This study presents a case of a girl of three year and 4 month old with ataxia and severe sen-sorineural hearing loss for 2 years.In order to improve hearing,she was hospitalized in the PUMC Hospital.Ge-netic testing performed found compound heterozygous variants of c.1186C＞T(p.P396S)and c.1357C＞T(p.R453W)in TWNK gene.After a multidisciplinary discussion of the case,the team suspected mitochondrial DNA depletion syndrome type 7(hepatocerebral type).The patient has shown nervous system impairment in-volvement but no evidence of liver dysfunction.The efficacy of cochlear implantation is uncertain and general anesthesia if applied will accelerate the progress of encephalopathy and might lead to multiple organ failure.Unsure of the perioperative safety,the parents of the girl did not chose the option of hearing intervention tempo-rarily,but chose oral symptomatic supportive treatment with coenzyme Q10,folate,levocarnitine,and complex vitamins as recommended.

This study critically examines the current status of interoception research in modern psychology， taking into account perspective of traditional Chinese medicine （TCM）， encompassing both foundational studies and clinical applications. The investigation highlights a deep interconnection between psychosomatic theories in TCM， such as the TCM emotions and viscera theory and the view of body-spirit syncretism， and the concept of interoception at the cognitive level. Moreover， philosophical principles， particularly the “Zhi Yi Lun” in TCM， align naturally with the three-dimensional interoception model. Importantly， this comparative analysis emphasizes that Western and Chinese medicine place different emphasis on interoception research with the former focusing on diagnosis and the latter on treatment. These differing approaches complement each other and provide opportunities for cross-fertilization. At the practical level of interoception application， “five-state personality classification” demonstrates promising potential for further clinical application. In addition， TCM has valuable insights for contemporary medical practices in terms of emotional regulation. TCM methods for emotional regulation， known as “Daoyin”， provide important knowledge in this area. One concept developed by TCM for clinical intervention targeting interoception is “Tiao Qi” （regulating qi）. This concept is used during diagnosis and treatment in TCM and plays a crucial role in managing interoceptive states. This paper aims to explain the cognitive and applied aspects of interoception in TCM， offering a perspective for future research and clinical application. By integrating modern psychology's psychosomatic medicine model， TCM can enhance its relevance and efficacy in contemporary medical contexts. This integration promotes a balanced relationship between the mind and body. TCM researchers have a responsibility to explore the inherent strengths and practical value of TCM in interoception research， and contribute to the advancement of TCM.

Objective:To analyze the impact of baseline quantification of hepatitis B core antibody (qHBcAb) on prognosis of patients with hepatitis B virus (HBV) related acute-on-chronic liver failure (HBV-ACLF).Methods:A total of 91 HBV-ACLF patients (HBV-ACLF group), who admitted to Wuxi No.5 People′s Hospital from July 1, 2019 to December 30, 2021, were included in this study. Fifty chronic hepatitis B (CHB) patients (CHB group) and 50 chronic HBV carriers (HBV carrier group) were enrolled as controls. Baseline clinical data such as qHBcAb, blood routine examination biochemical, and coagulation indices, HBsAg, hepatitis B e antigen (HBeAg), HBV DNA levels were recorded and analyzed retrospectively. The HBV-ACLF, HBsAg and HBV-DNA data were converted logarithmically. Patients were followed-up for 90 days. Cox regression was used to analyze the correlation between HBV-ACLF and survival outcome; survival rate was estimated by the Kaplan-Meier method; receiver operating characteristic (ROC) curve was used to evaluate the predictive value of baseline qHBcAb for the prognosis in patients with HBV-ACLF.Results:The baseline qHBcAb level in HBV-ACLF patients was (4.83±0.42) IU/ml, which was significantly higher than that in the CHB group [(4.59±0.54) IU/ml] and chronic HBV carrier group [(3.86±0.74) IU/ml] (all P<0.05). At the end of 90 days follow-up, 46 patients (50.55%) survived, and 45 patients (49.45%) died in the HBV-ACLF group. The baseline qHBcAb level was significantly higher in the survival group [(4.93±0.22) IU/ml] than in the death group [(4.70±0.52) IU/ml, P<0.01]. Significant differences were also found in the alpha fetoprotein, international normalized ratio, prothrombin activity, antithrombin Ⅲ activity, platelet, end-stage liver disease model score and hepatic encephalopathy complication between the two groups ( P<0.05). Cox regression analysis showed that the baseline qHBcAb was an independent risk factor affecting the 90-day survival of HBV-ACLF patients [hazard ratio=0.027,95% confidence interval ( CI) 0.001-0.696, P<0.05]. The area under the ROC curve of baseline qHBcAb level for predicting the 90-day survival outcome of HBV-ACLF patients was 0.639 (95% CI 0.525-0.752, P<0.05), with a cut-off value of 4.89 IU/ml. The cumulative survival rate of patients with baseline qHBcAb≥4.89 IU/ml was higher than that of patients with baseline qHBcAb<4.89 IU/ml ( P<0.05). Conclusions:Higher baseline qHBcAb level is associated with favorable outcome of HBV-ACLF patients and baseline qHBcAb may be used as a new biomarker to predict the clinical outcome of HBV-ACLF patients. HBV-ACLF patients with serum qHBcAb lower than 4.89 IU/ml face increased risk of short-term death.

ObjectiveTo explore the association between social support， parent-child relationships， and depression， anxiety， and loneliness among adolescents， in order to provide a reference for improving mental health in youth. MethodsA total of 11，596 middle school students from two districts of Shanghai were investigated with the stratified random cluster sampling method. The Chinese version of Patient Health Questionnaire （PHQ-2-C）， Generalized Anxiety Disorder （GAD-7）， UCLA Loneliness Scale （ULS-6）， Perceived Social Support Scale and Parent-child Cohesion Questionnaire were used in the survey. Statistical inferences were made using t-test， ANOVA， and logistic regression analysis. ResultsGirls， non-graduates， students ranking in the top 25%， adolescents living with parents and with higher socioeconomic status had higher scores of social support and parent-child cohesion than boys， graduates， students ranking in the middle or in the bottom 25%， adolescents not living with parents and with lower socioeconomic status （P<0.05）. Adolescents' parent-child cohesion and social support were negatively correlated with all kinds of emotions. Parent-child cohesion was an associated factor of depression （OR=0.93， 95%CI：0.91‒0.94）， loneliness （OR=0.94， 95%CI：0.94‒0.95） and anxiety （OR_mild=0.98， 95%CI： 0.98‒0.99； OR_{moderate or severe}=0.96， 95%CI： 0.95‒0.98）， but there were differences in the correlation between emotions and social support in different dimensions. ConclusionSocial support and parent-child relationship are significantly associated with depression， anxiety and loneliness in adolescent students. Paying more attention to youth with different characteristics， taking targeted measures to improve the level of social support and establishing a good family relationship are conducive to promoting the mental health of adolescents.

Objective To investigate and validate the effect of relevant parameters of pancreatic anatomic structure under standard pancreatic neck transection in predicting postoperative pancreatic fistula (POPF). Methods A total of 140 patients who underwent pancreaticoduodenectomy (PD) in The General Hospital of Western Theater Command from June 2016 to December 2019 were enrolled as prediction group, and 82 patients who underwent PD in the same hospital from January 2020 to March 2021 were enrolled as validation group. Baseline levels were compared between the two groups. A univariate analysis was performed for the prediction group to screen out the risk factors for POPF, and in the validation group, the interclass correlation coefficient (ICC) was used to compare the consistency between preoperative imaging measurements and actual intraoperative measurements. The risk factors for POPF were validated in each 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 continuous data with skewed distribution between groups; the chi-square test was used for comparison of categorical data between groups. The multivariate logistic regression analysis was used to investigate the risk factors for POPF. Youden index was calculated, GraphPad Prism was used to plot the receiver operating characteristic (ROC) curve, and the area under the ROC curve (AUC) was calculated. ICC was used for the reliability analysis of preoperative imaging measurements and actual intraoperative measurements. Results Pancreatic duct diameter at the pancreatic neck (odds ratio [ OR ]=0.347, 95% confidence interval [ CI ]: 0.192-0.626, P < 0.001), the major axis of the pancreatic neck parenchyma ( OR =1.127, 95% CI : 1.031-1.231, P =0.008), and the minor axis of the pancreatic neck parenchyma ( OR =1.350, 95% CI : 1.137-1.602, P =0.001) were risk factors for POPF. Pancreatic duct diameter at the pancreatic neck had an AUC of 0.785 (95% CI : 0.128-0.302, P < 0.001) and a cut-off value of 2.7 mm; the major axis of the pancreatic neck parenchyma had an AUC of 0.669 (95% CI : 0.564-0.774, P =0.006) and a cut-off value of 19.3 mm, and the minor axis of the pancreatic neck parenchyma had an AUC of 0.720 (95% CI : 0.627-0.813, P < 0.001) and a cut-off value of 9.9 mm. Preoperative imaging measurements were highly consistent with actual intraoperative measurements for 30 patients in the validation group, with an ICC of > 0.75 ( P < 0.001). Grouping validation of cut-off values showed that there was a significant different in the incidence rate of POPF between the high-risk group and the low-risk group based on pancreatic duct diameter at the pancreatic neck ( χ 2 =0.645, P =0.011), as well as between the high-risk group and the low-risk group based on the minor axis of the pancreatic neck parenchyma ( χ 2 =5.901, P =0.015). Conclusion Structural features of the pancreatic neck under standard pancreatic neck transection are risk factors for POPF, which can be differentiated by preoperative CT, and the method is easy and convenient in clinical practice.

Hyperglycemia is a common complication of critical patients. Currently, clinical assessment of the changes in the blood glucose of critical patients is mainly based on the intermittent monitoring of peripheral blood glucose at a certain time point. This method cannot get the true blood glucose fluctuation, and it is more difficult to find asymptomatic hyperglycemia and hypoglycemia, so the guiding value of blood glucose control is limited. Arterial blood is the most accurate sample of blood glucose monitoring, so it is urgent to ensure the accuracy of arterial blood sample. A continuous arterial blood glucose monitoring equipment was independently developed by general surgical intensive care unit (ICU) of the First Affiliated Hospital of Nanjing Medical University, and National Utility Model Patent of China was obtained. It could greatly improve the efficiency of medical staff, and provide accurate and dynamic statistic data that would be an important basis for doctors' clinical decision-making. The continuous arterial blood glucose monitoring equipment was mainly composed of arterial pressure measuring monitor, program-controlled dynamic blood glucose meter, wire, electric switch, integrated collecting syringe, electric clip, rotary electric bracket, and blood glucose test strips, etc., which could be continuously and dynamically monitor patient blood glucose levels and perform various additional value-added functions such as automatic recording and alarming.

Objective: To explore the characteristics underlying Th1/Th2/Th17 expression level after entecavir (ETV) discontinuation of chronic hepatitis B (CHB) patients who were HBeAg-positive and define the role of Th1/Th2/Th17 in maintaining virological response after ETV discontinuation. Methods: We selected 112 HBeAg positive CHB patients who met the withdrawal criteria according to the guideline of prevention and treatment of chronic hepatitis B (2010 version), and we also separated them into virology sustained response (SVR) group and virological relapse (VR) group according to the recurrence in 52 weeks. We detected serum level of Th1/Th2/h17 related cytokines during 0, 12, 24 and 52 weeks follow-up to further analyze their dynamic changes and expression differences. Results: The results of the study reveals that serum levels of IFN-γ in the group of SVR were at a higher level compared with VR group during follow-up (all P<0.05). While, the serum level of IL-10 decreased in SVR group and was lower than the paired IL-10 level in VR group with significance during follow-up. In VR group, the serum level of IFN-γ decreased during the first 24 weeks after ETV withdrawal, and after then, the level rose. The serum levels of IFN-γ (Th1) in SVR patients were significantly higher than those in VR patients in the different follow-up time points after ETV discontinuation (all P<0.05). And the serum levels of IL-10 (Th2) in SVR patients were significantly lower than that in VR patients (all P<0.05). The comparison of serum levels of IL-17A (Th17) between the two groups had no significant difference (all P>0.005). Conclusions The serum level of IFN-γ in SVR group maintained a high level is conducive to maintaining virological response after ETV withdrawal and high level of IL-10 may be related to virologic relapse.

Objective To explore the relationship between viral load and expression of CD 226 on the surface of peripheral blood T follicular helper cells (Tfh) in patients with chronic hepatitis C (CHC) . Methods One hundred and thirty-five CHC patients hospitalized at Wuxi Fifth People′s Hospital from March 2015 to April 2017 were collected ,and another 30 healthy blood donors were set as healthy control group .CHC patients were divided into two groups based on hepatitis C virus (HCV) RNA level ,with 49 cases (36 .3％ ) in low viral load group and 86 cases (63 .7％ ) in high viral load group .Expression of CD226 on the surface of peripheral blood Tfh cells , Tfh cells ,interleukin (IL )-21 and HCV specific cytotoxic lymphocyte (CTL) levels of two patient groups were compared .Categorical data were compared with chi-square test and normally distribute continuous data were compared with t test .Correlations between different factors were analyzed by Pearson correlation analysis .Results Expression of CD226 on the surface of peripheral blood Tfh cells in 135 cases of CHC patients was (77 .69 ± 5 .42)％ ,which was lower than that of healthy control ([90 .06 ± 5 .83]％ ) ,and the difference between the two groups was significant (t= 7 .541 , P < 0 .01) .The CD226 expression on the peripheral blood Tfh cells in low viral load group was (88 .75 ± 6 .68)％ ,which was higher than that of high viral load group ([69 .23 ± 5 .86]％ ) ,and the difference between the two groups was significant (t = 19 .232 , P< 0 .01) .The viral load was negatively correlated with Tfh cell surface CD 226 expression (r = - 0 .705 , P < 0 .01) .The peripheral blood Tfh cell level in 135 CHC patients was higher than that of healthy control ,and the difference between the two groups was significant (t= 13 .878 , P< 0 .01) .The peripheral blood Tfh cell level in low viral load group was higher than that in high viral load group ,and the difference between the two groups was significant (t= 26 .993 , P< 0 .01) .The IL-21 level of 135 CHC patients was lower than that of healthy control ([70 .35 ± 1 .6]％ ) ,and the difference between the two groups was significant (t=18 .322 , P< 0 .01) .The IL-21 level in peripheral blood of low viral load group was higher than that of high viral load group ,and the difference between the two groups was significant (t= 84 .54 , P< 0 .01) . HCV specific CTL level in peripheral blood of low viral load group was higher than that of high viral load group ,and the difference between the two groups was significant (t = 29 .869 , P< 0 .01) .The viral load was negatively correlated with levels of HCV specific CTL (r= -0 .734 ,P< 0 .01) .Conclusions In patients with chronic hepatitis C ,different levels of viral load can result in different levels of CD 226 expression on the peripheral blood Tfh cells .Patients with low viral load has high CD226 expression on Tfh cell surface , resulting in rise of Tfh cell level ,IL-21 level and HCV specific CTL level .

Objective To study the correlation between interleukin(IL)-21 and the recurrence of chronic hepatitis B(CHB)in hepatitis B e antigen(HBeAg)-positive patients after discontinuation of entecavir(ETV).Methods A total of 112 HBeAg-positive CHB patients treated with ETV were enrolled.Serum levels of IL-21 at week 0,12,24 and 52 after ETV discontinuation were detected.The Cox regression model was used to analyze the correlation between IL-21 and the recurrence after ETV discontinuation.The receiver operating characteristic(ROC)curve was applied to determine the predictive value of IL-21 for CHB recurrence after ETV discontinuation.The expression differences of IL-21 were compared between sustained viral response(SVR)group and viral relapse(VR)group.The t test and Chi-square test were used for statistical analysis.Results The serum levels of IL-21 in SVR group at week 0,12,24 and 52 after ETV withdrawal were(60.0 ± 10.8),(60.2 ± 14.7),(60.6 ± 19.5)and (61.2 ± 15.4)ng/L,respectively,which were all significantly higher than those in VR group(47.5 ± 10.7),(47.3 ± 12.9),(46.9 ± 12.2)and(46.4 ± 12.8)ng/L,respectively(t=6.153,4.926,4.382 and 5.515,respectively,all P< 0.01).The area under curve(AUC)was 0.811(95% CI:0.728 ~0.893,P<0.01)and the best cut-off value of serum IL-21 level was 49.8 ng/L.The recurrence rates of patients with serum IL-21 level ≥49.8 ng/L and <49.8 ng/L at time of ETV withdrawal was 25.4%(16/63)and 77.6%(38/49),respectively.The difference was statistically significant(χ2=30.027,P<0.01).The serum IL-21 level at the time of drug withdrawal(P= 0.005),serum hepatitis B surface antigen(HBsAg)level at the time of HBeAg seroconversion(P= 0.008)and age(P= 0.016)were factors associated with CHB recurrence after ETV withdrawal by multivariate Cox model analysis.The serum levels of ALT,HBV DNA,HBeAg and HBsAg in SVR group were significantly lower than those of VR group at week 12,24 and 52 after ETV withdrawal(t= -5.968,-7.691,-8.093; -3.047,-9.477,-28.900;-2.872,-10.424,-18.330;-4.633,-4.030 and -5.032,respectively;all P<0.01).Serum level of IL-21 was negatively correlated with HBsAg in SVR group after ETV withdrawal (r= -0.241,P<0.01),while positively correlated with HBsAg in VR group(r=0.286,P<0.01). Conclusions The serum IL-21 level at the time of drug withdrawal is associated with the recurrence after ETV discontinuation.IL-2l may play an important role as an immunomodulatory factor in maintaining virological responses in HBeAg-positive CHB patients after ETV withdrawal.