Objective:The transjugular or transfemoral approach is used as a common method for hepatic venous pressure gradient (HVPG) measurement in current practice. This study aims to confirm the safety and effectiveness of measuring HVPG via the forearm venous approach.Methods:Prospective recruitment was conducted for patients with cirrhosis who underwent HVPG measurement via the forearm venous approach at six hospitals in China and Japan from September 2020 to December 2020. Patients' clinical baseline information and HVPG measurement data were collected. The right median cubital vein or basilic vein approach for all enrolled patients was selected. The HVPG standard process was used to measure pressure. Research data were analyzed using SPSS 22.0 statistical software. Quantitative data were used to represent medians (interquartile ranges), while qualitative data were used to represent frequency and rates. The correlation between two sets of data was analyzed using Pearson correlation analysis.Results:A total of 43 cases were enrolled in this study. Of these, 41 (95.3%) successfully underwent HVPG measurement via the forearm venous approach. None of the patients had any serious complications. The median operation time for HVPG detection via forearm vein was 18.0 minutes (12.3~38.8 minutes). This study confirmed that HVPG was positively closely related to Child-Pugh score ( r = 0.47, P = 0.002), albumin-bilirubin score ( r = 0.37, P = 0.001), Lok index ( r = 0.36, P = 0.02), liver stiffness ( r = 0.58, P = 0.01), and spleen stiffness ( r = 0.77, P = 0.01), while negatively correlated with albumin ( r = -0.42, P = 0.006). Conclusion:The results of this multi-centre retrospective study suggest that HVPG measurement via the forearm venous approach is safe and feasible.

Background and Aims:In the era of minimally invasive surgery,the role of pancreatic tumor enucleation(PTE)in treating benign or low-grade malignant tumors is gaining attention.The Da Vinci robot offers advantages such as enhanced visualization and flexible instrument manipulation,which can ensure the safe implementation of PTE.However,whether robotic pancreatic tumor excision(RPTE)is superior to laparoscopic pancreatic tumor enucleation(LPTE)remains undetermined.Therefore,this study was performed to explore this aspect. Methods:The clinical data of 38 patients who underwent surgical treatment for benign or low-grade malignant tumors in the Third Xiangya Hospital of Central South University from April 2020 to May 2024 were collected.Among them,18 cases underwent RPTE(RPTE group),and 20 cases underwent LPTE(LPTE group).Relevant clinical variables were compared between the two groups,and subgroup comparisons were further conducted for patients with tumors in the head and neck/body/tail of the pancreas. Results:The average operative time for the entire group was 125 min,with an average intraoperative blood loss of 67.89 mL,and no C-grade pancreatic fistula occurred.The incidence rates of B-grade pancreatic fistula,postoperative bleeding,and readmission were 39.5％,21.1％,and 18.4％,respectively,with an average postoperative hospital stay of 11.44 d.Overall,the RPTE group had shorter operative time and less intraoperative blood loss than the LPTE group(both P＜0.05).There were no statistically significant differences between the two groups regarding the incidence of B-grade pancreatic fistula,intraoperative bleeding,readmission rate,and postoperative hospital stay(all P＞0.05).Subgroup analysis showed that for patients with head tumors,the RPTE group had shorter operative time,less intraoperative blood loss,and a lower incidence of postoperative bleeding than the LPTE group(all P＜0.05).However,the differences in the incidence of B-grade pancreatic fistula,readmission rate,and postoperative hospital stay were not statistically significant(all P＞0.05).In patients with neck/body/tail tumors,the RPTE group also had shorter operative time and less intraoperative blood loss(both P＜0.05),but the differences in incidence of B-grade pancreatic fistula,incidence of postoperative bleeding,readmission rate,and postoperative hospital stay were not statistically significant(all P＞0.05). Conclusion:Minimally invasive PTE for the treatment of benign or low-grade malignant pancreatic tumors is safe.Compared to LPTE,RPTE can significantly reduce operative time and intraoperative blood loss and shows certain advantages in reducing postoperative complications,particularly for patients with head tumors.However,the conclusion of this study needs to be confirmed by larger prospective studies.

Objective:To investigate the classification of main pancreatic duct and treatment strategy after linear stapler closure of pancreatic neck in laparoscopic pancreaticoduodenectomy (LPD).Methods:The records of 51 consecutive patients with LPD who were treated by linear staple closure technique of pancreatic neck from February to December 2022 from Binzhou Second People′s Hospital, Shijingshan Campus, Beijing Chaoyang Hospital, Capital Medical University, Rizhao Hepatobiliary-Pancreatic-Splenic Surgery Research Institute, Chaoyang Central Hospital, Shandong Juxian People′s Hospital, Weihai Municipal Hospital, Binzhou Central Hospital, and Affiliated Hospital of Chifeng University were retrospectively reviewed. According to the visibility, position and diameter of the main pancreatic duct at the stump of the pancreas, the type of main pancreatic duct was divided into type I, type Ⅱ, type Ⅲa and type Ⅲb. The number of cases in each main pancreatic duct classification and the corresponding treatment strategies were examined.Results:A total of 51 cases of LPD were successfully completed. Of these patients, the males comprised 56.9%(29/51), and females comprised 43.1%(22/51), with age ranging from 31 to 88 years old. The type of the main pancreatic duct at the stump of the pancreas included 7 cases (13.7%) of type Ⅰ, 39 cases (76.5%) of type Ⅱ, 2 cases (3.9%) of type Ⅲa, and 3 cases (5.9%) of type Ⅲb. Corresponding treatment strategies were adopted according to different main pancreatic duct types, the main pancreatic duct was successfully found, and a support drainage tube was inserted.Conclusion:After linear stapler closure of pancreatic neck, corresponding treatment strategies should be adopted according to the classification of the main pancreatic duct, which would help to improve the success rate of finding the main pancreatic duct and placing a support drainage tube.

Objective:To explore the value of HDlive Flow in prenatal diagnosis of the velamentous placenta.Methods:A total of 2 723 pregnant women underwent prenatal ultrasonography in the second trimester and delivered at Zhejiang Provincial People's Hospital from January 2019 to January 2020, and 48 of them were diagnosed as having velamentous placenta confirmed by postpartum clinical and pathological examination and were included in this retrospective analysis. Two-dimensional echocardiography-color Doppler flow imaging (2D-CDFI) and HDlive Flow were both performed during the prenatal ultrasound examination. The sonographic features of velamentous placenta by HDlive Flow were summarized and the prenatal detection rate between two methods were compared using Chi-square test. Results:The incidence of velamentous placenta was 1.8% (48/2 723) in our hospital. Out of the 48 enrolled cases, 45 were diagnosed by HDlive Flow with a detection rate of 93.8% (45/48), three of them were complicated by vasa previa; the other three cases were misdiagnosed as battledore placenta. There were 38 cases diagnosed by 2D-CDFI with a detection rate of 79.2% (38/48), which was lower than HDlive Flow ( χ2=4.360, P=0.037); the other ten cases were misdiagnosed as battledore placenta. The sonographic features by HDlive Flow were as follow: (1) Umbilical cord attached to fetal membranes outside the placenta in 41 cases with the umbilical vessels distributing along the fetal membrane in a mesh pattern; (2) In three cases, the umbilical cord insertion was located on fetal membranes at the edge of placenta; (3) One case was shown that umbilical cord and the branches of umbilical vessels were inserted into the placenta in a "λ" shape. Conclusions:The anatomy of the umbilical cord, umbilical blood vessels and placenta can be directly shown under HDlive Flow, which can improve the prenatal detection rate of the velamentous placenta.

Objective:To explore the effects of health education using new media in nursing outside the hospital among colon cancer patients.Methods:From January 2016 to December 2018, this study selected 86 colon cancer patients at Nanyang Central Hospital as subjects by convenience sampling. A total of 43 patients between January 2016 to June 2017 were in control group, and 43 patients from July 2017 to December 2018 were in observation group. Control group carried out health education outside the hospital, while observation group implemented health education using new media outside the hospital for six months. The effects were compared with the knowledge need questionnaire for cancer patients, Champion Health Belief Model Scale (CHBMS) and the Strategies Used by People to Promote Health (SUPPH) .Results:Six months after discharge, the scores of knowledge need questionnaire of patients in observation group and control group were (41.24±7.64) and (51.94±9.62) respectively ( t=5.712, P<0.01) ; the score of CHBMS of patients in observation group and control group were (118.10±31.53) and (92.20±28.23) respectively ( t=4.013, P<0.01) ; and the score of SUPPH of patients in observation group and control group were (98.37±17.17) and (80.45±17.45) respectively ( t=4.800, P<0.01) ; the differences were all statistical. Conclusions:The application of health education using new media in nursing outside the hospital among colon cancer patients can improve patients' health knowledge need, rebuild the health belief and increase self-management efficacy.

Objective? To explore the effects of health education under the concept of health quotient on self-management ability and medication compliance among ulcerative colitis patients. Methods? From December 2015 to December 2017, we selected 140 ulcerative colitis patients at Nanyang City Center Hospital of the Affiliated Hospital of Zhengzhou University as subjects by convenience sampling. All of the patients were divided into observation group and control group with the method of random number table, 70 cases in each group. Control group adopted routine health education, while observation group carried out health education under the concept of health quotient which implemented health education using five dimensions of health quotient concept as start points. The intervention effects of patients of two groups, self-management ability and medication compliance, were compared with the Adult Health Self-Management Skill Rating Scale (AHSMSRS) and Morisky Medication Adherence Scale before (on admission) and after (reexamining three months after discharge) intervention. Results? Before intervention, there were no statistical differences in the dimension scores of AHSMSRS of patients between two groups (P＞ 0.05). After intervention, the scores of AHSMSRS both groups all increased compared with those before intervention;the scores of diet management, sport management, responses to the diseases, resource usage, self-efficacy and environment self-management and the total score of AHSMSRS in observation group after intervention were higher than those in control group with statistical differences (P＜0.05). After intervention, the fine rate of medication compliance of observation group was 95.71% statistically higher than that (85.71%) of control group (P＜0.05). Conclusions? Health education under the concept of health quotient can improve self-management ability and medication compliance among ulcerative colitis patients which is worthy of being spread in clinical application.

Objective: To detect the expression level of miR-27a during the osteogenic differentiation of beagle maxillary sinus membrane stem cells (MSMSCs) and explore the role of miR-27a in the osteogenic differentiation of MSMSCs. Methods: Beagle MSMSCs were cultured in vitro. The expression level of miR-27a was detected via RT-PCR after an osteogenic inductive culture was prepared. The mRNA expression levels of Runx2 and OPN were examined via RT-PCR, and the protein expression levels of Runx2 and OPN were examined via Western blot after the cells were transfected with pre-miR-27a or anti-miR-27a. Finally, osteoprogenitor cells transfected with pre-miR-27a were composited with Bio-Oss particles and subcutaneously implanted into nude mice to form ectopic bone formation models, and then the inhibition of bone formation from miR-27a was observed in vivo. Results: The expression level of miR-27a in the beagle MSMSCs decreased after osteogenic inductive culturing. The relative miR-27a levels were significantly decreased at day 1 (t=3.795, P=0.023), day 3 (t=4.493, P=0.011), day 7 (t=11.591, P < 0.001), day 14 (t=12.542, P < 0.001), and day 21 (t=5.621, P=0.008) compared with day 0. In addition, the expression levels of Runx2 mRNA (t=4.923, P=0.007) and protein (t=4.425, P=0.008) were reduced after the cells were transfected with pre-miR-27a. The expression levels OPN mRNA (t=5.253, P=0.006) and protein (t=5.132, P=0.006) were also reduced. In contrast, the mRNA expression levels of Runx2 (t=3.925, P=0.013) and OPN (t=3.712, P=0.019) were increased after the cells were transfected with anti-miR-27a, and bone formation was observed after the subcutaneous implantation of beagle MSMSCs composited with Bio-Oss in nude mice. Nevertheless, ectopic bone formation was inhibited by pre-miR-27a-transfected beagle MSMSCs composited with Bio-Oss (t=7.219, P=0.0020). Conclusion MiR-27a negatively regulates the osteogenic differentiation of MSMSCs.

Objective: To investigate the osteogenic properties of maxillary sinus membrane stem cells (MSMSCs). Methods : Beagle maxillary sinus mucosa was collected, immunomagnetic bead method was applied for isolation of CD146+ cells, and MSMSCs were harvested and cultured from the canine maxillary sinus floor mucosa. The levels of the cell surface antigens CD44, CD146, and CD34 were determined at passage one by flow cytometry. Cells at passage one were cultured in basal medium and osteogenic inductive medium. Real-time PCR, immunohistochemical staining, alkaline phosphatase activity, alizarin red staining and Von Kossa staining were used to investigate the osteogenic properties in vitro. Results: The canine MSMSCs were cultured successfully. The results of flow cytometry were positive for CD146 and CD44 expression but negative for CD34 expression. The relative mRNA expression of runt-related transcription factor 2 (RUNX2) (t = 14.44,P < 0.001), osteopontin (OPN) (t = 7.85,P = 0.001) and alkaline phosphatase alkaline phosphatase (t = 14.27,P < 0.001) was apparently higher in the osteoinductive medium group than in the basal medium group, the differences in relative mRNA expression between the groups were significant. The protein levels of RUNX2 and OPN increased in the osteoinductive medium group. The alkaline phosphatase activity of the MSMSCs increased when the cells were cultured in osteoinductive medium; the activity increased to a level that was significantly higher than that in basal medium, particularly at days 3 (t = 8.79, P < 0.001), 7 (t = 9.75,P < 0.001), 14 (t = 12.14,P < 0.001), 21 (t = 19.62,P < 0.001) and 28 (t = 17.53,P < 0.001). Obvious mineralized nodules were observed by alizarin red staining or Von Kossa staining. Conclusion Maxillary sinus membrane stem cells exhibit osteogenic ability.

Objective:To evaluate the clinical application value of gastrointestinal contrast-enhanced ultrasound combined gas injection method in verifying the location of nasointestinal tube in critically ill patients.Methods:Data of 60 critically ill patients who had the indications of indwelling nasointestinal tube were collected from September 1,2015 to September 1,2016 in the Intensive Care Unit of Zhejiang Provincial People(s) Hospital.The position of nasointestinal tube in patients who underwent bedside blind insertion would be confirmed routinely through gas injection auscultation method.After tube was inserted,its route was scanned by ultrasound with gas perfusion assistance.Afterwards,rapid gas perfusion was used until suspicious tube end position was determined.Furthermore,oral ultrasound contrast agent was injected into the tube if instantaneous strong echo of gas was observed in localized lumen,and contrast agent filling meant the placement being successful.Two methods of position confirmation of nasointestinal tube in critically ill patients included gastrointestinal contrast enhanced ultrasound combined gas injection and gas injection auscultation only,and the effect of the two methods was compared and confirmed by chest and abdominal X ray examinations to verify the location of nasointestinal tube below pylorus.Results:A total of 60 patients were included in this study,58 patients(96.7％)in gastrointestinal contrast enhanced ultrasound combined gas injection group were successfully positioned.Among them,the placements of tube in 56 cases were below pylorus,while 2 cases were above pylorus.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of location of gastrointestinal contrast enhanced ultrasound combined gas injection method were 96.6％,100％,100％,50％,96.7％ and of gas injection auscultation method were 74.1％,50％,97.7％,6.3％ and 73.3％.The differences of the sensitivity,specificity,negative predictive value and accuracy between the two methods were statistically significant (P ＜ 0.05).Conclusion:Gastrointestinal contrastenhanced ultrasound combined gas injection method is a safe,simple and convenient method with high sen-sitivity,specificity,negative predictive value and accuracy in confirming the location of the nasointestinal tube.

Objective To study the change of expression of c-fos and c-jun when using IN-1 alone or combination with NT-3 after spinal cord injury. Methods 120 adult health Sprague-Dawley (SD) rats were random divided into three groups, including control group, IN-1 group, and IN-1 combination with NT-3 group. All rats were killed at the scheduled time and its myeloid tissues were taken out. In each group, the expression of c-fos and c-jun gene was detected by using reverse transcription- polymerase chain reaction technique ( RT-PCR ). Result The transcriptional levels of c-fos decreased and c-jun increased when using IN-1 alone, and the levels changed more when using IN-1 combination with NT-3. The peak of c-fos reached to 0. 974 ±0. 126 in control group, 0. 834 ±0. 047 in IN-1 group, and 0. 698 ±0. 052 in IN-1 combination with NT-3 group, and the peak of c-jun reached 0. 642 ±0. 048, 0. 712 ±0. 050, and 0. 814 ±0. 041, respectively. Conclusion One of the mechanisms of IN-1 and NT-3 to protect the spinal cord might be through inhibiting the expression of c-fos and enhancing the expression of c-jun.