Objective:To explore the predictive role of dynamic changes in serum Golgi protein 73 (GP73) and its inflammatory influencing factors on the reversal of hepatitis B virus-related liver fibrosis.Methods:Two hundred and seventy-eight patients with hepatitis B virus-related liver fibrosis who received entecavir or combined Fuzheng Huayu tablets treatment and completed two liver biopsies (biopsy) in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from September 2014 to July 2019 were selected. The correlation between serum GP73 level and fibrosis stage (Ishak) and inflammation grade (HAI) was analyzed. The patients were divided into a fibrosis reversal group (Ishak decreased≥1 point) and a non-reversal group (Ishak score remained unchanged or increased), and an inflammation improvement group (ΔHAI≤-2) and a non-improvement group (ΔHAI>-2) according to the pathological changes of liver tissue before and after treatment. The cross-sectional value of GP73, its change value (ΔGP73), and the role of inflammatory influencing factors on the liver before and after treatment were evaluated for their predictive efficacy regarding liver fibrosis regression. The receiver operating characteristic curve was used to explore the predictive value of serum ΔGP73 combined with liver stiffness change value (ΔLSM) for the reversal of hepatitis B virus-related liver fibrosis. One-way analysis of variance was used to compare the data between the groups of quantitative data, and a paired t-test or rank sum test was used for the data before and after treatment. The χ2 test was used to compare the differences between the groups of enumeration data. Spearman and Pearson correlation methods were used for correlation analysis. Results:The serum GP73 level was higher in the cirrhosis group than that in the group without significant fibrosis ( P<0.01). The GP73 level was higher in patients with moderate and severe inflammation than that in the mild group ( P<0.05). Pre-treatment serum GP73 was positively correlated with fibrosis stage ( r=0.248), inflammation grade ( r=0.318), and alanine aminotransferase level ( r=0.203) ( P<0.01). The area under the receiver operating characteristic curve (AUROC) for the predictive ability of post-treatment GP73 levels in the fibrosis reversal was 0.633 (95% CI: 0.573-0.689, sensitivity 62.68%, and specificity 59.56%). The decrease in ΔGP73 was significantly higher in the liver fibrosis reversal group ( n=142) than that in the non-reversal group ( n=136) [-39.22(-85.08,-14.31) ng/mL vs. -30.06(-61.29,-5.84) ng/mL, P<0.01]. ΔGP73 was also associated with liver inflammation changes (AUROC=0.634, 95% CI: 0.574-0.690, sensitivity of 51.64%, specificity of 69.87%). Additionally, the predictive effectiveness of GP73 for fibrosis reversal improved after normalization of serum ALT (AUROC: 0.651 vs. 0.522 at baseline). ΔGP73 combined with ΔLSM had improved the AUROC predictive effectiveness from single indicators of 0.609 (ΔGP73) and 0.656 (ΔLSM) to 0.800 (95% CI: 0.662-0.899), with specificity increasing from 72.22% to 86.11%. Conclusion:Serum GP73 level is positively correlated with the degree of liver fibrosis and inflammation. Serum GP73 levels and ΔGP73 can predict the reversal of fibrosis, with liver inflammation being an important influencing factor following treatment. ΔGP73 combined with ΔLSM can significantly optimize the evaluation efficiency of liver fibrosis reversal.

Objective:To explore the predictive role of dynamic changes in serum Golgi protein 73 (GP73) and its inflammatory influencing factors on the reversal of hepatitis B virus-related liver fibrosis.Methods:Two hundred and seventy-eight patients with hepatitis B virus-related liver fibrosis who received entecavir or combined Fuzheng Huayu tablets treatment and completed two liver biopsies (biopsy) in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from September 2014 to July 2019 were selected. The correlation between serum GP73 level and fibrosis stage (Ishak) and inflammation grade (HAI) was analyzed. The patients were divided into a fibrosis reversal group (Ishak decreased≥1 point) and a non-reversal group (Ishak score remained unchanged or increased), and an inflammation improvement group (ΔHAI≤-2) and a non-improvement group (ΔHAI>-2) according to the pathological changes of liver tissue before and after treatment. The cross-sectional value of GP73, its change value (ΔGP73), and the role of inflammatory influencing factors on the liver before and after treatment were evaluated for their predictive efficacy regarding liver fibrosis regression. The receiver operating characteristic curve was used to explore the predictive value of serum ΔGP73 combined with liver stiffness change value (ΔLSM) for the reversal of hepatitis B virus-related liver fibrosis. One-way analysis of variance was used to compare the data between the groups of quantitative data, and a paired t-test or rank sum test was used for the data before and after treatment. The χ2 test was used to compare the differences between the groups of enumeration data. Spearman and Pearson correlation methods were used for correlation analysis. Results:The serum GP73 level was higher in the cirrhosis group than that in the group without significant fibrosis ( P<0.01). The GP73 level was higher in patients with moderate and severe inflammation than that in the mild group ( P<0.05). Pre-treatment serum GP73 was positively correlated with fibrosis stage ( r=0.248), inflammation grade ( r=0.318), and alanine aminotransferase level ( r=0.203) ( P<0.01). The area under the receiver operating characteristic curve (AUROC) for the predictive ability of post-treatment GP73 levels in the fibrosis reversal was 0.633 (95% CI: 0.573-0.689, sensitivity 62.68%, and specificity 59.56%). The decrease in ΔGP73 was significantly higher in the liver fibrosis reversal group ( n=142) than that in the non-reversal group ( n=136) [-39.22(-85.08,-14.31) ng/mL vs. -30.06(-61.29,-5.84) ng/mL, P<0.01]. ΔGP73 was also associated with liver inflammation changes (AUROC=0.634, 95% CI: 0.574-0.690, sensitivity of 51.64%, specificity of 69.87%). Additionally, the predictive effectiveness of GP73 for fibrosis reversal improved after normalization of serum ALT (AUROC: 0.651 vs. 0.522 at baseline). ΔGP73 combined with ΔLSM had improved the AUROC predictive effectiveness from single indicators of 0.609 (ΔGP73) and 0.656 (ΔLSM) to 0.800 (95% CI: 0.662-0.899), with specificity increasing from 72.22% to 86.11%. Conclusion:Serum GP73 level is positively correlated with the degree of liver fibrosis and inflammation. Serum GP73 levels and ΔGP73 can predict the reversal of fibrosis, with liver inflammation being an important influencing factor following treatment. ΔGP73 combined with ΔLSM can significantly optimize the evaluation efficiency of liver fibrosis reversal.

Objective To summarize the endoscopic and clinical diagnosis and treatment of 4 cases of gastric fundus adenocarcinoma.Method A retrospective analysis was conducted on the clinical data of four cases of gastric fundus adenocarcinoma from July 2021 to December 2023.Result All the 4 cases of gastric fundus adenocarcinoma were completely removed by endoscopic submucosal dissection(ESD),with good postoperative recovery,no surgical complications,and no recurrence or metastasis during follow-up.Conclusion ESD treatment for gastric fundus adenocarcinoma is safe,reliable,and can completely remove the lesion.

Objective: To investigate the quantitative evaluation efficiency of gadolinium- ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced T₁ mapping in staging hepatic fibrosis caused by viral hepatitis B. Methods: One hundred and fifty patients with chronic hepatitis B were prospectively enrolled in Shanghai Public Health Clinical Center, Fudan University from August 2016 to August 2018.These patients underwent liver aspiration biopsy were divided into four subgroups: S1 (n=38), S2 (n=30), S3 (n=33), S4 (n=49) according to Scheuer-Ludwig scoring system. Non-enhanced and Gd-EOB-DTPA-enhanced MRI were performed in all subjects. Look-Locker sequences were performed to acquire T₁ mapping of pre and post-contrast at 20 minutes after Gd-EOB-DTPA administration. The T₁ value after 20 minutes of Gd-EOB-DTPA administration (T_{1 20 min}), the reduction rate of T₁ value (ΔT_{1 20 min}%), the increase of 1/T₁ value (ΔR_{1 20 min}%) were measured and calculated. The one-way ANOVA was applied to compare the difference in T_{1 20 min}, ΔT_{1 20 min}%, ΔR_{1 20 min}% of various fibrosis stages. ROC curves were used to assess the efficacy of T_{1 20 min}, ΔT_{1 20 min}%, ΔR_{1 20 min}% for diagnosing ≥ S2, ≥ S3, ≥ S4. P<0.05 was considered to be statistically significant. Results: The T_{1 20 min} raised with fibrosis stage increased, ΔT_{1 20 min}% and ΔR_{1 20 min}% reduced with fibrosis stage increased. Areas under the curves of T_{1 20 min}, ΔT_{1 20 min}%, ΔR_{1 20 min}% for diagnosing ≥ S2 were 0.844, 0.905, 0.869; and diagnosing ≥ S3 were 0.832, 0.907, 0.862; and diagnosing ≥ S4 were 0.853, 0.897, 0.873, respectively. The diagnostic efficiency of ΔT_{1 20 min}% was the best. Conclusion Gd-EOB-DTPA-enhanced T₁ mapping could be regarded as a reliable diagnostic tool for the evaluation of hepatic fibrosis caused by viral hepatitis B.

Objective To investigate the quantitative evaluation efficiency of gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid (Gd?EOB?DTPA) enhanced T1 mapping in staging hepatic fibrosis caused by viral hepatitis B. Methods One hundred and fifty patients with chronic hepatitis B were prospectively enrolled in Shanghai Public Health Clinical Center, Fudan University from August 2016 to August 2018.These patients underwent liver aspiration biopsy were divided into four subgroups: S1 (n=38), S2 (n=30), S3 (n=33), S4 (n=49) according to Scheuer?Ludwig scoring system. Non?enhanced and Gd?EOB?DTPA?enhanced MRI were performed in all subjects. Look?Locker sequences were performed to acquire T1 mapping of pre and post?contrast at 20 minutes after Gd?EOB?DTPA administration. The T1 value after 20 minutes of Gd?EOB?DTPA administration (T1 20 min), the reduction rate of T1 value (ΔT1 20 min% ), the increase of 1/T1 value (ΔR1 20 min% ) were measured and calculated. The one?way ANOVA was applied to compare the difference in T1 20 min, ΔT1 20 min%, ΔR1 20 min% of various fibrosis stages. ROC curves were used to assess the efficacy of T1 20 min, ΔT1 20 min%, ΔR1 20 min% for diagnosing≥S2,≥S3,≥S4. P<0.05 was considered to be statistically significant. Results The T1 20 min raised with fibrosis stage increased, ΔT1 20 min% and ΔR1 20 min% reduced with fibrosis stage increased. Areas under the curves of T1 20 min, ΔT1 20 min%, ΔR1 20 min% for diagnosing≥S2 were 0.844, 0.905, 0.869; and diagnosing≥S3 were 0.832, 0.907, 0.862; and diagnosing≥S4 were 0.853, 0.897, 0.873, respectively. The diagnostic efficiency of ΔT1 20 min% was the best. Conclusion Gd?EOB?DTPA?enhanced T1 mapping could be regarded as a reliable diagnostic tool for the evaluation of hepatic fibrosis caused by viral hepatitis B.

Objective To explore the death risk factors of septic myocardial depression (SMD) and their predictive effect, and to set up a death early-warning model. Methods A retrospective analysis was conducted. The patients with SMD admitted to emergency department and rescue room of Beilun Branch of the First Affiliated Hospital of Zhejiang University Medical College from January 2015 to November 2017 were enrolled. The patients were divided into survival group and non-survival group according to 28-day outcome, and the gender, age, and the initial examination parameters [white blood cell (WBC) count, neutrophil (Neut) count, activated partial thromboplastin time (APTT), procalcitonin (PCT), D-dimer, C-reactive protein (CRP), cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left atrium diameter (LAD)] of both groups were compared. Binary logistic regression analysis was conducted on the factors with statistically significant difference analyzed in univariate analysis, and death early-warning model was set up subsequently. For parameters in early-warning model after variable screening, receiver operating characteristic curve (ROC) was applied to evaluate the predictive effect of death. Results A total of 129 patients were enrolled, 34 patients died within 28 days with the mortality of 26.4%. Univariate analysis showed that the PCT, cTnI and NT-proBNP in non-survival group were significantly higher than those of the survival group. However, there was no statistical difference in gender, age, WBC, Neut, APTT, D-dimer, CRP, LVEF, LVEDD or LAD between the two groups. Logistic stepwise regression analysis showed that PCT and cTnI were the independent factors influencing the death of patients with SMD [PCT: odds ratio (OR) =1.495, 95% confidence interval (95%CI) = 1.192-1.876, P = 0.001; cTnI: OR = 11.154, 95%CI = 5.709-17.264, P = 0.004], and the death early-warning model was logP =-3.737+0.402×PCT+2.412×cTnI. According to the statistics of Homser-Lemeshow, the effect of this model was good (χ2= 6.258, P = 0.617). The analysis of ROC displayed that the area under ROC curve (AUC) of the combination of PCT and cTnI for predicting the prognosis of SMD patients was 0.851, and it was significantly higher than that of PCT and cTnI alone (0.738 and 0.719, respectively, both P < 0.05). When the combination of PCT and cTnI was 0.26, the sensitivity was 79.97%, the specificity was 87.01%, the positive predictive value was 71.3%, and the negative predictive value was 91.7%. Conclusions PCT and cTnI are independent factors influencing the death of SMD patients. The combination of PCT and cTnI has predictive value for the prognosis of SMD patients. The death early-warning model of SMD patients can be used to predict the prognosis of SMD patients.

Objective To explore the value of prenatal ultrasound in diagnosis of omphalocele-exstrophy-imperforate anusspinal defects (OEIS) in first trimester.Methods Prenatal ultrasonic characteristics of 10 fetuses with OEIS complex in first trimester were retrospectively analyzed and compared with autopsy results.Results Cystic bulging in the lower anterior abdominal wall was observed in all 10 fetuses.Spinal scoliosis dysplasia was found in 10 fetuses,with myelomeningocele in 3 fetuses.No normal bladder was visualized in 8 fetuses.Thickened nuchal translucency was noticed in 5 fetuses,among which neck lymphatic hydrocele was found in 1 fetus.The bilateral clubbed feet and left lower mutilation was observed in 1 fetus,respectively.All 10 OEIS complex fetuses were found accompanied with short umbilical cord,while single umbilical artery and umbilical cord cyst were found in 4 and 1 fetus,respectively.Autopsy showed abdominal wall defects with exstrophy in 10 fetuses.However,no complete cystic bulging was found.Besides,autopsy also showed pubic symphysis separation and bladder exstrophy in 10 fetuses without obvious genitalia nor anus.Conclusion Cystic bulging in the lower anterior abdominal wall is the most common prenatal ultrasonic characteristic of OEIS complex in first trimester.

Objective: To analyze the association of cytogenetic abnormalities with the prognosis of chronic myeloid leukemia (CML) patients in tyrosine kinase inhibitors (TKI) era. Methods: Karyotype analysis of chromosome G-banding was carried out in 387 newly diagnosed CML patients by short-term culture of bone marrow cells. The correlation of cytogenetic abnormalities and CML progression was explored in combination with ABL tyrosine point mutations. Result: Of 387 patients with positive BCR-ABL fusion gene assayed by fluorescence in situ hybridization (FISH) technique, 94.1% (364/387) patients were Ph positive and 5.9% (23/387) Ph negative; 320 patients (87.9%) had a translocation t (9;22) (q34;q11) and 5 (1.4%) a variant translocation t (v;22) . Additional cytogenetic aberrations (ACA) at diagnosis were found in 10.7% (39/387) Ph⁺ patients, major route ACA in 22 (56.4%) cases and minor route ACA in 15 (38.5%) cases and 2 patients (5.1%) lacked the Y chromosome (−Y) ; 23.4% (71/303) patients occurred ACA during TKI treatment and the most frequent abnormalities were abnormal chromosome numbersd, which were likely associated with high proportion of disease progression (χ²=168.21, P<0.001) and ABL tyrosine point mutations (χ²=29.04, P<0.001) . Newly diagnosed CML-CP patients with t (9;22) (q34;q11) had a longer event-free survival (EFS) and disease-free survival (DFS) rates than that of patients with ACA (P=0.037; P=0.003) , while the overall survival (OS) had no significant differences (P=0.209) . As for CML-CP patients that occurred ACA during TKI therapy would have a marked low OS, EFS and DFS (all P<0.001) compared with no ACA occurred patients. Survival of advanced patients that occurred ACA were dramatically reduced. Conclusion ACA often emerged during the disease progress in CML patients, regular and timely detection of chromosomes karyotype and ABL tyrosine point mutations during TKI treatment was important for therapeutic evaluation, progress and prognosis of CML.

Objective: To investigate the clinical implications of p16 gene deletion in adult Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph⁺ ALL) . Methods: Retrospective analysis of clinical, immunophenotypic, cytogenetics, molecular characteristics and prognosis of 80 newly diagnosed Ph⁺ ALL patients with p16 deletion. Results: Of 80 adult Ph⁺ ALL, the prevalence of p16 gene deletion was 31.3%. p16 gene deletion carriers frequently accompanied with high WBC counts (WBC≥30×10⁹/L) and CD20 expression. The incidence of complex chromosome abnormality in p16 gene deletion group was higher than that in non-deletion group, with alternations in chromosome 7, 8, 19 and der (22) more frequently observed. There was no difference occurred between patients with or without p16 gene deletion in complete remission (CR) rate following induction chemotherapy combined with tyrosine kinase inhibitors (TKIs) . However, after three cycles of chemotherapy, the MMR and CMR rate in the p16 gene deletion group was lower than patients with wild-type p16 gene (P=0.034, P=0.036) . The p16 gene deletion patients showed no significant differences in MMR, CMR and relapse rate between Imatinib or Dasatinib plus chemotherapy (P>0.05) . Deletion of p16 gene was significantly associated with poor outcomes including worse overall survival (OS) (37.1% vs 54.1%, P=0.037) , lower disease free-survival (DFS) (12.4% vs 45.9%, P=0.026) , and increased cumulative incidence of relapse (P=0.033) . Among the 25 patients with p16 deletion, 14 underwent allo-HSCT and the median survival was 21 months, better than that of patients received chemotherapy alone (12 months) (P=0.030) . Conclusion This study indicated that deletion of p16 was associated with poor prognosis in adult Ph⁺ ALL, and the utility of second-generation TKI (Dasatinib) does not necessarily have an edge on efficacy over Imatinib, but allo-HSCT has the potential of elongating life expectancy. It is an important significance to define the status of p16 in Ph⁺ ALL for predicting prognosis and guiding therapy decision-making.

Objective To explore the clinical value of total hemihepatic vascular exclusion (THHVE) in right hepatectomy for hepatocellular carcinoma (HCC). Methods One hundred and twenty-three consecutive patients who underwent right hepatectomy for HCC between February 2006 and December 2008 were studied retrospectively. THHVE was used in 58 patients (group A) and Pringle maneuver in 65 patients (group B). The patient's demographics,surgical procedure and outcome were collected and compared between the two groups.ResultsThe tumor size was significantly bigger in group A than group B (7.69±3.70 cm vs.6.08±4.07 cm,P＜0.05).The vascular occlusion time in group A was significantly longer than groupB (28.55±8.67 min vs.19.85±6.71 min,P＜0.05). However, intraoperative blood loss in group A was significantly less than group B (304.31±270.36 ml vs.542.62±876.84 ml,P＜0.05),and the elevation of serum alanine aminotransferase (ALT) on day- 1,-3 and- 7 after operation in group A were significantly lower than group B (P＜0.05).The postoperative complication rate in group A was lower than group B (18.97％ vs.38.46％,P＜0.05).ConclusionTHHVE was a safe and efficacious technique in right hepatectomy for HCC.It significantly decreased blood loss,alleviated liver injury and reduced postoperative morbidity and mortality.