Background/Aims: Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy. Methods: We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues. Results: We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts. Conclusion Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.

Objective:To investigate the ameliorative effects of N-acetyl-D-mannosamine(ManNAc) on glucose and lipid metabolic disorders in obese mice.Methods:In vivo experiments were conducted using 21 four-week-old C57BL/6JGpt mice, randomly divided into three groups( n=7 per group): a normal control group, a high-fat diet(HFD) control grooup, and a ManNAc treatment group(400 mg·kg -1·d -1). The intervention lasted for 20 weeks. Body weight, food intake, and fasting blood glucose levels were monitored weekly. Glucose tolerance tests(GTT), insulin sensitivity tests(ITT), and respiratory metabolism monitoring were performed in the 17th, 18th, and 19th weeks, respectively. At the end of the experiment, whole-body fat distribution was assessed, and serum lipid profiles were measured. Liver and adipose tissue weights were recorded, and histological analyses including HE staining of liver, adipose and pancreatic tissues were performed. Liver transcriptome sequencing and quantitative real-time PCR(qPCR) were conducted to evaluate hepatic gene expression. In vitro, a hepatic steatosis model was established by inducing HepG2 cell with 0.4 mmol/L oleic acid, followed by treatment with 500 μg/mL ManNAc. Lipid accumulation was assessed using BODIPY staining, and the expression of lipid metabolism-related genes was quantified by qPCR. Results:ManNAc administration attenuated HFD-induced weight gain, reduced total body fat volume, and decreased liver and adipose tissue weights as well as intracellular lipid accumulation. Pancreatic islet numbers increased, while fasting blood glucose levels, glucose tolerance, and insulin sensitivity significantly improved. Serum levels of triglycerides, total cholesterol, and low-density lipoprotein levels were decreased, accompanied by enhanced energy expenditure. Additionally, hepatic expression of Cd36, Fabp3, and Scd1 was downregulated. In vitro, ManNAc significantly reduced lipid accumulation in HepG2 cells and downregulated the expression of Cd36, Fabp3, and Scd1 genes.Conclusion:ManNAc may improve glucose and lipid metabolism by modulating the PPARs-mediated fatty acid metabolic pathway, reducing lipogenesis, promoting fatty acid oxidation and energy expenditure, and enhancing insulin sensitivity, ultimately ameliorating disorders in obese mice.

Objective:To investigate the ameliorative effects of N-acetyl-D-mannosamine(ManNAc) on glucose and lipid metabolic disorders in obese mice.Methods:In vivo experiments were conducted using 21 four-week-old C57BL/6JGpt mice, randomly divided into three groups( n=7 per group): a normal control group, a high-fat diet(HFD) control grooup, and a ManNAc treatment group(400 mg·kg -1·d -1). The intervention lasted for 20 weeks. Body weight, food intake, and fasting blood glucose levels were monitored weekly. Glucose tolerance tests(GTT), insulin sensitivity tests(ITT), and respiratory metabolism monitoring were performed in the 17th, 18th, and 19th weeks, respectively. At the end of the experiment, whole-body fat distribution was assessed, and serum lipid profiles were measured. Liver and adipose tissue weights were recorded, and histological analyses including HE staining of liver, adipose and pancreatic tissues were performed. Liver transcriptome sequencing and quantitative real-time PCR(qPCR) were conducted to evaluate hepatic gene expression. In vitro, a hepatic steatosis model was established by inducing HepG2 cell with 0.4 mmol/L oleic acid, followed by treatment with 500 μg/mL ManNAc. Lipid accumulation was assessed using BODIPY staining, and the expression of lipid metabolism-related genes was quantified by qPCR. Results:ManNAc administration attenuated HFD-induced weight gain, reduced total body fat volume, and decreased liver and adipose tissue weights as well as intracellular lipid accumulation. Pancreatic islet numbers increased, while fasting blood glucose levels, glucose tolerance, and insulin sensitivity significantly improved. Serum levels of triglycerides, total cholesterol, and low-density lipoprotein levels were decreased, accompanied by enhanced energy expenditure. Additionally, hepatic expression of Cd36, Fabp3, and Scd1 was downregulated. In vitro, ManNAc significantly reduced lipid accumulation in HepG2 cells and downregulated the expression of Cd36, Fabp3, and Scd1 genes.Conclusion:ManNAc may improve glucose and lipid metabolism by modulating the PPARs-mediated fatty acid metabolic pathway, reducing lipogenesis, promoting fatty acid oxidation and energy expenditure, and enhancing insulin sensitivity, ultimately ameliorating disorders in obese mice.

Objective:To observe and explore the therapeutic effect of ankle brain computer interface therapy based on motor imagination on the rehabilitation of lower limb motor function and balance ability in stroke patients with hemiplegia.Method:Total 40 patients with hemiplegia after stroke were randomly divided into an experimental group and a control group using a random number table method,with 20 people in each group.Both groups received con-ventional clinical medicine and conventional rehabilitation treatment.The control group was given additional an-kle stretching robot training,once a day,30min/times,for 2 weeks.The experimental group was given addition-al foot and ankle brain-computer interface treatment based on movement imagination,once a day,30min/time,for 2 weeks,before treatment.After 2 weeks of treatment(after treatment),the Hoggan Micro FET3 tester was used to measure the back flexion muscle strength and active joint range of motion(AROM);Clinical evaluation was conducted using the modified Ashworth muscle tension scale(MAS),Fugl-Meyer lower limb movement score(FMA-LE),Berg balance scale(BBS),functional walking scale(FAC),and 6-minute walk test(6MWT).Result:Three patients in the control group and three patients in the experimental group dropped off.After 2 weeks of treatments,significant improvements were observed on the dorsiflexion muscle strength,dorsiflexion AROM,FMA-LE,BBS,FAC,and 6MWT(P<0.05)in the two groups.The MAS of the experimental group improved significantly(P<0.05)compared with that before treatment.After treatment,there were significant differ-ences in AROM,FMA-LE,and BBS between the two groups(P<0.05).Conclusion:Motor imagery-foot and ankle brain-computer interface therapy can effectively improve lower limb motor function and balance in stroke hemiplegic patients.

Objective:To observe and explore the therapeutic effect of ankle brain computer interface therapy based on motor imagination on the rehabilitation of lower limb motor function and balance ability in stroke patients with hemiplegia.Method:Total 40 patients with hemiplegia after stroke were randomly divided into an experimental group and a control group using a random number table method,with 20 people in each group.Both groups received con-ventional clinical medicine and conventional rehabilitation treatment.The control group was given additional an-kle stretching robot training,once a day,30min/times,for 2 weeks.The experimental group was given addition-al foot and ankle brain-computer interface treatment based on movement imagination,once a day,30min/time,for 2 weeks,before treatment.After 2 weeks of treatment(after treatment),the Hoggan Micro FET3 tester was used to measure the back flexion muscle strength and active joint range of motion(AROM);Clinical evaluation was conducted using the modified Ashworth muscle tension scale(MAS),Fugl-Meyer lower limb movement score(FMA-LE),Berg balance scale(BBS),functional walking scale(FAC),and 6-minute walk test(6MWT).Result:Three patients in the control group and three patients in the experimental group dropped off.After 2 weeks of treatments,significant improvements were observed on the dorsiflexion muscle strength,dorsiflexion AROM,FMA-LE,BBS,FAC,and 6MWT(P<0.05)in the two groups.The MAS of the experimental group improved significantly(P<0.05)compared with that before treatment.After treatment,there were significant differ-ences in AROM,FMA-LE,and BBS between the two groups(P<0.05).Conclusion:Motor imagery-foot and ankle brain-computer interface therapy can effectively improve lower limb motor function and balance in stroke hemiplegic patients.

Objective::To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta (PA).Methods::This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. According to the intraoperative findings after delivery, the study population was divided into PA and non-PA groups. We compared the pregnancy outcomes between the two groups, used multivariate logistic regression to analyze the risk factors for placental accreta.Results::For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage (236/10,205, 2.31% vs. 283/869, 32.57%), severe postpartum hemorrhage (89/10,205, 0.87% vs. 186/869, 21.75%), diffuse intravascular coagulation (3/10,205, 0.03% vs. 4/869, 0.46%), puerperal infection (33/10,205, 0.32% vs. 12/869, 1.38%), intraoperative bladder injury (1/10,205, 0.01% vs. 16/869, 1.84%), hysterectomy (130/10,205, 1.27% vs. 59/869, 6.79%), and blood transfusion (328/10,205,3.21 % vs. 231/869,26.58%) was significantly increased in the PA group ( P < 0.05). At the same time, the neonatal birth weight (3250.00 (2950.00-3520.00) g vs. 2920.00 (2530.00-3250.00) g), the probability of neonatal comorbidities (245/10,205, 2.40% vs. 61/869, 7.02%), and the rate of neonatal intensive care unit admission (817/10,205, 8.01% vs. 210/869, 24.17%) also increased significantly ( P < 0.05). Weight (odds ratio ( OR)= 1.03, 95% confidence interval ( CI): 1.01-1.05)), parity ( OR= 1.18, 95% CI: 1.03-1.34), number of miscarriages ( OR= 1.31, 95% CI: 1.17-1.47), number of previous cesarean sections ( OR= 2.57, 95% CI: 2.02-3.26), history of premature rupture of membrane ( OR= 1.61, 95% CI: 1.32-1.96), previous cesarean-section transverse incisions ( OR= 1.38, 95% CI: 1.12-1.69), history of placenta previa ( OR= 2.44,95% CI: 1.50-3.96), and the combination of prenatal hemorrhage ( OR= 9.95,95% CI: 8.42-11.75) and placenta previa ( OR= 91.74, 95% CI: 74.11-113.56) were all independent risk factors for PA. Conclusion::There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.

Objective::To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta (PA).Methods::This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. According to the intraoperative findings after delivery, the study population was divided into PA and non-PA groups. We compared the pregnancy outcomes between the two groups, used multivariate logistic regression to analyze the risk factors for placental accreta.Results::For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage (236/10,205, 2.31% vs. 283/869, 32.57%), severe postpartum hemorrhage (89/10,205, 0.87% vs. 186/869, 21.75%), diffuse intravascular coagulation (3/10,205, 0.03% vs. 4/869, 0.46%), puerperal infection (33/10,205, 0.32% vs. 12/869, 1.38%), intraoperative bladder injury (1/10,205, 0.01% vs. 16/869, 1.84%), hysterectomy (130/10,205, 1.27% vs. 59/869, 6.79%), and blood transfusion (328/10,205,3.21 % vs. 231/869,26.58%) was significantly increased in the PA group ( P < 0.05). At the same time, the neonatal birth weight (3250.00 (2950.00-3520.00) g vs. 2920.00 (2530.00-3250.00) g), the probability of neonatal comorbidities (245/10,205, 2.40% vs. 61/869, 7.02%), and the rate of neonatal intensive care unit admission (817/10,205, 8.01% vs. 210/869, 24.17%) also increased significantly ( P < 0.05). Weight (odds ratio ( OR)= 1.03, 95% confidence interval ( CI): 1.01-1.05)), parity ( OR= 1.18, 95% CI: 1.03-1.34), number of miscarriages ( OR= 1.31, 95% CI: 1.17-1.47), number of previous cesarean sections ( OR= 2.57, 95% CI: 2.02-3.26), history of premature rupture of membrane ( OR= 1.61, 95% CI: 1.32-1.96), previous cesarean-section transverse incisions ( OR= 1.38, 95% CI: 1.12-1.69), history of placenta previa ( OR= 2.44,95% CI: 1.50-3.96), and the combination of prenatal hemorrhage ( OR= 9.95,95% CI: 8.42-11.75) and placenta previa ( OR= 91.74, 95% CI: 74.11-113.56) were all independent risk factors for PA. Conclusion::There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.

Objective To explore the clinical features and risk factors of post-concussion syndrome (PCS) in patients after mild traumatic brain injury (mTBI).Methods Two hundred and seventy-six patients with mTBI,admitted to our hospital from December 2016 to June 2018,were chosen in our study;114 patients (41.30％) developed PCS.The epidemiological data,causes and sites of brain injury,clinical symptoms,and duration and time of PCS occurrence were investigated.Multivariate Logistic regression was used to analyze the risk factors of PCS in patients with mTBI.Results The most common syndromes of PCS were headache (89.13％),amnesia (63.77％),dizziness (63.04％) and nausea (57.61％).The incidence rate of PCS was 51.75％ in the first month of injury and decreased with time.Multifactor Logistic regression analysis showed that student (P=0.041,OR=0.36,95％ CI:0.14-0.95),electric bicycle accidents (P=0.043,OR=0.54,95％CI:0.30-0.98),and occipital injury (P=0.022,OR=0.28,95％CI:0.09-0.83) were independent risk factors of PCS of mTBI patients.Conclusion Patients with mTBI,especially those who are students,victims of electric bicycle accidents and victims of occipital injury,should be highly alert to the occurrence of PCS,and need reasonable rest,symptomatic treatments and memory training or other rehabilitation treatments within one month of injury,in order to prevent the development of PCS.

Objective: To study the expression of PDCD5 mRNA and its significance in esophageal cancer in Xinjiang Kazakh and Han nationality. Methods: RT-PCR was used to detect the mRNA of PDCD5 in 40 cases of esophageal cancer (18 cases of Kazakh, 22 cases of Han). Results: The positive rate of PDCD5 mRNA expression in 40 samples of esopha-geal cancer tissue, adjacent tissue, and normal tissue was 80.0% (32/40), 80.0% (32/40) and 87.5% (35/40), respectively, with no significant difference (P>0.05). The Ods of cancer tissues, adjacent tissues, and normal tissues were 0.7644± 0.1444, 0.9341 ±0.1631 and 1.8703±0.4767, respectively. The expression of PDCD5 was significantly increased in cancer tissues compared with that in normal tissues (P<0.05). The expression level of PDCD5 mRNA was not significantly correlat-ed with the degree of differentiation and lymph node metastasis. Conclusion: No significant difference was found in PDCD5 mRNA expression in esophageal cancer between Xinjiang kazakh and Han nationality (P>0.05). The expression of PDCD5 is not correlated with the degree of differentiation, depth of invasion or lymph node metastasis. Detection of PDCD5 mRNA expression in esophageal cancer tissues may provide valuable information for patient prognosis.

Objective To detect the DMD gene mutation sites and the regions of breakpoints in Duchenne/Becker muscular dystrophy (DMD/BMD) patients in northern China. Methods Multiplex amplifiable probe hybridization (MLPA) was used to detect the mutation in 59 cases (51 cases with DMD and 8 with BMD) from northern China and dystrophin gene mutations in their parents. Results From northern China and dystrophin gene mutations 59 families found gene deletions in 33 cases of 59 DMD/BMD patients (55.9%), duplications in 6 cases (10. 2%) and point mutation in one case (1.7%). Intron 44 was most frequently affected (n = 13, 33.3%), followed by intron 50 (n = 11, 28.2%) and intron 45 (n=8, 20.5%). The novel mutations were identified, in two patients including two independent duplications carried by patient D1 149 and a point mutation [5208del(A)] carried by patient D1 65, which were not included in Leiden database. In addition, an exon 22 deletion was found in one patient, which was the first reported case in Chinese patients. Conclusions Deletions are mostly located in the hotspot between exon 45 and 50. Duplications mostly occurred in the 5' end of the gene. Intron 44 is the most frequently affected breakpoint in northern Chinese population.