Objective:To determine the clinical factors affecting Central lymph node metastases (CLNM) of single Papillary thyroid carcinoma (PTC). To predict the value of age for CLNM under different genders and the status of Hashimoto’s thyroiditis (HT) .Methods:The clinical data of 4 115 patients with PTMC (≤10.0 mm) and 664 patients with PTC (> 10.0 mm) in Hangzhou First People’s Hospital affiliated to Westlake University Medical School from Jan. 2010 to Aug. 2023 were retrospectively analyzed, and the independent risk factors of PTMC and PTC CLNM were identified by univariate and multivariate logistic regression analysis. According to different gender and HT status, the patients were divided into male group, female group, HT group and non-HT group. The optimal age threshold and diagnostic efficacy of CLNM in each subgroup were determined by Receiver operating characteristic area under the curve (AUC) .Results:The proportion of CLNM in 3451 PTMCs and 664 PTCs was 27.2% (937/3451) and 58.9% (391/664) ( χ2=256.565, P<0.050), respectively. Univariate and multivariate regression analysis showed that larger tumor ( OR 1.230), male ( OR 2.085), older age ( OR 0.960) and HT ( OR 0.697) were independent predictors of the occurrence of CLNM in PTMC. Only male ( OR 1.460) and older ( OR 0.963) PTC were independently associated with CLNM. Subgroup analysis showed that the age-predicted AUC of CLNM in male, HT and non-HT patients in PTC were higher than that of PTMC, which were 0.642-0.689 and 0.635-0.659, respectively. The age thresholds of female, HT and non-HT subgroups in PTC were lower than those in PTMC, which were 38.5 to 39.5 years old and 41.5 to 42.5 years old, respectively. Conclusions:Larger tumor, male, older patients and HT can independently predict the risk of CLNM in PTMC, while only male and older people can independently predict the risk of CLNM in PTC. There are certain differences in the age of CLNM occurrence between PTMC and PTC patients with different genders and HT combination status. It is of great significance to correctly understand these differences for providing personalized clinical treatment.

Objective:To detect the level of the circulating cell-free mitochondrial DNA (ccf-mtDNA) in plasma of children with primary carnitine deficiency (PCD)-associated cardiomyopathy and evaluate its clinical significance.Methods:In this prospective case-control study, peripheral blood samples were collected from 7 PCD patients with cardiomyopathy (PCD group), 16 dilated cardiomyopathy (DCM) patients (DCM group), and 50 healthy children (healthy control group) in the Pediatric Cardiovascular Department Ward of First Hospital of Jilin University from July 2017 to June 2022.The ccf-mtDNA levels were measured and compared between groups by the real-time fluorescence quantitative polymerase chain reaction.The correlations between plasma ccf-mtDNA level and blood free carnitine level and cardiac function in the PCD group were analyzed.The changes in the ccf-mtDNA level were monitored after L-carnitine treatment in the PCD group.The Kruskal-Wallis test was used for comparison among the three groups.The Mann-Whitney test was used for comparison between the PCD group and the control group.Changes before and after treatment in the PCD group were analyzed using the paired Wilcoxon rank sum test.The correlation between variables was evaluated by Logistic regression.Results:The plasma ccf-mtDNA levels in the PCD and DCM groups were 3.69×10 6 (1.09×10 6-7.26×10 6) copies/L and 0.99×10 6 (0.25×10 6-4.10×10 6) copies/L, respectively, which were significantly higher than that in the healthy control group[0.09×10 6 (0.01×10 6-0.35×10 6) copies/L]( H=33.34, 24.69; all P<0.01). Besides, the plasma ccf-mtDNA level in the PCD group was higher than that in the DCM group ( H=6.31, P<0.05). In the PCD group, the plasma ccf-mtDNA level was negatively correlated with the blood free carnitine level and left ventricular ejection fraction ( r=-0.85, -0.82, all P<0.05) and positively correlated with the modified Ross score and the N-terminal pro B type natriuretic peptide level ( r=0.81, 0.83, all P<0.05) before L-carnitine treatment.After treatment, the plasma ccf-mtDNA level decreased, and the blood free carnitine level and cardiac function recovered in the PCD group.The plasma ccf-mtDNA level declined sharply from the 3 rd month[0.96×10 6(0.50×10 6-2.27×10 6) copies/L] after treatment ( Z=2.24, P<0.05) and got to 0.27×10 6 (0.18×10 6-0.76×10 6) copies/L, 0.29×10 6(0.19×10 6-0.78×10 6) copies/L, and 0.16×10 6(0.10×10 6-1.06×10 6) copies/L at the 6 th, 9 th, and 12 th months after treatment, respectively, with no statistically significant difference compared to the healthy control group[0.09×10 6(0.01×10 6-0.35×10 6) copies/L] ( Z=1.23, 1.09, 2.12; all P>0.05). Conclusions:Plasma ccf-mtDNA may act as one pathogenic factor of cardiomyopathy in PCD, and monitoring its level is clinically important for heart condition assessment in PCD.

Cardiovascular diseases are now the leading cause of serious harms to human health,have drawn widespread attention both domestically and internationally. But the current research on mechanism of cardiovascular diseases is not keeping up with the current status of their treatment. The microbiota in the gut,the largest microecological system in the human body and its interaction with the human host have been implicated in a variety of diseases. The relationship between gut microbiota and cardiovascular diseases has been increasingly understood in recent years. The changes of gut microbiota and its metabolites are the major contributing factor for the occurrence and development of cardiovascular diseases,therefore,correction of gut microbiota dysbiosis may provide a novel therapeutic alternative for cardiovascular diseases. This article reviews the role of gut microbiota and its metabolites in cardiovascular diseases,aiming to provide reference for future related studies.

Purpose To observe the CT imaging features of dermatomyosistis patients with anti-melanoma differentiation related genes 5(MDA-5),and to analyze the relationship between CT imaging indicators and short-term prognosis of patients.Materials and Methods Sixty-seven MDA-5-positive dermatomyosistis patients admitted to China-Japan Friendship Hospital from January 2017 to December 2018 were retrospectively included.Prognosis of included patients in one year were followed-up.Analysis of the relationship between chest CT imaging and short-term poor prognosis.Results Among 67 patients,nine patients died in one year.There was a statistically significant difference between the two groups(the death group and the survivor group)in the interstitial lung disease(ILD)imaging types(χ2=0.198,P=0.025)and pulmonary/aortic diameter ratios(U=103.0,P=0.004).CT imaging of dermatomyosistis-ILD with anti-MDA5 antibody positive patients showed organizing pneumonia.Mortality of diffuse alveolar damage type was significantly higher than that of other types.Logistic regression analysis showed that pulmonary/aortic diameter ratio(OR:4.208,P=0.002)was a strong independent risk factor for the death of patients with anti-MDA5 antibody.Conclusion Most patients with anti-MDA5 antibody positive dermatomyositis show ILD,with the main feature of organic pneumonia.Patients with poor prognosis within 1 year have different types of ILD,while the pulmonary/aortic diameter ratio is a strong independent risk factor for the death of dermatomyosistis-ILD with anti-MDA5 antibody positive patients.

ObjectiveTo investigate the effect of Xinfeng capsules on immunoinflammatory indicators in patients with rheumatoid arthritis （RA） due to spleen deficiency and dampness exuberance. MethodA total of 102 patients were randomly divided into control group and observation group according to the random number table method， with 51 cases in each group. All patients were treated with methotrexate tablets， while those in the observation group received additional Xinfeng capsules. The course of treatment in both groups was 12 weeks. The 28-joint disease activity score （DAS28）， visual analogue scale （VAS） scores， morning stiffness time， erythrocyte sedimentation rate （ESR）， high-sensitivity C-reactive protein （hs-CRP）， rheumatoid factor （RF）， anti-cyclic citrullinated peptide （anti-CCP） antibody， vascular endothelial growth factor （VEGF）， and serum amyloid A （SAA） of the two groups before and after treatment were compared. The efficacy and incidence of adverse events were compared between the two groups. The Apriori association rule model and random walk model were constructed to evaluate the effect of Xinfeng capsules in improving hs-CRP， ESR， RF， SAA， VEGF， and anti-CCP. ResultThere were no dropouts in this study. There was no statistical difference in the indicators between the two groups before treatment. After 12 weeks of treatment， the total effective rate in the observation group was 90.19% （46/51）， which was higher than 74.51% （38/51） in the control group （χ²＝4.320，P<0.05）. DAS28， VAS score， and morning stiffness time in the observation group were improved compared with those in the control group （P<0.05）. Apriori association rule model results showed that the application of Xinfeng capsules in the observation group had a strong correlation with the reduction of RF， ESR， hs-CRP， SAA， and VEGF. The results of the random walk model showed that the improvement coefficients of hs-CRP， ESR， RF， SAA， and VEGF in the observation group were all better than those of the control group， and the improvement coefficient of anti-CCP in the control group was better than that of the observation group. The improvement degree of hs-CRP， ESR， RF， SAA， and VEGF in the observation group was superior to that of the control group （P<0.05）. The incidence of adverse reactions in the observation group was lower than in the control group （χ²＝4.057，P<0.05）. ConclusionOn the basis of the treatment with methotrexate tablets， Xinfeng capsules can effectively improve the immunoinflammatory level in RA due to spleen deficiency and dampness exuberance and reduce the incidence of adverse reactions.

Objective:To investigate the predictive value of dual-phase enhanced CT for central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC) .Methods:The CT data of 220 central lymph nodes in 182 cases of PTMC confirmed by surgery and pathology were retrospectively analyzed. The lymph nodes were divided into 0.3 cm-0.4 cm group, 0.4 cm-0.5 cm and ≥ 0.5 cm groups according to the size of them. The CT values of arterial phase and venous phase of lymph nodes were measured, respectively. The distribution of dual-phase CT values of lymph nodes in the three groups was analyzed by t test. The optimal threshold values of dual-phase enhanced CT values of lymph nodes in each group were obtained by receiver operating characteristic (ROC) . Results:The area under ROC curve of arterial phase CT in predicting CLNM was 0.717, 0.707 and 0.761, the optimal threshold was 71.4Hu, 63.3Hu and 72.9Hu, and the sensitivity and specificity were 50.0% and 92.3%, 63.6% and 81.0%, 52.4% and 82.9%, respectively. The area under the ROC curve of venous phase CT value in predicting CLNM was 0.744, 0.729, and 0.662, the optimal thresholds were 71.1 HU, 80.3 HU, and 61.3 HU, and the sensitivity and specificity were 52.8% and 87.2%, 54.2% and 86.7%, 82.6% and 46.7%, respectively. The sensitivity and specificity of dual-phase combined CT values in predicting CLNM in 3 groups were 44.1% and 94.7%, 50.0% and 88.1%, 52.4% and 85.4%, respectively.Conclusion:Dual-phase enhanced CT can effectively predict central lymph node metastasis of PTMC, and the combination of the two can further improve the specificity of predicting CLNM and provide an important basis for reducing unnecessary surgical trauma.

Objective To investigate the characteristic manifestation of the peripheral seroimmunological indicators such as cellular immunity and cytokines in drug-induced liver injury (DILI). Methods The medical records of 219 patients with DILI collected in Shuguang Hospital and Baoshan Branch from January 2019 to August 2021 were retrospectively analyzed, grouped according to the type of drug injury and the degree of injury, and their clinical characteristics, biochemical and peripheral serum immunological characteristics were analyzed. analyze.Twenty-nine cases were selected from the healthy subjects as the normal liver function group, and 42 cases of DILI cases who had undergone cytokine and cellular immune evaluation within 1 week before the acute onset treatment were confirmed as the DILI control group. The t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher test was used to compare the count data between groups. Results Among the 219 DILI patients, 122 (56%) were female and 97 (44 %) were male. 89 cases (40%) of injuries were caused by traditional Chinese medicines, proprietary Chinese medicines or health products, and 130 cases (60%) were caused by western medicines such as anti-tuberculosis and anti-tumor. Among them, 82 cases (37%) were classified as hepatocyte injury type, 17 cases (8%) of cholestatic type, and 120 cases (55%) of mixed injury type. The longest incubation period was 180 days, the shortest was 1 day, and the median was 15 days. Fatigue accounted for 49% of the main symptoms. There were statistically significant differences in cytotoxic T lymphocytes (%) and CD4/CD8 ratio between the traditional Chinese medicine, Chinese patent medicine or health product group and the western medicine group ( Z =2.55 and 3.08, P =0.011 and 0.002, ). From 219 DILI patients, it was confirmed that 42 patients who had detected peripheral immune indicators were compared with 29 patients with normal liver function physical examination. The statistical analysis showed that IL-6 and IL-10 were statistically significant in the peripheral immune serum distribution of DILI. Significance ( Z =3.828 and 2.695, P < 0.001 and 0.007). Conclusion Cytotoxic T lymphocytes may play different roles in the pathogenic mechanisms of Chinese herbal medicines, Chinese patent medicine preparations or health products and western medicines; drugs or drug-protein complexes may affect inflammatory and immune pathways and release related cytokines For example, IL-6 and IL-10 are involved in the pathogenesis of DILI.

Objective:To study the regulatory effects of transforming growth factor beta-activated kinase 1 (TAK1) on microglia pyroptosis in hypoxic-ischemic brain damage (HIBD).Methods:Primary microglia cells were isolated from fetal mice and randomly assigned into 4 groups: the control group, 5z-7-oxozeaneol (5z-7) group, oxygen-glucose deprivation (OGD) group and OGD+5z-7 group. OGD models of microglia cells were established for the OGD groups and 5z-7 groups received a small molecule TAK1 inhibitor 5z-7. Expression of phosphorylated TAK1(P-TAK1), pyroptosis related proteins including NOD-like receptor pyrin domain containing 3 (NLRP-3), apoptosis-associated speck-like protein containing a CARD (ASC) oligomers, N terminal of Gasdermin D (GSDMD-N) and interleukin 1β (IL-1β) were examined using Western blot at 0 h, 6 h and 24 h after intervention. Lactate dehydrogenase (LDH) test and transmission electron microscope were used for pyroptosis evaluation.Results:(1) Compared with the control group, expressions of all proteins including P-TAK1, NLRP-3, ASC oligomers, GSDMD-N, IL-1β and LDH level showed no significant differences in the OGD group at 0 h ( P>0.05). P-TAK1 levels in OGD group at 6 h and 24 h were lower than the control group and the levels of NLRP-3, ASC oligomers, GSDMD-N, IL-1β and LDH were significantly higher ( P<0.05). Microglia pyroptosis (characterized by disruption of cell membrane, extravasation of cytoplasm and chromatin margin aggregation) was observed under electron microscope. (2) 5z-7 group and OGD+5z-7 group had lower P-TAK1 levels and higher NLRP-3, ASC oligomers, GSDMD-N, IL-1β and LDH levels than the control group and OGD group at 6 h and 24 h. Conclusions:The down-regulation of TAK1 phosphorylation level may promote microglia pyroptosis in HIBD. This regulatory effects is related to the up-regulation of NLRP-3 expression and the oligomerization of ASC.

Objective:To study the clinical value of color Doppler ultrasonography in the diagnosis of persistent sciatic vein(PSV).Methods:A retrospective study was performed on 17 patients who were diagnosed with PSV by color Doppler ultrasound in the Second Hospital of Shandong University and the Shandong Provincial Hospital Affiliated to Shandong First Medical University from May 2010 to December 2021. Their sonographic features were analyzed, summarized and classified.Results:In all the 17 cases, the sciatic vein showed a vein adjacent to the sciatic nerve in the pelvis or back of the thigh. According to anatomy, persistent sciatic vein could be divided into three types: complete PSV, upper PSV and lower PSV. There were 7 cases of complete PSV, 2 cases of upper PSV and 8 cases of lower PSV. Femoral vein dysplasia was found in 11 of 17 patients with PSV. In addition to 1 case of bilateral PSV, the diameter of the femoral vein on the affected side was (0.36±0.19)cm in 16 cases, and the diameter of femoral vein at the corresponding position on the healthy side was (0.61±0.11)cm, there was significant difference between the two groups ( P<0.001). Conclusions:Color Doppler ultrasonography is the effective imaging method for diagnosis of the PSV.

As a disease that requires long-term treatment, the safety of treatment is particularly important in the treatment of inflammatory bowel disease (IBD). Numerous studies have shown that diet can alter the intestinal barrier, IBD susceptibility gene expression, immune function, and microbial metabolites by influencing the balance of gut microbes. Diet is therefore one of the key environmental factors that affect the symptoms and recurrence of IBD. The resistant starch diet can increase the viscosity of feces, promote the proliferation of colon symbiotic bacteria and generate a large number of short-chain fatty acids, which is highly correlated with the course of IBD. This article reviewed the progress of resistant starch in treatment of IBD.