Acute-on-chronic liver failure is an acute decompensated syndrome that occurs on the basis of chronic liver disease and is characterized by a high short-term mortality rate. Metabolomics reveals the presence of significant energy metabolic reprogramming， manifesting as extensive dysregulation of glucose/lipid/amino acid metabolism， mitochondrial metabolism， and intestinal flora， and it closely interacts with systemic inflammation and immune imbalance， jointly promoting disease progression. The core metabolic phenotypes include suppressed gluconeogenesis， enhanced glycolysis， impaired β-oxidation， inhibited mitochondrial oxidative phosphorylation， ammonia metabolic imbalance， and gut microbiota dysbiosis. This article analyzes the latest studies on metabolomic and molecular mechanisms and systematically reviews the dysregulation characteristics of the five major metabolic networks. In terms of intervention for energy metabolism， this article summarizes the five strategies of glucose metabolism regulation， lipid metabolism intervention， mitochondria-targeted protection， gut microbiota rebalancing， and amino-acid optimization and assesses their application value and prospects for clinical translation， so as to provide a scientific basis for the treatment， alleviation， and even reversal of disease progression.

Acute-on-chronic liver failure(ACLF)is a group of clinical syndromes related to severe acute liver function damage and multiple organ failure caused by various acute inducing factors on the basis of chronic liver disease.Due to its serious condition,rapid progression and high mortality,it has attracted more and more attention.Recent studies have shown that the pathogenesis of ACLF mainly includes direct injury and immune injury.As the main immune cells in the liver,the immunoregulatory role of liver macrophages in ACLF has been increasingly recognized.Liver macrophages have excellent phenotype conversion function and plasticity characteristics under the influence of epigenetic reprogramming or local microenvironment.This adaptive expression ability can use key mediators to promote the early conversion of anti-inflammatory phenotype to alleviate liver injury.A large number of studies have shown that liver macrophages have a certain potential in reversing the process of ACLF.Therefore,from the perspective of the plasticity characteristics of liver macrophages,this paper expounds the role of liver macrophages in ACLF and the research on the intervention of ACLF disease process,and summarizes its potential significance in the treatment of ACLF.

The purpose of this paper is to systematically summarize the gene polymorphisms associated with osteoporosis(OP)susceptibility in Zhuang ethnic group in Guangxi.These genes mainly encode vitamin D receptor,estrogen receptor,calcitonin receptor,and adiponectin.The genotype and allele distribution frequency were compared between Zhuang ethnic group and other ethnic groups,which can clarify the existing genes and the potential gene polymorphism associated with OP in Zhuang ethnic group.The findings provide a representative solution for the subsequent research on the genes associated with OP susceptibility in ethnic minorities.

Objective:To build a hospital bed resource allocation model, for the reference of public hospitals in optimizing their bed resource allocation.Methods:Based on ReLU activation function, a hospital bed resource allocation model was constructed by combining DRG and public hospital performance appraisal requirements, including discharge person times, average length of stay, hospital bed utilization rate, proportion of surgery, proportion of fourth level surgery, case mix index, average bed day income and other indicators. When the existing number of hospital beds available was greater than the number of hospital beds allocated for the first time, a secondary allocation should be made. A tertiary general hospital was taken as an example for a model analysis.Results:As found in the model analysis, among the 2 729 beds of the hospital in the first allocation, 110 beds were left available for secondary allocation. The results of bed allocation of 40 inpatient departments in the hospital were as follows: 15 departments need more beds, 3 departments need more beds and shorter length of stay, 2 departments need no change, 1 department needs shorter length of stay, 4 departments need less beds, and 15 departments need less beds and shorter length of stay.Conclusions:The bed resource allocation model enriches the connotation of indicators, reflects the specialty characteristics. These indicators can be flexibly adjusted in combination with hospital development planning and budget management, hence conducive to refined management of hospital bed resources in public hospitals.

Autism spectrum disorder (ASD), a representative disease of children's neurodevelopmental disorders, brings huge pressure and financial burden to families and society. It is of great significance to explore its etiology and pathogenesis. Therefore, we established an ASD Cohort based on the existing China National Birth Cohort (CNBC), which applied parallel design to recruit and follow up families who achieved pregnancy after receiving assisted reproductive technologies (ART) and families with spontaneous conception. The main aims of this study are to compare the incidence of ASD among children born after ART with those born under spontaneous pregnancy, and to evaluate the impact of ART on the neurobehavioral development of offspring. Additionally, with a variety of clinical and behavioral related information collected during pregnancy and at early life of offspring, we are able to investigate the risk factors associated with ASD comprehensively. This article briefly introduces the objectives, contents, preliminary progress, strength and limitations, as well as further prospects of the ASD cohort study, mainly focusing on the overall design and current progress.

Objective To evaluate the utilization of human serum albumin (HSA ) in intensive care unit (ICU ) to pro-mote rational use of HSA clinically .Methods Data were collected from the patients received HSA therapy during the period of January 1 ,2015 to December 31 ,2015 .The indications and usage of HSA were analyzed statistically .Results 416 bottles of HSA were administered to 64 patients .The average dose was 62 .5g per patient .The most popular indication was for hypopro-teinemia (39 .1% ) followed by encephaledema ,craniocerebral trauma ,shock and tumors .Before the HSA therapy ,36 patients (56 .3% ) had albumin level of 15-25 g/L and 23 patients (35 .9% ) of 25-35 g/L .Conclusion HSA is widely used in ICU for different indications .Some misuses still exist .Guidelines for proper use of HSA are needed to guarantee its rational use .HSA should be used strictly following these guidelines .

Objective To compare the whole brain grey matter volume(GMV)in first-episode major depressive disorder (MDD) with different age-onset. Methods 101 first-episode, drug-naive depressive patients were divided into three groups on the basis of age of MDD onset: 32 patients with early adult onset depression (18-29 years,EOD), 39 patients with middle age onset depression (30-44 years, MOD), and 30 patients with late adult onset depression (45-60 years, LOD). A total of 91 healthy controls (HCs),well matched by age and gender, were also collected into three groups: the 32 young HCs (18-29 years), the 30 middle-aged HCs (30-44 years), and the 29 late onset HCs (45-60 years). Magnetic resonance imaging was conducted on all subjects. The voxel-based morphometry (VBM) approach was employed to analyze the images. Results Compared to young HCs, the EOD group showed decreased GMV in the left thalamus, right lingual gyrus, right cuneus and cerebellumⅥ(t=-4.26--3.58,all P<0.01), and increased GMV in right angular gyrus(t=4.45,P<0.01). Compared to middle-aged HCs, the MOD group showed decreased GMV in the right middle frontal gyrus(t=-3.62,P<0.01). Compared to late onset HCs, the LOD group exhibited decreased GMV in the right middle temporal gyrus, right lingual gyrus, left fusiform gyrus and bilateral cerebellum Ⅸ(t=-4.87--3.91,P<0.01), but an increased right amygdala(t=3.36,P<0.01). The full factorial analysis revealed that the right middle frontal gyrus(t=7.40)and right cerebellum Crusl (t=7.20)were significantly different among the three patient subgroups(P<0.005,unadjusted). The whole brain GMV of EOD and MOD subgroups positively correlated with the symptom severity(r=0.553-0.641,P<0.01), while the whole brain GMV of LOD subgroup negatively correlated with their symptom severity (r=- 0.626,P<0.01). Conclusions Individuals with MDD may have the GMV reduced in the limbic-cortical-striatal-pallidal-thalamic (LCSPT) circuit. The whole GMV changes are different in MDD patients with various age-onsets. The findings may suggest different pathophysiological characteristics among first episode MDD patients with different age-onset.

Objective To compare the whole brain grey matter volume(GMV)in first-episode major depressive disorder (MDD) with different age-onset. Methods 101 first-episode, drug-naive depressive patients were divided into three groups on the basis of age of MDD onset: 32 patients with early adult onset depression (18-29 years,EOD), 39 patients with middle age onset depression (30-44 years, MOD), and 30 patients with late adult onset depression (45-60 years, LOD). A total of 91 healthy controls (HCs),well matched by age and gender, were also collected into three groups: the 32 young HCs (18-29 years), the 30 middle-aged HCs (30-44 years), and the 29 late onset HCs (45-60 years). Magnetic resonance imaging was conducted on all subjects. The voxel-based morphometry (VBM) approach was employed to analyze the images. Results Compared to young HCs, the EOD group showed decreased GMV in the left thalamus, right lingual gyrus, right cuneus and cerebellumⅥ(t=-4.26--3.58,all P<0.01), and increased GMV in right angular gyrus(t=4.45,P<0.01). Compared to middle-aged HCs, the MOD group showed decreased GMV in the right middle frontal gyrus(t=-3.62,P<0.01). Compared to late onset HCs, the LOD group exhibited decreased GMV in the right middle temporal gyrus, right lingual gyrus, left fusiform gyrus and bilateral cerebellum Ⅸ(t=-4.87--3.91,P<0.01), but an increased right amygdala(t=3.36,P<0.01). The full factorial analysis revealed that the right middle frontal gyrus(t=7.40)and right cerebellum Crusl (t=7.20)were significantly different among the three patient subgroups(P<0.005,unadjusted). The whole brain GMV of EOD and MOD subgroups positively correlated with the symptom severity(r=0.553-0.641,P<0.01), while the whole brain GMV of LOD subgroup negatively correlated with their symptom severity (r=- 0.626,P<0.01). Conclusions Individuals with MDD may have the GMV reduced in the limbic-cortical-striatal-pallidal-thalamic (LCSPT) circuit. The whole GMV changes are different in MDD patients with various age-onsets. The findings may suggest different pathophysiological characteristics among first episode MDD patients with different age-onset.

OBJECTIVETo retrospectively analyze the clinicopathology of patients with gastric gastrointestinal stromal tumor(gGIST) who underwent radical excision within 18 years in 10 domestic medical centers in order to understand the status of domestic surgical treatment of gGIST.

METHODSClinicopathological data of gGIST patients undergoing radical excision in 10 medical centers from January 1998 to January 2016 were collected, and their operational conditions, postoperative adjuvant therapy, gene detection and survival were analyzed retrospectively.

RESULTSA total of 1 846 cases were recruited in this study, including 246 cases from Guangdong General Hospital, 331 cases from Sun Yat-sen University Cancer Center, 374 cases from Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, 342 cases from Nanfang Hospital of Southern Medical University, 265 cases from Fujian Medical University Union Hospital, 148 cases from Fudan University Shanghai Cancer Center, 49 cases from West China Hospital of Sichuan University, 43 cases from Peking University Cancer Hospital and Institute, 28 cases from the 81st Hospital of Pepole's Liberation Army(PLA), 20 cases from Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute. There were 918 male (49.7%) and 928 female patients (50.3%) with median onset age of 59(18 to 95) years old. Fundus(735 cases, 39.8%) and body (781 cases, 42.3%) of stomach were the common sites of lesions. The average size of tumor was (5.3±4.6) cm. There were 1 421 cases with mitotic count ≤5(77.0%). According to the operation procedure, 924 cases (50.1%) underwent laparoscopic surgery, 759 cases (41.1%) laparotomy, 120 cases (6.5%) endoscopic surgery, and 20 cases (1.1%) laparoscopic combined with endoscopic surgery, 6 cases (0.3%) laparoscopic excision surgery through gastric wall and cavity, and 17 cases (0.9%) laparoscopy and then were transferred to laparotomy. Wedge excision were performed in 1 308 cases (70.9%), proximal gastric excision in 226 cases(12.2%), distal gastric excision in 92 cases (5.0%), total gastrectomy in 94 cases (5.1%), and local gastrectomy in 126 cases(6.8%). Multi-visceral excision was performed in 138 cases, and the splenectomy was performed in 83 cases(60.1%)with the highest ratio. According to modified NIH classification, 399 cases(21.6%) were extreme low risk, 580 cases(31.4%) were low risk, 424 cases(23.0%) were moderate risk, 443 cases (24.0%) were high risk. A total of 461 cases received postoperative imatinib adjuvant therapy, accounting for 53.2%(461/867) of patients with moderate and high risk. Among 1 846 cases, 1 402 cases (75.9%) had complete follow-up data and the median follow-up time was 33.6 (0.1 to 158) months. The 5-year survival rates of extreme low risk, low risk, moderate risk and high risk were 100%, 98.5%, 92.5%, and 79.2% with significant difference(P=0.000).

CONCLUSIONSGastric GIST occurs mostly in fundus and body of stomach in China. Wedge excision is the main operational procedure and laparoscopic operation is over 50%. General prognosis of gastric GIST is quite good.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents ; therapeutic use ; China ; Combined Modality Therapy ; Female ; Gastrectomy ; Gastrointestinal Neoplasms ; Gastrointestinal Stromal Tumors ; pathology ; surgery ; Humans ; Imatinib Mesylate ; therapeutic use ; Laparoscopy ; Laparotomy ; Male ; Middle Aged ; Postoperative Period ; Prognosis ; Retrospective Studies ; Splenectomy ; Stomach Neoplasms ; pathology ; surgery ; Survival Rate ; Young Adult

Objective To study the cholesterol nuclear-cytoplasmic interaction effect and position cholesterol traits QTL in mice.Methods Improving the nuclear-cytoplasmic interaction models and methods that have been constructed, and analyzing the public database of total cholesterol and lipoprotein data of F2 group that derived from DBA/2J ( D2) and CAST/EiJ ( CAST) mice.Results Six QTL that controlling total cholesterol, HDL and nonHDL were located in 4 linkage groups in the genome.In the models constructed in this study, we found a QTL has significant interaction with cytoplasmic background, which changes the previous results of data analysis, the genetic mouse cholesterol and lipoprotein components opened up new ideas.Conclusion Mouse cholesterol trait is the result of interaction of nuclear genes and cytoplasmic background.