OBJECTIVE: To explore the clinical characteristics and genetic factors in four patients with Disorder of sex development (DSD). METHODS: Four patients who visited Tianjin Medical University General Hospital between January 2023 and January 2024, presenting with short stature, abnormal external genitalia, or infertility as their chief complaints, were selected as the study subjects. Clinical data were collected, and peripheral or umbilical cord blood samples were obtained for karyotyping analysis and low-depth whole-genome sequencing (CNV-seq). Quantitative fluorescence PCR (QF-PCR) was used to detect the sex-determining region Y (SRY) gene and azoospermia factor (AZF) on the Y chromosome, while fluorescence in situ hybridization (FISH) was employed to determine the location of the SRY gene. Whole exome sequencing (WES) was performed for genetic testing, and Sanger sequencing was used for familial validation of the candidate variants. The study procedure and protocol were approved by the Medical Ethics Committee of Tianjin Medical University General Hospital (Ethics No.: IRB2024-WZ-006). RESULTS: Case 1 had a karyotype of 45,X[22]/46,XY[8], with CNV-seq indicating a mosaic deletion of 7.44 Mb (copy number = 0.2) at Yp11.31-p11.2, a mosaic deletion of 5.32 Mb (copy number = 0.3) at Yq11.1-q11.221, and a deletion of 10.26 Mb (copy number = 0) at Yq11.221-q11.23. Y chromosome microdeletion analysis showed SRY and AZFa (+), AZFb+c (-). Case 2 had a karyotype of 45,X[12]/46,X,del(X)(q26.3)[18], with CNV-seq indicating a mosaic deletion of 132.62 Mb (copy number = 1.4) at Xp22.33-q26.3 and a deletion of 19.62 Mb (copy number = 1) at Xq26.3-q28. Case 3 had a karyotype of 46,XX, with CNV-seq showing two copies of the X chromosome and no Y chromosome. Y chromosome microdeletion analysis showed SRY (+) and AZFa+b+c (-), and FISH confirmed a translocation of the SRY gene to the terminal end of the short arm of the X chromosome. Case 4 had a karyotype of 46,XY, with CNV-seq showing one copy each of the X and Y chromosomes. Y chromosome microdeletion analysis showed SRY(+) and AZFa+b+c (+), and WES revealed a c.1103del variant in the AR gene (maternal origin), which was classified as a pathogenic variant based on the guidelines from the American College of Medical Genetics and Genomics (ACMG) (PVS1+PP1+PM2_Supporting). CONCLUSION The combined application of multiple detection techniques such as chromosomal karyotyping analysis, CNV-seq, QF-PCR, and WES can identify the genetic etiology of DSD patients, providing a basis for clinical consultation and treatment plan formulation.
Humans ; Male ; Female ; Chromosomes, Human, Y/genetics* ; Disorders of Sex Development/genetics* ; Sex-Determining Region Y Protein/genetics* ; Karyotyping ; In Situ Hybridization, Fluorescence ; Exome Sequencing ; Adult ; Child

Objective:To evaluate the effect of difference of fluid intake and excretion on the prognosis of elderly patients with septic shock during hospitalization in ICU, and to provide evidence for clinical assessment of the condition, prognosis prediction, and optimization of fluid resuscitation strategies during hospitalization.Methods:A retrospective cohort study was conducted, involving elderly septic shock patients admitted to the ICU of Zhoupu Hospital affiliated to Shanghai Health College from January 2018 to June 2024. Data on general characteristics, clinical parameters at 6 h and 24 h after ICU admission, and cumulative difference of fluid intake and excretion during ICU stay were collected. Patients were divided into survival group and death group based on whether they survived during hospitalization. Differences in study variables between groups were analyzed. Logistic regression analysis was performed on the independent risk factors of the mortality rate during hospitalization. Receiver operating characteristic (ROC) was plotted to evaluate the prognostic value of difference of fluid intake and excretion in elderly patients with septic shock during hospitalization in ICU.Results:A total of 159 elderly septic shock patients were included (108 males, 51 females), with an in-hospital mortality rate of 66.66% (106 deaths vs. 53 survivors). Compared with the survival group, the difference of total fluid intake and excretion during hospitalization in ICU in the death group was significantly lower [2 441.00 (228.50, 5 101.50) mL vs. 6 215.50 (3 755.00, 9 874.75) mL, P<0.001]. Multivariate logistic regression analysis showed that SOFA score ( OR=1.359, 95% CI: 1.135-1.626, P=0.001) and the difference of total fluid intake and excretion during hospitalization in ICU ( OR=1.174, 95% CI: 1.067-1.291, P=0.001) were independent risk factors for predicting prognosis during hospitalization. ROC analysis revealed that the cumulative difference of fluid intake and excretion achieved an AUC of 0.756 (95% CI: 0.674-0.838, P<0.001), with a sensitivity of 61.8% and specificity of 82.4% at a cutoff value of ≥5 396.5 mL. In addition, AUC of the total fluid intake and excretion difference and SOFA score during hospitalization in ICU was 0.885 (95% CI: 0.825-0.944, P<0.001). Conclusions:A higher cumulative difference of fluid intake and excretion during ICU hospitalization is associated with increased mortality in elderly septic shock patients. A positive difference of fluid intake and excretion may serve as a clinical indicator for predicting prognosis of elderly patients with septic shock.

Objective:To explore the clinical characteristics and genetic factors in four patients with Disorder of sex development (DSD).Methods:Four patients who visited Tianjin Medical University General Hospital between January 2023 and January 2024, presenting with short stature, abnormal external genitalia, or infertility as their chief complaints, were selected as the study subjects. Clinical data were collected, and peripheral or umbilical cord blood samples were obtained for karyotyping analysis and low-depth whole-genome sequencing (CNV-seq). Quantitative fluorescence PCR (QF-PCR) was used to detect the sex-determining region Y ( SRY) gene and azoospermia factor ( AZF) on the Y chromosome, while fluorescence in situ hybridization (FISH) was employed to determine the location of the SRY gene. Whole exome sequencing (WES) was performed for genetic testing, and Sanger sequencing was used for familial validation of the candidate variants. The study procedure and protocol were approved by the Medical Ethics Committee of Tianjin Medical University General Hospital (Ethics No.: IRB2024-WZ-006). Results:Case 1 had a karyotype of 45, X[22]/46, XY[8], with CNV-seq indicating a mosaic deletion of 7.44 Mb (copy number = 0.2) at Yp11.31-p11.2, a mosaic deletion of 5.32 Mb (copy number = 0.3) at Yq11.1-q11.221, and a deletion of 10.26 Mb (copy number = 0) at Yq11.221-q11.23. Y chromosome microdeletion analysis showed SRY and AZFa (+ ), AZFb+ c (-). Case 2 had a karyotype of 45, X[12]/46, X, del(X)(q26.3)[18], with CNV-seq indicating a mosaic deletion of 132.62 Mb (copy number = 1.4) at Xp22.33-q26.3 and a deletion of 19.62 Mb (copy number = 1) at Xq26.3-q28. Case 3 had a karyotype of 46, XX, with CNV-seq showing two copies of the X chromosome and no Y chromosome. Y chromosome microdeletion analysis showed SRY (+ ) and AZFa+ b+ c (-), and FISH confirmed a translocation of the SRY gene to the terminal end of the short arm of the X chromosome. Case 4 had a karyotype of 46, XY, with CNV-seq showing one copy each of the X and Y chromosomes. Y chromosome microdeletion analysis showed SRY(+ ) and AZFa+ b+ c (+ ), and WES revealed a c. 1103del variant in the AR gene (maternal origin), which was classified as a pathogenic variant based on the guidelines from the American College of Medical Genetics and Genomics (ACMG) (PVS1+ PP1+ PM2_Supporting). Conclusion:The combined application of multiple detection techniques such as chromosomal karyotyping analysis, CNV-seq, QF-PCR, and WES can identify the genetic etiology of DSD patients, providing a basis for clinical consultation and treatment plan formulation.

Objective:To explore the clinical characteristics and genetic factors in four patients with Disorder of sex development (DSD).Methods:Four patients who visited Tianjin Medical University General Hospital between January 2023 and January 2024, presenting with short stature, abnormal external genitalia, or infertility as their chief complaints, were selected as the study subjects. Clinical data were collected, and peripheral or umbilical cord blood samples were obtained for karyotyping analysis and low-depth whole-genome sequencing (CNV-seq). Quantitative fluorescence PCR (QF-PCR) was used to detect the sex-determining region Y ( SRY) gene and azoospermia factor ( AZF) on the Y chromosome, while fluorescence in situ hybridization (FISH) was employed to determine the location of the SRY gene. Whole exome sequencing (WES) was performed for genetic testing, and Sanger sequencing was used for familial validation of the candidate variants. The study procedure and protocol were approved by the Medical Ethics Committee of Tianjin Medical University General Hospital (Ethics No.: IRB2024-WZ-006). Results:Case 1 had a karyotype of 45, X[22]/46, XY[8], with CNV-seq indicating a mosaic deletion of 7.44 Mb (copy number = 0.2) at Yp11.31-p11.2, a mosaic deletion of 5.32 Mb (copy number = 0.3) at Yq11.1-q11.221, and a deletion of 10.26 Mb (copy number = 0) at Yq11.221-q11.23. Y chromosome microdeletion analysis showed SRY and AZFa (+ ), AZFb+ c (-). Case 2 had a karyotype of 45, X[12]/46, X, del(X)(q26.3)[18], with CNV-seq indicating a mosaic deletion of 132.62 Mb (copy number = 1.4) at Xp22.33-q26.3 and a deletion of 19.62 Mb (copy number = 1) at Xq26.3-q28. Case 3 had a karyotype of 46, XX, with CNV-seq showing two copies of the X chromosome and no Y chromosome. Y chromosome microdeletion analysis showed SRY (+ ) and AZFa+ b+ c (-), and FISH confirmed a translocation of the SRY gene to the terminal end of the short arm of the X chromosome. Case 4 had a karyotype of 46, XY, with CNV-seq showing one copy each of the X and Y chromosomes. Y chromosome microdeletion analysis showed SRY(+ ) and AZFa+ b+ c (+ ), and WES revealed a c. 1103del variant in the AR gene (maternal origin), which was classified as a pathogenic variant based on the guidelines from the American College of Medical Genetics and Genomics (ACMG) (PVS1+ PP1+ PM2_Supporting). Conclusion:The combined application of multiple detection techniques such as chromosomal karyotyping analysis, CNV-seq, QF-PCR, and WES can identify the genetic etiology of DSD patients, providing a basis for clinical consultation and treatment plan formulation.

Objective:To establish UPLC fingerprint method and 2 contents determination methods of Buddleja officinalis; To provide a reference for improving the quality control standard and evaluation of Buddleja officinalis from different habitats.Methods:UPLC method was used to establish the fingerprints of 17 batches of Buddleja officinalis. The similarity evaluation, clustering analysis, principal component analysis and orthogonal partial least squares discriminant analysis were used to compare the quality differences of Buddleja officinalis from different habitats. The contents of acteoside and linarin in Buddleja officinalis were determined.Results:There were 12 common peaks in UPLC fingerprints of Buddleja officinalis, six of which were identified as echinacoside, acteoside, cynaroside, isoacteoside, linarin, and apigenin. The fingerprint similarity of 17 batches of Buddleja officinalis was more than 0.9; Buddleja officinalis from different habitats were classified into 2 groups. Five differential markers were determined by OPLS-DA analysis. The order of significance was acteoside > peak 3 > echinacoside > isoacteoside > linarin. Edgeworthia chrysantha was identified by the method of fingerprint as counterfeit. The results of content determination showed that the content of Buddleja officinalis in Hubei and Sichuan was the high and stable.Conclusion:The method can effectively analyze the differences of Buddleja officinalis from different habitats, and provide reference for the quality control of Buddleja officinalis.

Objective:To observe the effect of Wenyang Huazhuo recipe (WYHZ) on pregnancy outcomes in patients with unexplained recurrent spontaneous abortion (URSA).Methods:A retrospective cohort study was used and 240 cases of pregnancy URSA patients with spleen kidney yang deficiency syndrome at the Reproductive Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine and Department of Gynaecology and Obstetrics, General Hospital of Tianjin Medial University from November 2018 to March 2022 were recruited. The patients were assigned to WYHZ group (120 cases) and control group (120 cases) based on whether accepting oral WYHZ from 3 months before pregnancy to 8-12 weeks after pregnancy regularly. Pregnancy outcomes, perinatal period outcomes and obstetric complications were compared between the two groups. Multivariate logistic regression were used to analyze the effect of WYHZ on pregnancy outcome.Results:The live birth rate and the clinical pregnancy rate in WYHZ group [86.67% (104/120), 90.00% (108/120)] were higher than those in control group [71.67% (86/120), P=0.004; 75.00% (90/120), P=0.002]. The early abortion rate in WYHZ group [10.08% (12/119)] was lower than that in control group [25.86% (30/116), P=0.002], the differences were statistically significant. There were no significant differences in perinatal outcome and incidence rate of obstetric complications between the two groups (all P>0.05). Multivariate logistic regression analysis showed that the application of WYHZ significantly improved the live birth rate ( OR=8.818, 95% CI: 3.556-21.871, P<0.001) and sustained pregnancy rate ( OR=11.261, 95% CI: 4.262-29.751, P<0.001) in URSA patients. Conclusion:WYHZ using before and during pregnancy can significantly improve the live birth rate and the clinical pregnancy rate of URSA patients with syndrome of yang deficiency of spleen and kidney, and improve their pregnancy outcomes.

Objective:To compare the surgical efficacy and perioperative complications of total intracorporeal neobladder (ICNB) and extracorporeal neobladder (ECNB) reconstruction during robot-assisted radical cystectomy.Methods:We retrospectively reviewed our single-institutional, prospectively collected database for consecutive patients who underwent RARC with an ileum neobladder from January 2017 to June 2022. A total of 265 patients were collected, 158 in ICNB group and 107 in ECNB group. The two groups were matched 1∶1 according to gender, age, BMI, ASA score, NAC, history of abdominal surgery and tumor characteristics using propensity score matching (PSM) method. After PSM, operating time, estimated blood loss and perioperative complications were compared between ICNB and ECNB group. A total of 186 patients were paired (93 patients in each group). There were 91 males and 2 females in ICNB group. The median age of ICNB group was 64(55, 68) years; median BMI was 23.54(22.39, 25.39) kg/m 2; There were 91 cases with Clinical stage ≤T 2 stage and 15 cases with ASA score ≥3; 25 cases received neoadjuvant chemotherapy. There were 91 males and 2 females in ECNB group. The median age of ECNB group was 63(52, 67) years; median BMI was 23.31(20.76, 24.80) kg/m 2; There were 90 cases with Clinical stage ≤T 2 stage and 8 cases with ASA score ≥3; 12 cases received neoadjuvant chemotherapy. In the ECNB group, after completing the radical cystectomy and pelvic lymph node dissection with robot assistance, the traditional lower abdominal incision was used to pull the intestinal tube outside the body to complete the preparation of the new bladder and then restore it to the pelvic cavity for anastomosing, while in the ICNB group, the reconstruction of the new bladder in situ was always completed in the body cavity with robot assistance. The operative time, intraoperative blood loss and perioperative complications were compared between the two groups. Results:The median operative time in ICNB and ECNB groups was 302(261, 350) min and 337(285, 397) min, respectively ( P=0.003); median intraoperative blood loss was 300(225, 500) ml and 500(300, 650) ml, respectively ( P<0.01); perioperative blood transfusion rates were 4.3%(4/93) and 14.0%(13/93), respectively ( P=0.022); all the differences between the 2 groups were statistically significant. 90-d overall complications rate was significant lower in ICNB group (38.7% vs. 61.3%, P=0.002). There was no difference in 90-d major complications (8.6% vs. 16.1%, P=0.119). On multivariate logistic regression analysis, operating time( OR=1.004, 95% CI 1.000-1.007, P=0.040), surgical approach (ICNB/ECNB)( OR=2.248, 95% CI 1.220-4.141, P=0.009) and age( OR=1.036, 95% CI 1.002-1.072, P=0.037) were associated with 90-day overall complications. Operating time( OR=1.036, 95% CI 1.002-1.072, P=0.037), neoadjuvant chemotherapy( OR=0.198, 95% CI 0.059-0.663, P=0.009) and ASA score( OR=0.167, 95% CI 0.044-0.634, P=0.009) were associated with 90-day high-grade complications. Conclusion:Intracorporeal neobladder during robot-assisted radical cystectomy is safe and feasible. Compared with ECNB, ICNB significantly improved perioperative outcomes such as shorter operating time, fewer estimated blood loss and perioperative complications.

Objective:To compare the surgical efficacy and perioperative complications of total intracorporeal neobladder (ICNB) and extracorporeal neobladder (ECNB) reconstruction during robot-assisted radical cystectomy.Methods:We retrospectively reviewed our single-institutional, prospectively collected database for consecutive patients who underwent RARC with an ileum neobladder from January 2017 to June 2022. A total of 265 patients were collected, 158 in ICNB group and 107 in ECNB group. The two groups were matched 1∶1 according to gender, age, BMI, ASA score, NAC, history of abdominal surgery and tumor characteristics using propensity score matching (PSM) method. After PSM, operating time, estimated blood loss and perioperative complications were compared between ICNB and ECNB group. A total of 186 patients were paired (93 patients in each group). There were 91 males and 2 females in ICNB group. The median age of ICNB group was 64(55, 68) years; median BMI was 23.54(22.39, 25.39) kg/m 2; There were 91 cases with Clinical stage ≤T 2 stage and 15 cases with ASA score ≥3; 25 cases received neoadjuvant chemotherapy. There were 91 males and 2 females in ECNB group. The median age of ECNB group was 63(52, 67) years; median BMI was 23.31(20.76, 24.80) kg/m 2; There were 90 cases with Clinical stage ≤T 2 stage and 8 cases with ASA score ≥3; 12 cases received neoadjuvant chemotherapy. In the ECNB group, after completing the radical cystectomy and pelvic lymph node dissection with robot assistance, the traditional lower abdominal incision was used to pull the intestinal tube outside the body to complete the preparation of the new bladder and then restore it to the pelvic cavity for anastomosing, while in the ICNB group, the reconstruction of the new bladder in situ was always completed in the body cavity with robot assistance. The operative time, intraoperative blood loss and perioperative complications were compared between the two groups. Results:The median operative time in ICNB and ECNB groups was 302(261, 350) min and 337(285, 397) min, respectively ( P=0.003); median intraoperative blood loss was 300(225, 500) ml and 500(300, 650) ml, respectively ( P<0.01); perioperative blood transfusion rates were 4.3%(4/93) and 14.0%(13/93), respectively ( P=0.022); all the differences between the 2 groups were statistically significant. 90-d overall complications rate was significant lower in ICNB group (38.7% vs. 61.3%, P=0.002). There was no difference in 90-d major complications (8.6% vs. 16.1%, P=0.119). On multivariate logistic regression analysis, operating time( OR=1.004, 95% CI 1.000-1.007, P=0.040), surgical approach (ICNB/ECNB)( OR=2.248, 95% CI 1.220-4.141, P=0.009) and age( OR=1.036, 95% CI 1.002-1.072, P=0.037) were associated with 90-day overall complications. Operating time( OR=1.036, 95% CI 1.002-1.072, P=0.037), neoadjuvant chemotherapy( OR=0.198, 95% CI 0.059-0.663, P=0.009) and ASA score( OR=0.167, 95% CI 0.044-0.634, P=0.009) were associated with 90-day high-grade complications. Conclusion:Intracorporeal neobladder during robot-assisted radical cystectomy is safe and feasible. Compared with ECNB, ICNB significantly improved perioperative outcomes such as shorter operating time, fewer estimated blood loss and perioperative complications.

Objective:To observe the effect of Wenyang Huazhuo recipe (WYHZ) on pregnancy outcomes in patients with unexplained recurrent spontaneous abortion (URSA).Methods:A retrospective cohort study was used and 240 cases of pregnancy URSA patients with spleen kidney yang deficiency syndrome at the Reproductive Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine and Department of Gynaecology and Obstetrics, General Hospital of Tianjin Medial University from November 2018 to March 2022 were recruited. The patients were assigned to WYHZ group (120 cases) and control group (120 cases) based on whether accepting oral WYHZ from 3 months before pregnancy to 8-12 weeks after pregnancy regularly. Pregnancy outcomes, perinatal period outcomes and obstetric complications were compared between the two groups. Multivariate logistic regression were used to analyze the effect of WYHZ on pregnancy outcome.Results:The live birth rate and the clinical pregnancy rate in WYHZ group [86.67% (104/120), 90.00% (108/120)] were higher than those in control group [71.67% (86/120), P=0.004; 75.00% (90/120), P=0.002]. The early abortion rate in WYHZ group [10.08% (12/119)] was lower than that in control group [25.86% (30/116), P=0.002], the differences were statistically significant. There were no significant differences in perinatal outcome and incidence rate of obstetric complications between the two groups (all P>0.05). Multivariate logistic regression analysis showed that the application of WYHZ significantly improved the live birth rate ( OR=8.818, 95% CI: 3.556-21.871, P<0.001) and sustained pregnancy rate ( OR=11.261, 95% CI: 4.262-29.751, P<0.001) in URSA patients. Conclusion:WYHZ using before and during pregnancy can significantly improve the live birth rate and the clinical pregnancy rate of URSA patients with syndrome of yang deficiency of spleen and kidney, and improve their pregnancy outcomes.

ObjectiveTo study the effect of Qizhu Kang'ai prescription （QZAP） on the gluconeogenesis enzyme phosphoenolpyruvate carboxykinase 1 （PCK1） in the liver of mouse model of liver cancer induced by diethylnitrosamine （DEN） combined with carbon tetrachloride （CCl₄） and Huh7 cells of human liver cancer， so as to explore the mechanism on regulating metabolic reprogramming and inhibiting cell proliferation of liver cancer cells. MethodDEN combined with CCl₄ was used to construct a mouse model of liver cancer via intraperitoneal injection. A normal group， a model group， and a QZAP group were set up， in which QZAP （3.51 g·kg^-1） or an equal volume of normal saline was administered daily by gavage， respectively. Serum and liver samples were collected after eight weeks of intervention. Serum alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， γ-glutamyltransferase （γ-GT）， and alpha-fetoprotein （AFP） in mice were detected to evaluate liver function changes of mice in each group. Hematoxylin-eosin （HE） staining and Sirius red staining were used to observe pathological changes in liver tissue. In the cell experiment， Huh7 cells were divided into blank group， QZAP low， medium， and high dose groups and/or PCK1 inhibitor （SKF-34288 hydrochloride） group， and Sorafenib group. The corresponding drug-containing serum and drug treatment were given， respectively. Cell counting kit-8 （CCK-8） method， colony formation experiment， Edu fluorescent labeling detection， intracellular adenosine triphosphate （ATP） content detection， and cell cycle flow cytometry detection were used to evaluate the proliferation ability， energy metabolism changes， and change in the cell cycle of Huh7 cells in each group. Western blot was used to detect the protein expression levels of PCK1， serine/threonine kinase （Akt）， phosphorylated Akt （p-Akt）， and cell cycle-dependent protein kinase inhibitor 1A （p21）. ResultCompared with the model group， the pathological changes such as cell atypia， necrosis， and collagen fiber deposition in liver cancer tissue of mice in the QZAP group were alleviated， and the number of liver tumors was reduced （P<0.01）. The serum ALT， AST， γ-GT， and AFP levels were reduced （P<0.01）. At the cell level， compared with the blank group， low， medium， and high-dose groups of QZAP-containing serum and the Sorafenib group could significantly reduce the survival rate of Huh7 cells （P<0.01） and the number of positive cells with Edu labeling （P<0.01） and inhibit clonal proliferation ability （P<0.01）. The QZAP groups could also reduce the intracellular ATP content （P<0.05） and increase the distribution ratio of the G₀/G₁ phase of the cell cycle （P<0.05） in a dose-dependent manner. Compared with the model group and blank group， PCK1 and p21 protein levels of mouse liver cancer tissue and Huh7 cells in the QZAP groups were significantly reduced （P<0.05，P<0.01）， and the p-Akt protein level was significantly increased （P<0.01）. Compared with the blank group， the ATP content and cell survival rate of Huh7 cells in the SKF-34288 hydrochloride group were significantly increased （P<0.05）， but there was no statistical difference in the ratio of Edu-positive cells and the proportion of G₀/G₁ phase distribution. Compared with the SKF-34288 hydrochloride group， the QZAP combined with the SKF-34288 hydrochloride group significantly reduced the ATP content， cell survival rate， and Edu-positive cell ratio of Huh7 cells （P<0.05） and significantly increased the G₀/G₁ phase distribution proportion （P<0.05）. ConclusionQZAP may induce the metabolic reprogramming of liver cancer cells by activating PCK1 to promote Akt/p21-mediated tumor suppression， thereby exerting an anti-hepatocellular carcinoma proliferation mechanism.