Insufficient future liver remnant volume remains a critical limitation for single-stage resection in patients with hepatic malignancies. The techniques for promoting future liver remnant hypertrophy to realize two-stage hepatectomy include portal vein embolization， associating liver partition and portal vein ligation for staged hepatectomy， and portal vein ligation. In recent years， the application of auxiliary liver transplantation has further facilitated two-stage total hepatectomy. This article systematically reviews the clinical applications of these techniques and analyzes their advantages and limitations， so as to provide a reference for optimizing clinical decision-making.

Objective:This study aims to investigate the differences between two groups of patients treated with nucleos（t）ide analogues（NAs）：those with undetectable HBV DNA by ultrasensitive testing and those with HBV DNA below the quantification limit. The findings will provide a basis for the clinical interpretation and rational use of ultrasensitive HBV DNA results.Methods:This cross-sectional study included patients with chronic HBV infection who were treated with NAs between May 2023 and December 2023 at the outpatient clinic and inpatient department of the Hepatology Department，The Second Hospital of Shandong University. All patients had ultrasensitive HBV DNA results that were either undetectable or less than 20 IU/ml. The group with undetectable ultrasensitive HBV DNA was defined as the target not detected（TND）group，while the group with HBV DNA levels below 20 IU/ml was defined as the limit of quantitation（LOQ）group. Data on patients' sex，age，type of NAs used，routine blood tests，liver and kidney function，quantitative hepatitis B serology，ultrasensitive HBV DNA，HBV pregenomic RNA（pgRNA），abdominal ultrasound，CT or MRI imaging were collected. Differences between the two groups in terms of demographic data and HBV markers were analyzed.Results:A total of 827 patients were included in the study，with 536 patients in the TND group and 291 in the LOQ group. Compared with the TND group，the LOQ group had a younger age（ P<0.001），and higher level of ALT，AST，HBeAg positive rate，HBsAg，and HBV pgRNA（all P<0.001）. Subgroup analyses stratified by HBeAg status，cirrhosis status，and sex showed that the LOQ group had significantly higher levels of HBsAg and HBV pgRNA compared to the TND group in all subgroups（all P<0.05）. Conclusion:The LOQ group had significantly higher levels of HBsAg and HBV pgRNA compared to the TND group.

Adenomyosis(AM)is a common gynecologic disease,which could be more accurately diagnosed based on morphological uterus sonographic assessment(MUSA)criteria.MUSA criteria and clinical application for diagnosing AM were reviewed in this article.

AIM:To investigate the preventive and therapeutic effects of sesamin(SES)on fatty liver disease in rats with hypertension combined with dyslipidemia,and to explore the potential mecha-nisms based on mRNA-seq.METHODS:Spontane-ously hypertensive rats(SHRs)were fed a high-fat,high-cholesterol diet to establish a rat model of hy-pertension combined with dyslipidemia,and then treated with SES for 16 weeks continuously.The ex-periment was divided into four groups:WKY,SHR,Model,and Model+SES(160 mg·kg-1·d-1).Blood pressure was measured using the tail-cuff method.Body weight was monitored,and body mass index was calculated.Liver morphology was detected by ultrasound,and liver thickness was measured.Liver wet weight was weighed,and liver index was calcu-lated.Liver volume was detected by the water dis-placement method.Serum triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),alanine aminotransferase(ALT),aspartate amino-transferase(AST),and total bile acids(TBA)were de-tected by ELISA.Liver sequencing analysis was per-formed using mRNA-seq.Liver histomorphological changes were observed by HE staining.The degree of hepatic steatosis was observed by Oil Red O stain-ing,and the degree of hepatic fibrosis was observed by MASSON staining.The mRNA expression of Al-dh1a7,Nnmt,Irs2,Pltp,and Scd was detected by q-PCR.The protein expression of Scd,Nnmt,AMPK,p-AMPK,PPARα,and PPARγ was detected by Western blotting.RESULTS:After 16 weeks of continuous SES administration to rats with hypertension combined with dyslipidemia,blood pressure was significantly reduced(P＜0.01),and body weight was decreased.Serum TG,TC,and LDL-C levels were decreased,while HDL-C levels were increased.Serum ALT and AST levels were decreased.Liver weight,organ in-dex,liver thickness,and liver volume were de-creased.The degree of hepatic steatosis and hepat-ic fibrosis was improved.A total of 545 differentially expressed mRNAs were identified in the livers of rats in each group,of which 278 were upregulated and 267 were downregulated.Among the 27 com-monly differentially expressed mRNAs,five mRNAs related to lipid metabolism were screened,namely Aldh1a7,Nnmt,Irs2,Pltp,and Scd.KEGG enrich-ment analysis showed that the enriched pathways were AMPK and PPAR.Further validation revealed that in the SES-treated group,the mRNA expression of Scd in the liver was decreased,while the mRNA expression of Nnmt was increased.The protein ex-pression of Scd was decreased,while the protein ex-pression of Nnmt,AMPK,p-AMPK,PPARα,and PPARγ was increased.CONCLUSION:SES has preven-tive and therapeutic effects on fatty liver disease in rats with hypertension combined with dyslipidemia,and its mechanism of action may be related to the reduction of Scd expression levels in the liver and the increase in the expression of Nnmt,AMPK,p-AMPK,PPARα,and PPARγ.

Adenomyosis(AM)is a common gynecologic disease,which could be more accurately diagnosed based on morphological uterus sonographic assessment(MUSA)criteria.MUSA criteria and clinical application for diagnosing AM were reviewed in this article.

AIM:To investigate the preventive and therapeutic effects of sesamin(SES)on fatty liver disease in rats with hypertension combined with dyslipidemia,and to explore the potential mecha-nisms based on mRNA-seq.METHODS:Spontane-ously hypertensive rats(SHRs)were fed a high-fat,high-cholesterol diet to establish a rat model of hy-pertension combined with dyslipidemia,and then treated with SES for 16 weeks continuously.The ex-periment was divided into four groups:WKY,SHR,Model,and Model+SES(160 mg·kg-1·d-1).Blood pressure was measured using the tail-cuff method.Body weight was monitored,and body mass index was calculated.Liver morphology was detected by ultrasound,and liver thickness was measured.Liver wet weight was weighed,and liver index was calcu-lated.Liver volume was detected by the water dis-placement method.Serum triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),alanine aminotransferase(ALT),aspartate amino-transferase(AST),and total bile acids(TBA)were de-tected by ELISA.Liver sequencing analysis was per-formed using mRNA-seq.Liver histomorphological changes were observed by HE staining.The degree of hepatic steatosis was observed by Oil Red O stain-ing,and the degree of hepatic fibrosis was observed by MASSON staining.The mRNA expression of Al-dh1a7,Nnmt,Irs2,Pltp,and Scd was detected by q-PCR.The protein expression of Scd,Nnmt,AMPK,p-AMPK,PPARα,and PPARγ was detected by Western blotting.RESULTS:After 16 weeks of continuous SES administration to rats with hypertension combined with dyslipidemia,blood pressure was significantly reduced(P＜0.01),and body weight was decreased.Serum TG,TC,and LDL-C levels were decreased,while HDL-C levels were increased.Serum ALT and AST levels were decreased.Liver weight,organ in-dex,liver thickness,and liver volume were de-creased.The degree of hepatic steatosis and hepat-ic fibrosis was improved.A total of 545 differentially expressed mRNAs were identified in the livers of rats in each group,of which 278 were upregulated and 267 were downregulated.Among the 27 com-monly differentially expressed mRNAs,five mRNAs related to lipid metabolism were screened,namely Aldh1a7,Nnmt,Irs2,Pltp,and Scd.KEGG enrich-ment analysis showed that the enriched pathways were AMPK and PPAR.Further validation revealed that in the SES-treated group,the mRNA expression of Scd in the liver was decreased,while the mRNA expression of Nnmt was increased.The protein ex-pression of Scd was decreased,while the protein ex-pression of Nnmt,AMPK,p-AMPK,PPARα,and PPARγ was increased.CONCLUSION:SES has preven-tive and therapeutic effects on fatty liver disease in rats with hypertension combined with dyslipidemia,and its mechanism of action may be related to the reduction of Scd expression levels in the liver and the increase in the expression of Nnmt,AMPK,p-AMPK,PPARα,and PPARγ.

BACKGROUND:Spinal osteosarcoma is a rare and highly aggressive malignant tumor.Most existing studies are based on small sample sizes and have inconsistent results,making it difficult to provide reliable clinical guidance.Especially in China,due to the low incidence of spinal osteosarcoma and limited related research,clinicians lack effective prognostic tools during treatment.OBJECTIVE:To construct and validate a nomogram model for predicting the survival of spinal osteosarcoma patients based on the Surveillance,Epidemiology,and End Results(SEER)database,providing scientific evidence for clinical decision-making,particularly for optimizing treatment plans for Chinese patients.METHODS:This study conducted a retrospective analysis of patient data diagnosed with spinal osteosarcoma from the SEER database between 2000 and 2021.First,independent prognostic factors associated with specific mortality from spinal osteosarcoma were identified through univariate and multivariate Cox proportional hazards models.Subsequently,these independent prognostic factors were used to construct a nomogram model for predicting survival rates of spinal osteosarcoma patients using the"rms"package in RStudio.The model's discrimination was assessed using the C-index.Predictive ability was validated through receiver operating characteristic curves and area under the curve values.Calibration was evaluated by calibration plots,and clinical value was measured using decision curve analysis.Additionally,Kaplan-Meier survival analysis was performed to assess the rationality of the nomogram groupings.RESULTS AND CONCLUSION:(1)The final model included six variables:chemotherapy,tumor size,histological type,grade,race,and surgical intervention.(2)The C-indices of the model in the training and validation sets were 0.685 and 0.673,respectively,indicating good discrimination.(3)Calibration curves showed high consistency between predicted survival probabilities and actual survival probabilities.(4)Decision curve analysis indicated that the model provided significant net benefits across a wide range of mortality risks.(5)Kaplan-Meier survival analysis revealed significant differences in prognosis between high-risk and low-risk groups.(6)The constructed nomogram model accurately predicts the 1-year,2-year,and 3-year survival rates of spinal osteosarcoma patients,demonstrating high clinical applicability.This model not only provides an effective survival prediction tool for American patients but also offers important insights for optimizing treatment plans for spinal osteosarcoma patients in China.Future research should further validate the model's applicability in different populations and explore the impact of novel treatment methods on the prognosis of spinal osteosarcoma,aiming to improve the survival rates and quality of life of patients in China.

BACKGROUND:Spinal osteosarcoma is a rare and highly aggressive malignant tumor.Most existing studies are based on small sample sizes and have inconsistent results,making it difficult to provide reliable clinical guidance.Especially in China,due to the low incidence of spinal osteosarcoma and limited related research,clinicians lack effective prognostic tools during treatment.OBJECTIVE:To construct and validate a nomogram model for predicting the survival of spinal osteosarcoma patients based on the Surveillance,Epidemiology,and End Results(SEER)database,providing scientific evidence for clinical decision-making,particularly for optimizing treatment plans for Chinese patients.METHODS:This study conducted a retrospective analysis of patient data diagnosed with spinal osteosarcoma from the SEER database between 2000 and 2021.First,independent prognostic factors associated with specific mortality from spinal osteosarcoma were identified through univariate and multivariate Cox proportional hazards models.Subsequently,these independent prognostic factors were used to construct a nomogram model for predicting survival rates of spinal osteosarcoma patients using the"rms"package in RStudio.The model's discrimination was assessed using the C-index.Predictive ability was validated through receiver operating characteristic curves and area under the curve values.Calibration was evaluated by calibration plots,and clinical value was measured using decision curve analysis.Additionally,Kaplan-Meier survival analysis was performed to assess the rationality of the nomogram groupings.RESULTS AND CONCLUSION:(1)The final model included six variables:chemotherapy,tumor size,histological type,grade,race,and surgical intervention.(2)The C-indices of the model in the training and validation sets were 0.685 and 0.673,respectively,indicating good discrimination.(3)Calibration curves showed high consistency between predicted survival probabilities and actual survival probabilities.(4)Decision curve analysis indicated that the model provided significant net benefits across a wide range of mortality risks.(5)Kaplan-Meier survival analysis revealed significant differences in prognosis between high-risk and low-risk groups.(6)The constructed nomogram model accurately predicts the 1-year,2-year,and 3-year survival rates of spinal osteosarcoma patients,demonstrating high clinical applicability.This model not only provides an effective survival prediction tool for American patients but also offers important insights for optimizing treatment plans for spinal osteosarcoma patients in China.Future research should further validate the model's applicability in different populations and explore the impact of novel treatment methods on the prognosis of spinal osteosarcoma,aiming to improve the survival rates and quality of life of patients in China.

Objective:This study aims to investigate the differences between two groups of patients treated with nucleos（t）ide analogues（NAs）：those with undetectable HBV DNA by ultrasensitive testing and those with HBV DNA below the quantification limit. The findings will provide a basis for the clinical interpretation and rational use of ultrasensitive HBV DNA results.Methods:This cross-sectional study included patients with chronic HBV infection who were treated with NAs between May 2023 and December 2023 at the outpatient clinic and inpatient department of the Hepatology Department，The Second Hospital of Shandong University. All patients had ultrasensitive HBV DNA results that were either undetectable or less than 20 IU/ml. The group with undetectable ultrasensitive HBV DNA was defined as the target not detected（TND）group，while the group with HBV DNA levels below 20 IU/ml was defined as the limit of quantitation（LOQ）group. Data on patients' sex，age，type of NAs used，routine blood tests，liver and kidney function，quantitative hepatitis B serology，ultrasensitive HBV DNA，HBV pregenomic RNA（pgRNA），abdominal ultrasound，CT or MRI imaging were collected. Differences between the two groups in terms of demographic data and HBV markers were analyzed.Results:A total of 827 patients were included in the study，with 536 patients in the TND group and 291 in the LOQ group. Compared with the TND group，the LOQ group had a younger age（ P<0.001），and higher level of ALT，AST，HBeAg positive rate，HBsAg，and HBV pgRNA（all P<0.001）. Subgroup analyses stratified by HBeAg status，cirrhosis status，and sex showed that the LOQ group had significantly higher levels of HBsAg and HBV pgRNA compared to the TND group in all subgroups（all P<0.05）. Conclusion:The LOQ group had significantly higher levels of HBsAg and HBV pgRNA compared to the TND group.

Medical microbiology experiment is faced with many problems in online teaching. This study adopts the teaching mode of online live broadcast + operation video + virtual experiment, and make up the operation gap to some extent through operation video and virtual experiment. The mode of assessment is subjective thinking question (closely following the operation process) + experiment design + literature review (focusing on the key technology or new technology of clinical assessment that cannot be carried out due to the limitation of conditions in traditional experiments, such as mass spectrometry, fluorescence quantitative PCR, and G-test), and it is helpful to understand students' mastery of teaching objectives, and the ability of comprehensive application and innovative thinking. The student questionnaire shows that most students hold a positive attitude towards the online experimental teaching mode, and the quality of students' homework shows that most students have a good learning effect.