Hepatic encephalopathy is a common and serious complication of end-stage liver diseases such as liver cirrhosis， and it is basically a neuropsychiatric syndrome resulting from metabolic disorders caused by severe acute or chronic liver dysfunction or portosystemic shunt. In clinical practice， the onset of hepatic encephalopathy does not completely correlate linearly with the level of blood ammonia and is often triggered by extrahepatic factors， suggesting the presence of complex multiorgan crosstalk in the pathogenesis of hepatic encephalopathy. Based on the four main pathogeneses of ammonia toxicity， inflammation， neurotransmitter imbalance， and oxidative/nitrosative stress， this article systematically elaborates on the mechanism of multiorgan crosstalk in hepatic encephalopathy and discusses the emerging risk factors such as sarcopenia and diabetes mellitus， in order to provide a novel theoretical framework for deepening the understanding of the pathophysiological mechanisms of hepatic encephalopathy and formulating clinical diagnosis and treatment strategies in the future.

The aim of the experiment was to study the effects of Echinacea purpurea extract on the digestive ability,immune function and intestinal barrier of the Bamei ternary pigs.Forty-eight healthy pigs of 50 days old were randomly divided into four groups,each with three replicates and four pigs in each replicate.The control group(CON)was fed a basal diet,and the experimental group was divided into 5 g/kg(T1),10 g/kg(T2)and 15 g/kg(T3)of Echinacea extract in the basal diet.The pre-test period was 5 days and the main test period was 35 days with free feeding and drinking during the test period.The results showed that:There was no significant effect on the apparent digestibility of nutrients and jejunum morphology in the test group compared to the CON group(P＞0.05).Amylase and trypsin activities were significantly higher in the experimental group and lipase activities were significantly higher in T2 and T3 groups compared to CON group(P＜0.05).GSH,CAT and T-AOC activities were significantly higher in the experimental group compared to CON group(P＜0.05).In comparison with CON group,the levels of IL-1 and IL-6 were significantly lower in the experimental group(P＜0.05),and the levels of TNF-α were significantly lower in the T2 and T3 groups(P＜0.05);and the levels of IL-10 were signifi-cantly higher in the T3 group(P＜0.05).The mRNA and protein expression levels of TLR4,MyD88,TRAF6,and NF-κB were significantly lower in the experimental group(P＜0.05).The mRNA and protein expression levels of CLDN-1,OCLN and ZO-1 were significantly increased in the test group(P＜0.05).The results between the test groups showed that the protein expression levels of CLDN-1 and OCLN were significantly increased in the T3 group compared with the T1 group(P＜0.05).In conclusion,the addition of Echinacea extract to the ration can,to a certain ex-tent,improve the digestive ability,balance the immune ability,and improve the intestinal barrier function of the Bamei ternary pigs,thus promoting the intestinal health of pigs.

The aim of the experiment was to study the effects of Echinacea purpurea extract on the digestive ability,immune function and intestinal barrier of the Bamei ternary pigs.Forty-eight healthy pigs of 50 days old were randomly divided into four groups,each with three replicates and four pigs in each replicate.The control group(CON)was fed a basal diet,and the experimental group was divided into 5 g/kg(T1),10 g/kg(T2)and 15 g/kg(T3)of Echinacea extract in the basal diet.The pre-test period was 5 days and the main test period was 35 days with free feeding and drinking during the test period.The results showed that:There was no significant effect on the apparent digestibility of nutrients and jejunum morphology in the test group compared to the CON group(P＞0.05).Amylase and trypsin activities were significantly higher in the experimental group and lipase activities were significantly higher in T2 and T3 groups compared to CON group(P＜0.05).GSH,CAT and T-AOC activities were significantly higher in the experimental group compared to CON group(P＜0.05).In comparison with CON group,the levels of IL-1 and IL-6 were significantly lower in the experimental group(P＜0.05),and the levels of TNF-α were significantly lower in the T2 and T3 groups(P＜0.05);and the levels of IL-10 were signifi-cantly higher in the T3 group(P＜0.05).The mRNA and protein expression levels of TLR4,MyD88,TRAF6,and NF-κB were significantly lower in the experimental group(P＜0.05).The mRNA and protein expression levels of CLDN-1,OCLN and ZO-1 were significantly increased in the test group(P＜0.05).The results between the test groups showed that the protein expression levels of CLDN-1 and OCLN were significantly increased in the T3 group compared with the T1 group(P＜0.05).In conclusion,the addition of Echinacea extract to the ration can,to a certain ex-tent,improve the digestive ability,balance the immune ability,and improve the intestinal barrier function of the Bamei ternary pigs,thus promoting the intestinal health of pigs.

Objective To explore the characteristics of tumor immune microenvironment of pancreatic ductal adenocarcinoma(PDAC)based on the differentially expressed genes associated with macrophages in early and late tumor tissues of PDAC patients,so as to provide new targets for early diagnosis and treatment of PDAC.Methods Three early-stage and 4 late-stage tumor samples were collected from PDAC patients.Tissue transcriptome data were analyzed by single-cell sequencing technology.With The Cancer Genome Atlas(TCGA)database,macrophage related genes differentially expressed in early and late PDAC related to prognosis were obtained.The prognostic risk scoring model was constructed using the least absolute shrinkage and selection operator(LASSO)-Cox method.The risk genes associated with PDAC prognosis were screened using the Gene Expression Profiling Interaction Analysis 2(GEPIA2)online survival analysis tool.Their immune infiltration was analyzed using the cell-type identification by estimating relative subsets of RNA transcripts(CIBERSORT)method,and their expression in different subpopulations of macrophages at different periods was resolved by t-distributed stochastic nearest-neighbour embedding(tSNE)clustering downscaling and the Monocle package.The protein-protein interactions and immunohistochemistry were further analyzed with the help of STRING database and The Human Protein Atlas(HPA)database.Results A total of 48 differentially expressed macrophage-related genes in early and late PDAC were found to be associated with prognosis.Eleven differentially expressed macrophage genes were screened as PDAC prognostic genes,and they were used to construct a prognostic risk scoring model for PDAC.Two prognostic genes with significant risk indicators were screened:2'-5'-oligoadenylate synthetase 2(OAS2)was mainly expressed in secreted phosphoprotein 1(SPP1)-positive macrophages,and assembly factor for spindle microtubules(ASPM)was mainly expressed in proliferation marker protein Ki-67(MKI67)-positive macrophages.There were significant differences in the expression of OAS2 in PDAC macrophages at different stages.Immune infiltration studies showed that OAS2 and ASPM were highly expressed in regulatory T cells and M2-type macrophages(both P＜0.05).Protein-protein interaction network showed the expression relationship between OAS2 and ASPM and other co-expressed proteins.Immunohistochemistry results showed that the expression of OAS2 was higher in tumor tissues than in normal tissues.Conclusion OAS2 and ASPM are both poor prognostic genes that are specifically expressed and exert negative immune effects in SPP1+macrophages and MKI67+macrophages,respectively,promoting the progression of PDAC and ultimately leading to a poor prognosis,and it is expected to provide new targets for the prevention and treatment of PDAC.

Objective:To investigate the effects of intravenous lidocaine infusion (IVLI) on the quality of intraoperative neurophysiologic monitoring (IONM) in patients with thyroid tumor.Methods:A prospective randomized controlled study was conducted. A total of 60 patients with thyroid tumor undergoing thyroidectomy in the First Clinical Medical College of Shanxi Medical University between September 2022 and May 2023 were selected. According to the random number table method, all patients were divided into the lidocaine group and the control group, 30 cases in each group. The patients in the lidocaine group were continually given IVLI during the operation and the patients in the control group were continually given the equal 0.9% NaCl solution infusion during the operation. All patients in the 2 groups were induced by the same way of total intravenous anesthesia, and no muscle relaxants were added during anesthesia except the induction dose, and enhanced nerve monitoring tracheal catheter was inserted in the 2 groups. According to the standardized procedure of IONM, the electrode impedance values were measured at the time of eliciting the V1 and V2 signals from the vagus nerve, respectively, and the difference value was defined as the drop in the aggregate impedance level (DAIL). DAIL, perioperative hemodynamic parameters and postoperative recovery quality were compared between the 2 groups.Results:There were no statistically significant differences in the baseline data, operation time, intraoperative dosage of propofol and remifentanil between the 2 groups (all P > 0.05). Compared with the control group, the lidocaine group had a higher proportion of patients with DAIL<50% [80.0% (24/30) vs. 40.0% (12/30), χ2 = 10.00, P = 0.002], a lower hemodynamic fluctuation during extubation [mean arterial pressure: (95±6) mmHg (1 mmHg = 0.133 kPa) vs. (104±7) mmHg, t = 31.00, P < 0.001; heart rate: (73±5) times/min vs. (92±6) times/min, t = 172.58, P < 0.001], a lower visual analog score 24 h after surgery [(2.0±0.7) scores vs. (3.7±0.8) scores, t = -8.86, P < 0.001], a higher score of quality of recovery-15 scale [(127±11) points vs. (118±13) points, t = 2.92, P = 0.005]. Conclusions:IVIL can improve the quality of IONM in patients with thyroid tumor during surgery, reduce perioperative hemodynamic fluctuation and improve postoperative recovery quality of patients.

Objective:To apply data mining and bibliometric methods to collect and analyze literatures related to the uPMR 790 integrated positron emission tomography/magnetic resonance imaging(PET/MRI)of the United Imaging Healthcare(UIH)and assess its output effects in clinical research and application,continued research and development,performance improvement,technology assessment,healthcare technology management,and other aspects.Methods:To conduct literature searches on data platforms such as China National Knowledge Infrastructure(CNKI),WanFang Data Knowledge Service Platform(WANFANG DATA),Wanfang Medical Network(WANFANG MED ONLINE),Chinese Medical Association Journal Database(Yiigle),NIH/PubMed,etc.Based on literature review,to implement bibliometric analysis and evaluate from several technological output dimensions.Results:134 sample literatures were obtained.Among them,there are 121 journal articles,10 dissertations(1 doctoral dissertation and 9 master's theses),3 case reports from the Chinese Medical Case Repository,59 of foreign language journals,and 101 articles sourced from uPMR 790 users as the first author affiliation.Engineering and technical personnel from UIH participated in 58 journal articles;89 clinical research articles,accounting for 66.42%of the sample literatures,15 engineering research and artificial intelligence(AI)research articles,accounting for 11.19%,15 technology assessment articles,accounting for 11.19%,4 healthcare technology management articles,1 experimental research article,and 10 reviews.In addition,33 related patent technologies were retrieved from UIH and its cooperative institutions,as well as UIH PET/MRI equipment users,including 20 invention patents,13 utility model patents.Conclusion:The research results show that the innovative medical equipment,the uPMR 790 PET/MRI,has definite technological outputs in clinical research and application,providing important and widely data of evidence-based medicine for clinical application promotion.It also map out the effective support of this innovative medical equipment for multidisciplinary clinical research such as medical imaging,neurology,cardiovascular and cerebrovascular diseases,geriatrics,pediatrics,etc.Driven by the model of medical-engineering integration and synergy mechanism,display multidimensional output effects such as continuous research and development,quality improvement,technology assessment,configuration management,and healthcare technology management.UIH actively participates in researchs and follows up on innovative practices in medical-engineering integration,demonstrating a positive attitude as a leading medical equipment enterprise.Real world research will provide evidence support for the application demonstration and promotion for equipment manufactured by Chinese medical equipment enterprises.

Objective:To apply data mining and bibliometric methods to collect and analyze literatures related to the uPMR 790 integrated positron emission tomography/magnetic resonance imaging(PET/MRI)of the United Imaging Healthcare(UIH)and assess its output effects in clinical research and application,continued research and development,performance improvement,technology assessment,healthcare technology management,and other aspects.Methods:To conduct literature searches on data platforms such as China National Knowledge Infrastructure(CNKI),WanFang Data Knowledge Service Platform(WANFANG DATA),Wanfang Medical Network(WANFANG MED ONLINE),Chinese Medical Association Journal Database(Yiigle),NIH/PubMed,etc.Based on literature review,to implement bibliometric analysis and evaluate from several technological output dimensions.Results:134 sample literatures were obtained.Among them,there are 121 journal articles,10 dissertations(1 doctoral dissertation and 9 master's theses),3 case reports from the Chinese Medical Case Repository,59 of foreign language journals,and 101 articles sourced from uPMR 790 users as the first author affiliation.Engineering and technical personnel from UIH participated in 58 journal articles;89 clinical research articles,accounting for 66.42%of the sample literatures,15 engineering research and artificial intelligence(AI)research articles,accounting for 11.19%,15 technology assessment articles,accounting for 11.19%,4 healthcare technology management articles,1 experimental research article,and 10 reviews.In addition,33 related patent technologies were retrieved from UIH and its cooperative institutions,as well as UIH PET/MRI equipment users,including 20 invention patents,13 utility model patents.Conclusion:The research results show that the innovative medical equipment,the uPMR 790 PET/MRI,has definite technological outputs in clinical research and application,providing important and widely data of evidence-based medicine for clinical application promotion.It also map out the effective support of this innovative medical equipment for multidisciplinary clinical research such as medical imaging,neurology,cardiovascular and cerebrovascular diseases,geriatrics,pediatrics,etc.Driven by the model of medical-engineering integration and synergy mechanism,display multidimensional output effects such as continuous research and development,quality improvement,technology assessment,configuration management,and healthcare technology management.UIH actively participates in researchs and follows up on innovative practices in medical-engineering integration,demonstrating a positive attitude as a leading medical equipment enterprise.Real world research will provide evidence support for the application demonstration and promotion for equipment manufactured by Chinese medical equipment enterprises.

Objective:To investigate the effects of intravenous lidocaine infusion (IVLI) on the quality of intraoperative neurophysiologic monitoring (IONM) in patients with thyroid tumor.Methods:A prospective randomized controlled study was conducted. A total of 60 patients with thyroid tumor undergoing thyroidectomy in the First Clinical Medical College of Shanxi Medical University between September 2022 and May 2023 were selected. According to the random number table method, all patients were divided into the lidocaine group and the control group, 30 cases in each group. The patients in the lidocaine group were continually given IVLI during the operation and the patients in the control group were continually given the equal 0.9% NaCl solution infusion during the operation. All patients in the 2 groups were induced by the same way of total intravenous anesthesia, and no muscle relaxants were added during anesthesia except the induction dose, and enhanced nerve monitoring tracheal catheter was inserted in the 2 groups. According to the standardized procedure of IONM, the electrode impedance values were measured at the time of eliciting the V1 and V2 signals from the vagus nerve, respectively, and the difference value was defined as the drop in the aggregate impedance level (DAIL). DAIL, perioperative hemodynamic parameters and postoperative recovery quality were compared between the 2 groups.Results:There were no statistically significant differences in the baseline data, operation time, intraoperative dosage of propofol and remifentanil between the 2 groups (all P > 0.05). Compared with the control group, the lidocaine group had a higher proportion of patients with DAIL<50% [80.0% (24/30) vs. 40.0% (12/30), χ2 = 10.00, P = 0.002], a lower hemodynamic fluctuation during extubation [mean arterial pressure: (95±6) mmHg (1 mmHg = 0.133 kPa) vs. (104±7) mmHg, t = 31.00, P < 0.001; heart rate: (73±5) times/min vs. (92±6) times/min, t = 172.58, P < 0.001], a lower visual analog score 24 h after surgery [(2.0±0.7) scores vs. (3.7±0.8) scores, t = -8.86, P < 0.001], a higher score of quality of recovery-15 scale [(127±11) points vs. (118±13) points, t = 2.92, P = 0.005]. Conclusions:IVIL can improve the quality of IONM in patients with thyroid tumor during surgery, reduce perioperative hemodynamic fluctuation and improve postoperative recovery quality of patients.

Objective To explore the value of multi-sequence MRI radiomics for predicting clinical stage of cervical squamous cell carcinoma(CSCC).Methods Totally 190 patients with single CSCC confirmed by pathology were retrospectively collected.Among them,67 cases with International Federation of Gynecology and Obstetrics(FIGO)stage ⅠB—ⅡA were classified into early stage group,while 123 cases with FIGO ⅡB—ⅢC were enrolled in middle-late stage group.The patients were divided into training set(n=114,including 40 cases in early stage subgroup and 74 cases in middle-late stage subgroup)and test set(n=76,including 27 cases in early stage subgroup and 49 cases in middle-late stage subgroup)at the ratio of 6∶4.Single factor and logistic analyses were used to screen clinical relevant factors,and a clinical model was constructed.The best radiomics features of lesions were extracted and selected based on pre-treatment pelvic MR T2WI,diffusion-weighted imaging(DWI),dynamic contrast enhancement(DCE)-T1WI and all the three,respectively,and the radiomics models were constructed,including T2WI,DWI,DCE-TWI and combined sequences models,then a clinical-radiomics model was established based on clinical model and combined sequences model.The predictive efficacy of each model was evaluated by receiver operating characteristic curves,and the area under the curves(AUC)were calculated.The integrated discrimination improvement(IDI)index was also calculated to compare the diagnostic efficacy of each model in training set,and decision curve analysis(DCA)was used to evaluate their clinical value.Results Squamous cell carcinoma associated antigen in middle-late stage subgroup was higher than that in early stage subgroup in both training and test sets(both P＜0.05),which was used to establish the clinical model.The AUC of clinical,T2WI,DWI,DCE-TWI,combined sequences and clinical-radiomics models for predicting clinical stage of CSCC was 0.66,0.71,0.78,0.81,0.88 and 0.89 in training set,respectively,which was 0.62,0.64,0.72,0.73,0.77 and 0.76 in test set,respectively.In training set,the predictive efficacy of clinical-radiomics model was higher than that of combined sequences model(IDI=0.19,P＜0.05),both higher than that of the rest models(IDI=0.19-0.47,all P＜0.05).When the thresholds were 0.02-1.00 and 0.05-1.00,combined sequences and clinical-radiomics models had higher clinical net benefits in training set.Conclusion Multi-sequence MRI radiomics could effectively predict clinical stage of CSCC,and combining clinical data could improve its diagnostic efficacy.

Based on the perspective of medical equipment safety culture,analyze the Global Patient Safety Report 2024 released by the World Health Organization(WHO)on May 30,and extract patient safety elements related to medical devices.Propose to initiate action plan for patient safety related to medical devices and discuss the pathway and measures to further ensure patient safety and strengthen safety management in the clinical use of medical devices,in conjunction with promoting high-quality development of hospitals.