IgG Fc fusion protein and other drugs.SAPHO syndrome is rare, especially in children, which is easily misdiagnosed.This case report suggested that SAPHO should be considered in children with acne, especially those combined with arthritis.

Objective:To explore the microbiological characteristics of donor blood culture and donor liver perfusion culture and summarize the clinical experiences to provide basic rationales for preventing donor-derived infections.Methods:From August 1, 2018 to November 26, 2018 and November 27, 2018 to December 31, 2020 at First Affiliated Hospital, Zhengzhou University, culture results of donor blood and donor liver perfusate were retrospectively reviewed.According to whether or not donor liver was obtained without breaking diaphragm, removing gallbladder intraoperatively and flushing bile through cystic duct, two stages were assigned: before and after improvement measures of liver donor, i.e.August 1, 2018 to November 26, 2018 and November 27, 2018 to December 31, 2020.The culture results of donor blood samples and donor liver perfusion fluid samples in two stages of liver transplantation were statistically analyzed and infection preventing measures during donor liver maintenance and obtaining donor liver examined.Results:A total of 486 cases of blood culture from potential donors and 478 cases of liver perfusion culture were analyzed.The results showed that the incidence of blood culture infection was 4.5% and 4.3% before and after improvement measures( χ2=0.008; P=0.927)while the incidence of perfusion fluid infection was 56.8% and 46.2%( χ2=4.569; P=0.031); Klebsiella pneumoniae was a major pathogen cultured in perfusion solution before improvement measures and Staphylococcus epidermidis after improvement measures. Conclusions:Before organ donation, infection screening and prevention of potential donors and corresponding measures during donor liver acquisition can reduce donor source infection and effectively lower the mortality of recipients.

Objective:To investigate the predictive value of serum C-type lectin-like receptor 2 (CLEC-2) combined with insulin resistance in the outcome of patients with acute ischemic stroke (AIS) after intravenous thrombolysis.Methods:Patients with AIS received alteplase intravenous thrombolytic therapy in the Department of Neurology, the Second Affiliated Hospital of Nantong University from October 2019 to March 2021 were enrolled retrospectively. According to the modified Rankin Scale score at 90 d after onset, they were divided into good outcome group (0-2) and poor outcome group (>2). Homeostasis model assessment of insulin resistance (HOMA-IR) was used to evaluate insulin resistance. Person correlation analysis was used to determine the correlation between CLEC-2 and HOMA-IR. Multivariate logistic regression analysis was used to determine the correlation between serum CELC-2, HOMA-IR and the outcome after intravenous thrombolysis. Receiver operating characteristic (ROC) curve was used to determine the predictive value of serum CLEC-2 combined with HOMA-IR for poor outcome after intravenous thrombolysis. Results:A total of 100 patients were enrolled (56 males, 56.0%; aged 70.6±10.86 years, range 49-83 years). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 10.00±6.36. Senenty-four patients (74.0%) had a good outcome and 26 (26.0%) had a poor outcome. Person correlation analysis showed that there was a significant positive correlation between serum CLEC-2 and HOMA-IR ( r=0.523; P<0.001). Multivariate logistic regression analysis showed that after adjusting for confounding factors (C-reactive protein, baseline NIHSS score, onset-to-needle time), the highest quartile of serum CLEC-2 (compared with the lowest quartile: odds ratio [ OR] 4.836, 95% confidence interval [ CI] 1.105-21.169; P=0.036) and the highest quartile of HOMA-IR (compared with the quartile 1-3: OR 15, 95% CI 2.647-30.722; P=0.002) were the independent risk factors for the poor outcome in patients with AIS after intravenous thrombolysis. ROC curve analysis showed that the area under the curve for serum CLEC-2 combined with HOMA-IR to predict poor outcome was 0.785 (95% CI 0.688-0.883; P<0.001), the optimal cut-off value was 0.72, and the sensitivity and specificity were 76.0% and 95.0%, respectively. Conclusion:CLEC-2 combined with insulin resistance has a certain predictive value for the poor outcome of patients with AIS after intravenous thrombolysis.

OBJECTIVE: To explore the effects of lead exposure on inflammatory damage of hippocampus and cognitive impairment in diabetic rats. METHODS: The specific pathogen free(SPF) male healthy Wistar rats were randomly divided into control group and lead-exposed group. The SPF male Goto-Kakisaki Wistar rats rats were randomly divided into diabetes group and diabetes lead-exposed group, with 10 rats in each group. Rats in lead-exposed group and diabetes lead-exposed group were continuously exposed to lead acetate water with a mass fraction of 0.025% for 9 weeks. Rats in control group and diabetes group were given distilled water. The body weight and blood glucose level of rats were measured before lead exposure and at 1, 3, 5, 7 and 9 weeks after exposure. After the exposure, Morris water maze test was used to evaluate the learning and memory ability of rats. The lead levels in whole blood and hippocampal tissues were detected by inductively coupled plasma mass spectrometry, and the expression of mRNA and protein expression of inflammatory factors in hippocampal tissues of rats were detected by real-time fluorescence quantitative polymerase chain reaction and enzyme-linked immunoadsorption, respectively. RESULTS: At the end of lead exposure, the difference of body mass of rats in the diabetes group and the diabetes lead-exposed group was not statistically significant compared with that in the same group before exposure(all P values were >0.05); but the body mass of rats in these two groups was lower than that of the control group and the lead-exposure group(all P values were <0.05). The blood glucose levels of rats were higher in the diabetic group and the diabetes lead-exposed group than that in the control group and the lead-exposed group, respectively(all P values were <0.05). Morris water maze test showed that the escape latency of rats in the 1 st, 2 nd and 3 rd day were longer in diabetes group and the diabetes lead-exposed group than that in the control group and the lead-exposed group(all P values were <0.05). The number of times of crossing platforms were less in the lead-exposed group and the diabetes group than that of the control group(all P values were <0.05). The number of times of crossing platforms was more in the diabetes lead-exposed group than that in the other 3 groups(all P values were <0.05). The levels of lead in blood and hippocampus of rats were higher in the lead-exposed group than those in the control group(all P values were <0.05), and those in the diabetes lead-exposed group were higher than that in the other 3 groups(all P values were <0.05). The relative expression of mRNA of interferon-γ(ifn-γ) and interleukin(il)-6 in hippocampal tissues of rats was higher in the lead-exposed group and the diabetes group than that of the control group(all P values were <0.05). The relative expression of mRNA of tumour necrosis factor-α(tnf-α) and il-1β in the hippocampal tissues of rats was higher in the diabetes group than that of the control group and the lead-exposed group, respectively(all P values were <0.05). The relative expression of mRNA of ifn-γ, tnf-α, il-1β and il-6 in hippocampal tissues of rats was higher in the diabetes lead-exposed group than that of the other 3 groups(all P values were <0.05). The relative protein expression of IFN-γ, TNF-α, IL-4 and IL-6 in hippocampal tissues of rats was higher in lead-exposed group than that of the control group(all P values were <0.05). The relative protein expression of IFN-γ, TNF-α, IL-1β and IL-6 in hippocampal tissues of rats was higher in diabetes group than that of the control group(all P values were <0.05). The relative protein expression of IFN-γ, IL-1β and IL-6 in hippocampal tissues of rats was higher in diabetes group than that of the other 3 groups(all P values were <0.05). CONCLUSION: Diabetes can promote the lead accumulation in the blood and hippocampus of rats. The combined effect of lead exposure and diabetes can up-regulate the expression of pro-inflammatory cytokines in the hippocampal tissues of rats, aggravate the inflammatory response, and have a synergistic effect on the cognitive impairment in rats.