Objective By population survey,to explore the epidemiological characteristics of gastric precancerous lesions in Lishui District of Nanjing and provide objective basis for the prevention and treatment of early gastric cancer.Methods From July 2021 to December 2022,21 977 patients who received endoscopy and/or 13C-UBT in Lishui District People's Hospital and 6 medical community units in Nanjing City were retrospectively analyzed for demography characteristics,detection rate of gastric precancerous lesions,and H.Pylori infection rate.Results(1)590 cases of gastric precancerous lesions were detected(detection rate 2.68%);(2)The total detection rate of precancerous lesions and three pathological types in males were all higher than those in females(all P<0.001);(3)The minimum age for the total detection rate of precancerous lesions in males and the mini-mum age for each pathological type were lower than in females(P<0.001,0.009,0.005,0.002);(4)The popu-lation total H.pylori infection rate was 23.10%,the H.pylori infection rate in patients with precancerous lesions was higher than that in non-precancerous lesions(P<0.001),both H.pylori infection rate of male and female in precancerous lesions were all higher than those of non-precancerous lesions of the same sex(all P<0.001),in addition,the H.pylori infection rate of male whether in precancerous or non-precancerous lesions was higher than that of female(all P<0.001);(5)The precancerous lesions detection rate in male,female,and the overall age range of 20～29 to 70～79 years is positively correlated with age growth(P<0.001),and rapidly decreases after the age of 79,the of H.pylori infection rate was also positively correlated with age growth(P<0.001),and the trend of age change(P<0.001)was parallel to the precancerous lesions detection rate.Conclusions The detec-tion rate of gastric precancerous lesions in this region is above the average level in China;the total H.pylori infec-tion rate is at a relatively low level in China;the H.pylori infection rate is parallel to the age trend of the detection rate of gastric precancerous lesions,and increases with age.

Objective To evaluate the role of preoperative serological indexes in predicting long-term survival and tumor recurrence of hepatocellular carcinoma (HCC) patients after liver transplantation, aiming to explore its significance in expanding the Milan criteria. Methods Clinical data of 669 recipients undergoing liver transplantation for HCC were retrospectively analyzed. The optimal cut-off value was calculated by the receiver operating characteristic (ROC) curve. The risk factors affecting the overall survival and recurrence-free survival rates of HCC patients after liver transplantation were identified by univariate and multivariate regression analyses. The correlation between preoperative serum liver enzymes and pathological characteristics in HCC patients was analyzed. The predictive values of alpha-fetoprotein (AFP) combined with γ -glutamyl transferase (GGT) and different liver transplant criteria for the survival and recurrence of HCC patients after liver transplantation were compared. Results Exceeded Milan criteria, total tumor diameter (TTD) > 8 cm, AFP > 200 ng/mL and GGT > 84 U/L were the independent risk factors for the overall survival and recurrence-free survival rates of HCC patients after liver transplantation (all P < 0.05). Correlation analysis showed that preoperative serum GGT level was correlated with TTD, number of tumor, venous invasion, microsatellite lesions, capsular invasion, tumor, node, metastasis (TNM) stage, Child-Pugh score and exceeded Milan criteria (all P < 0.05). Milan-AFP-GGT-TTD (M-AGT) criteria were proposed by combining Milan criteria, TTD with serum liver enzyme indexes (AFP and GGT). The 5-year overall survival and recurrence-free survival rates of HCC recipients who met the M-AGT criteria (111 cases of exceeded Milan criteria) were significantly higher than those who met Hangzhou criteria (both P < 0.05), whereas had no significant difference from their counterparts who met the University of California at San Francisco (UCSF) criteria (both P > 0.05). Conclusions Preoperative serological indexes of AFP and GGT could effectively predict the long-term survival and tumor recurrence of HCC patients after liver transplantation. Establishing the M-AGT criteria based on serological indexes contributes to expanding the Milan criteria, which is convenient and feasible.

Calcium oxalate (CaOx) stone is the main type, and its formation is closely related to the metabolism of oxalic acid and calcium. Gut Microbiome is normal microflora which settled in the human intestinal tract and plays an important role in regulating a variety of metabolism in the body. In the past, Oxalobacter formigenes in gut was a protective factor for the formation of CaOx stones. Recently, it has been found that the bacteria regulating oxalate metabolism were not limited to Oxalobacter formigenes. Gut Microbiome of CaOx stones formers is different from healthy people. It regulates the metabolism of oxalic acid in the body through the gut-kidney axis and affect the formation of CaOx stone. The purpose of this study is to describe the characteristics of intestinal flora in patients with CaOx stones, and to summarize its potential function in the formation of CaOx stones and its possible clinical application in the future.

Objective:To investigate the clinical, skeletal muscle pathological, and genetic characteristics of fatal infantile hypertonic myofibrillar myopathy (FIHMM).Methods:The clinical manifestations, laboratory assessments data and gene sequencing results of 10 patients diagnosed with FIHMM in Shenzhen Children′s Hospital from February 2017 to April 2021 were retrospectively analyzed.Magnetic resonance imaging (MRI) of both musculoskeletal system and the brain, and electromyogram (EMG) were performed in 3 cases, while muscle biopsy was performed in 2 cases.Results:Among these 10 cases, 1 case was from Northeast China and 1 case from East China, while the rest 8 cases were from South China.Eight of the 10 patients were male, and the other 2 cases were female.They were all born normal and not related to each other.The age of onset varied from 2 to 12 months.The main clinical manifestations for all the patients were progressive rigidity of the rectus abdominis (8 cases), neck muscles (7 cases), rectus abdominis (2 cases) and intercostal muscles (1 case), resulting in respiratory failure.Mildly to moderately elevated serum creatine kinase level was detected (436-5 804 IU/L) (reference range: 24-229 IU/L). Complex repetitive discharges can be seen in the EMG, without any myotonic potential.Muscle fiber degeneration, necrosis, and vacuolar degeneration were noted in the histopathological examination of the vastus lateralis and rectus abdominis.An abnormal red granular deposit was observed in a portion of the field of the modified Gomory Trichrome staining.Immunohistochemistry showed substantial deposition of desmin.Under the electron microscopy, the sarcomere structure of the muscle fibers was seriously disordered, with the destruction of Z-bands and the presence of granular deposits.The whole-exome sequencing identified the same homozygous variation c. 3G>A, p.Met1? of CRYAB gene in all the patients, but heterozygous variation in their parents. Conclusions:Axial muscles involvement, such as rectus abdominis rigidity, is the main clinical characteristic of FIHMM.c.3G>A, p.Met1? mutation in the CRYAB gene is a hotspot mutation in Chinese children.

Objective To investigate the clinical characteristics of metabolically healthy obese ( MHO) individuals, and to explore the risk of progression into metabolic disorders after 3 years. Methods A total of 3943 residents in Jining City were evaluated twice from February 2012 to August 2015, and 3766 individuals were enrolled excluding those with missing data. Of the subjects, 875 subjects were screened as metabolic normal population, which were divided into MHO(n = 127), metabolically healthy overweight (MHOW, n = 386), and metabolically healthy normal weight ( MHNW, n = 362) groups. T test, x2 test, and logistic regression analysis were used for data analysis. Results The incidence of MHO was 11. 63％ (127 / 1092) in obesity, and the proportion of MHO in females was higher than that in males(13. 91％ vs 7. 82％ , P<0. 05). Compared with MHNW group, the levels of HbA1C , fasting insulin, low density lipoprotein-cholesterol ( LDL-C), triglyceride ( TG), glutamyl transpeptidase (GGT), systolic blood pressure(SBP), diastolic blood pressure(DBP), and waist circumference(WC) were higher in MHO while glomerular filtration rate (GFR) and high density lipoprotein-cholesterol (HDL-C) were lower(all P<0. 05); and fasting insulin, LDL-C, TG, GGT, SBP, WC were higher in MHOW while HDL-C was lower (all P<0. 05). The levels of fasting insulin, TG, SBP, WC were higher in MHO while GFR and HDL-C were lower compared with MHOW(all P<0. 05). Following up for 3 years, the incidences of dyslipidemia in MHNW, MHOW, and MHO were 17. 96％ (65 / 362), 32. 90％ (127 / 386), 42. 52％ (54 / 127), respectively, with significant difference among three groups(P<0. 05). The incidences of hyperglycemia in the three groups were 20. 17％ (73 / 362), 22. 80％(88 / 386), 26. 77％ (34 / 127), respectively, without significant difference among groups ( all P > 0. 05). After adjustment for some factors including sex, age, fasting insulin, glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, GGT, and creatinine, the risks of dyslipidemia in MHO ( OR = 2. 193, 95％ CI 1. 359-3. 539, P<0. 05) and MHOW(OR= 1. 705, 95％ CI 1. 190-2. 443, P<0. 05) were significantly increased as compared with MHNW. Conclusion Compared with MHNW individuals, MHOW/ MHO individuals show an obviously different clinical feature as well as with higher risks of dyslipidemia after 3 years.

OBJECTIVE:To observe clinical efficacy and safety of Bifidobacterium triple viable capsules in the adjunctive treatment of Helicobacter pylori(Hp)positive chronic atrophic gastritis(CAG)complicated with anxiety-depression. METHODS:A total of 100 Hp positive CAG patients with anxiety-depression were divided into control group and observation group according to random number table,with 50 cases in each group. Control group was given standard triple therapy (rabeprazole+amoxicillin and clavulanate+levofloxacin). Observation group was additionally given Bifidobacterium triple viable capsules 0.42 g,tid. The treatment lasted for 14 d in both groups. Clinical efficacies,Hp eradication rates as well as HAMA and HAMD scores before and after treatment were all observed in 2 group. The occurrence of ADR was compared. RESULTS:Total response rate of observation group was 94.0%,and Hp eradication rate was 92.0%,which were significantly higher than 76.0% and 78.0% of control group, with statistical significance (P<0.05). Before treatment,there was no statistical significance in HAMA and HAMD scores in 2 groups(P>0.05). After treatment,HAMA and HAMD scores of 2 groups were decreased significantly,the observation group was significantly lower than the control group,with statistical significance (P<0.05). The incidence of ADR in observation group (4.0%)was significantly lower than control group(20.0%),with statistical significance(P<0.05). CONCLUSIONS:Adjunctive use of Bifidobacterium triple viable capsules can significantly improve Hp eradication rate,clinical symptom,anxiety and depres-sion,while reduce the incidence of ADR.

Background Blepharitis caused by Demodex infestation is very common in clinical practice.There are various methods mentioned in the study of Demodex infestation in China,but a unified introduction and evaluation of the operating procedures is lacked.A quick and accurate clinical diagnostic method for Demodex infestation needs to be further studied.Objective This study aimed to establish operation procedures for the clinical examination of eyelid Demodex infestation,which were applied to evaluate the conditions of eyelid Demodex infestation in ocular patients with discomfort.Methods One thousand and fifty-two patients with eye dryness,eye itchiness or other symptoms were selected for slit lamp examination and photographing of the eyelid margin area.Three eyelashes with associated scurf from each superior eyelid were plucked out for examination of Demodex under the microscope.Positive findings included observation of Demodex mites or eggs.Their amounts were recorded individually for all eyelash samples.Results A procedure for observing,recording and reporting eyelid Demodex infestations in patients was successfully established.By using this procedure,1 052 patients were investigated for the examination of Demodex infestations.Demodex mites or eggs were found in 582 cases (55.3％).The positive rate of Demodex infestation increased with age,and the population over 60 years group had the highest positive rate,showing a significant difference among the different age groups (x2=10.547,P=0.001).There was no significant difference in positive rate between male patients and female patients (P =0.352).The test turnaround time (TAT) for one examination was (11.4±5.2) seconds.Conclusions The operational procedure for examining the palpebral margin Demodex infestation by the slit-lamp,optical microscope,photographing and laboratory reports is established.It is simple and quick in the appliation for the clinical diagnosis of eyelid Demodex infestation.

Objective To assess the effects of the risk factors of grafts from donors after cardiac death (DCD) on the prognosis of liver transplantation (LT).Methods In this retrospectively study,215 cases of LT using DCD donor grafts were performed at our institution from September 2013 to January 2017.Due to the loss to follow-up in 4 cases,211 cases were enrolled in the study.The following DCD donor data were collected:gender,age,primary disease,ABO blood type,body mass index (BMI),medical history (fatty liver,hypertension),ICU hospitalization time,mechanical ventilation time,warm ischemia time,cold ischemia time,and indexes of routine laboratory test before donation.Statistical analyses using the Kaplan-Meier method,log-rank test,multivariate step-wise Cox regression were performed.Results Of the 211 donors,univariate analysis showed that the overall 6-month,1-,and 3-year survival rate after DCD LT was 88％,84％,and 82％,respectively.Univariate analysis showed that donor serum sodium level ＜136 mmol/L (P =0.018) and cold ischemia time ＞9 h (P =0.013) were all significant risk factors affecting overall survival after DCD LT.Additionally,donor BMI ＞30 kg/m2 (P =0.011) and donor age ＞60 years (P =0.025) were significantly associated with postoperative complications.Multivariate analysis showed that donor serum sodium level (P=0.025) was an independent risk factor of survival after DCD LT.Conclusion To select suitable DCD liver allografts and control risk factors of donor can help to improve outcomes of recipients.

ObjectiveTo investigate the clinical efficacy of vastus medialisoblique enhancement plus electroacupuncture intervention in treating patellar chondromalacia.MethodFifty-two patients meeting the inclusion criteria were randomly allocated to a treatment group of 32 cases and a control group of 20 cases. The treatmentgroup received vastus medialis oblique enhancement plus electroacupuncture intervention and the control group, electroacupuncture intervention alone. Both groups were treated once daily, 10 times as a course, for four consecutive courses. The Visual Analogue Scale (VAS) score was counted in the two groups before and after treatment. The clinical therapeutic effects were evaluated in the two groups.ResultThe VAS score improved significantly in both groups of patients after treatment compared with before(P<0.05). It improved significantly more in the treatment group than in the control group (P<0.05). The cure rate and the total efficacy rate were 37.5% and 96.9%, respectively, in the treatment group, which were higher than a cure rate of 20.0% and a total efficacy rate of 75.0% in the control group, respectively. ConclusionVastus medialis oblique enhancement plus electroacupuncture intervention can improve the clinical symptom of pain more markedly and heighten the clinical therapeutic effect in patients with patellar chondromalacia. Its effect is better than that of electroacupuncture intervention alone.

Objective To analyse our clinical experience in pediatric living donor liver transplantation (PLDLT).Methods The clinical data of 45 patients who underwent PLDLT in our hospital from April 2005 to April 2014 were retrospectively studied and their preoperative,intraoperative and postoperative data were analyzed.Results All donors recovered well.The graft to recipient weight ratio (GRWR) ranged from 1.0％ ～ 6.4％ (2.5％ ± 1.2％).Size reduction of graft were performed in 2 patients.An interposition venous conduit from the confluence of the native right and left portal vein (PV) to the graft PV was carried out in 1 patient,venous grafts for revascularization of the tributaries of the middle hepatic vein from segment Ⅴ and Ⅷ were used in 3 patients,and a venous patch for revascularization of the left hepatic vein was used in 2 patients.Hepatic artery re-reconstruction was performed in 3 patients after hypoperfusion was detected on intraoperative Doppler ultrasound.The postoperative complications included acute rejection (n =2),vascular complications (n =7),biliary complications (n =11),and infectious complications (n =27).The 1-,2-and 5-year survival rates were all 84.4％.Seven of 45 recipients died within one year post transplantation,with 3 patients who died of vascular complications,and 4 patients who died of infection.The differences in age [(50.8 ± 49.8) months vs (12.6 ± 14.9) months],body weight [(16.2 ± 10.5) kg vs (7.3 ± 1.7) kg],serum total bilirubin [(177.0 ± 126.5) μmol/L vs (301.9 ± 110.6)μmol/L],Pediatric end-stage liver disease (PELD) score (16.1 ± 12.1 vs 26.2 ± 11.3) and GRWR (2.2％ ± 0.8％ vs 4.2％ ± 1.6％) between the survival and the dead groups were significant (P ＜ 0.05).Conclusions PLDLT is an effective method to treat children with end-stage liver disease.Using a multidisciplinary approach in the preoperative management,excellent surgical techniques,and proper postoperative management are extremely helpful to improve postoperative survival rate.