Objective To investigate the predictive value of CT perfusion imaging(CTP)parameters com-bined with platelet activator combined-1(PAC-1)level and hemorrhage after thrombolysis(HAT)score for hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute cerebral infarction(ACI).Methods A total of 162 patients with ACI who were treated with intravenous thrombolysis in Cheng-du 363 Hospital from January 2022 to April 2023 were selected.All patients underwent head CT examination(including plain scan and CTP)before intravenous thrombolytic therapy,and serum PAC-1 level and HAT score were measured at admission.According to whether HT occurred after intravenous thrombolysis,the pa-tients were divided into HT group(HT group)and non-HT group(non-HT group).The differences of CTP parameters,serum PAC-1 level and HAT score between the two groups were compared.Multivariate Logistic regression was used to analyze the independent risk factors of HT after intravenous thrombolysis in ACI pa-tients.The predictive value of CTP parameters combined with serum PAC-1 and HAT scores alone and in combination for HT after intravenous thrombolysis in ACI patients was evaluated by drawing the receiver op-erating characteristic(ROC)curve and calculating the area under the curve(AUC).Results The cerebral blood flow and blood volume in the HT group were significantly lower than those in the non-HT group(P＜0.05),while the serum PAC-1 level,peak time,mean transit time,flow extraction product,and HAT score were significantly higher than those in the non-HT group(P＜0.05).Multivariate Logistic regression analysis showed that CTP integration parameters which were composed of cerebral blood flow,cerebral blood volume,peak time,mean transit time and flow extraction product,serum PAC-1 level and HAT score were independ-ent risk factors for HT after intravenous thrombolysis in ACI patients(P＜0.05).ROC curve analysis showed that CTP integration parameters,serum PAC-1 level and HAT score all had certain predictive value for HT in ACI patients after intravenous thrombolysis,and their AUC and 95％CI were 0.766(95％CI:0.605-0.915),0.702(95％CI:0.451-0.955)and 0.741(95％CI:0.551-0.923),respectively.The com-bined application of CTP integration parameters,serum PAC-1 levels,and HAT scores significantly improved the predictive performance,and its AUC was 0.856(95％CI:0.750-0.951),which was higher than those of each index alone(Zcombination-CTP=2.177,P=0.032,Zcombination-PAC-1=2.917,P=0.004,Zcombination-HAT=2.537,P=0.013).Conclusion The combination of CTP integration parameters which are composed of cerebral blood flow,cerebral blood volume,peak time,mean transit time and flow extraction product,and serum PAC-1 level and HAT score has high predictive value for HT after intravenous thrombolysis in ACI patients,and has high clinical application potential.

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.

Extrarenal Wilms′ tumor is extremely rare and has no characteristic clinical manifestations. Diagnosis is difficult before surgery, and is often confirmed by histopathology. Comprehensive treatment by surgery, chemotherapy and radiotherapy is currently adopted for such patients, and the overall survival rate can reach about 90%. Here we report a 2-year-old child with Wilms′ tumor in the left scrotum.