Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

The effect of anti-programmed cell death 1 (anti-PD-1) immunotherapy is limited in patients with hepatocellular carcinoma (HCC). Yes-associated protein 1 (YAP1) expression increased in liver tumor cells in early HCC, and Akkermansia muciniphila abundance decreased in the colon. The response to anti-PD-1 treatment is associated with A. muciniphila abundance in many tumors. However, the interaction between A. muciniphila abundance and YAP1 expression remains unclear in HCC. Here, anti-PD-1 treatment decreased A. muciniphila abundance in the colon, but increased YAP1 expression in the tumor cells by mice with liver tumors in situ. Mechanistically, hepatocyte-specific Yap1 knockout (Yap1^LKO) maintained bile acid homeostasis in the liver, resulting in an increased abundance of A. muciniphila in the colon. Yap1 knockout enhanced anti-PD-1 efficacy. Therefore, YAP1 inhibition is a potential target for increasing A. muciniphila abundance to promote anti-PD-1 efficacy in liver tumors. Dihydroartemisinin (DHA), acting as YAP1 inhibitor, increased A. muciniphila abundance to sensitize anti-PD-1 therapy. A. muciniphila by gavage increased the number and activation of CD8⁺ T cells in liver tumor niches during DHA treatment or combination with anti-PD-1. Our findings suggested that the combination anti-PD-1 with DHA is an effective strategy for liver tumor treatment.

Objective:To understand the function of diaphragm and analyze the clinical factors affecting the function of diaphragm by measuring twitch tracheal pressure (TwPtr) in patients with mechanical ventilation and in the weaning phase.Methods:Patients with more than 48 hours of invasive mechanical ventilation admitted to the department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from December 2015 to March 2017 were enrolled. After the patient entered the weaning stage, TwPtr of patients was monitored by two-way non repetitive automatic respiratory trigger device, the effects of duration of mechanical ventilation, severe pulmonary infection, sedative application and chronic obstructive pulmonary disease (COPD) on weaning were analyzed.Results:A total of 62 patients were included, of which 45 were male and 17 were female. The average age was (66.8±11.7) years old. Twenty-three cases had severe pneumonia. The absolute value of TwPtr in severe pneumonia group was lower than that in non-severe pneumonia group [cmH 2O (1 cmH 2O = 0.098 kPa): 10.40±5.81 vs. 14.35±5.22, P = 0.021]. However, there was no significant difference in the duration of mechanical ventilation between the severe pneumonia group and non-severe pneumonia group [days: 26 (17, 43) vs. 15 (11, 36), P = 0.091]. In 62 patients with mechanical ventilation, there was a negative correlation between TwPtr and duration of mechanical ventilation ( r = 0.414, P = 0.002), there was also a negative correlation between the duration of mechanical ventilation and TwPtr after the assessment of diaphragm function ( r = 0.277, P = 0.039). There was a linear relationship between TwPtr and sedatives ( r = 0.220, P = 0.040), but there was no correlation between TwPtr and COPD ( r = -0.178, P = 0.166). Conclusions:For patients in the weaning stage of mechanical ventilation, severe pulmonary infection is one of the factors that affect the diaphragm dysfunction. There is a certain correlation between the diaphragm dysfunction and the use of sedatives.

Objective To investigate the interconnection of the executive control network in major depressive disorder when they recognized the sad facial stimuli,and to discuss the aberrant mechanism of emotion processing.Methods Twenty major depressive patients and 20 well-matched healthy volunteers participated in the experiment.The brain actions of all subjects were recorded by the magnetoencephalography (MEG) when they were required to distinguish the emotion face.Based on prior knowledge,the interested brain area consisted of the primary visual cortex (V1),the orbitofrontal cortex(OFC),the dorsolateral prefrontal cortex (DLPFC),the anterior cingulated cortex (ACC).Then constructing three competing models to select an optimal model by the method of dynamic causal model(DCM),finally the differences of the effective connections of the optimal model between the depressed patients and healthy controls were analyzed.Results According to the results of Bayesian model selection (BMS),model 1 had the most exceedance probability of 0.80 with the features that there were bidirectional modulatory connections between the OFC,ACC and DLPFC.Given the best model,the parameters of effective connectivity of the optimal model were extracted,and then two-sample t-test over the model 1 was adopted.The modulatory effective connectivity from the OFC to the DLPFC in both hemisphere(t=-2.73,P=0.0096;t=-3.01,P=0.0046) and the OFC to the ACC (t=-2.93,P=0.0057) in the left hemisphere were significantly reduced in MDD.Conclusion There exists abnormal function of executive control network in depressed patients,the decreased effective connections between the OFC and the DLPFC,as well as the OFC and the ACC,may have correlation with the negative

The primary importance of magnetic resonance (MR) imaging in evaluating anal fistulas lies in its ability to demonstrate hidden areas of sepsis and secondary extensions in patients with fistula in ano. MR imaging is relatively expensive, so there are many healthcare systems worldwide where access to MR imaging remains restricted. Until recently, computed tomography (CT) has played a limited role in imaging fistula in ano, largely owing to its poor resolution of soft tissue. In this article, the different imaging features of the CT and MRI are compared to demonstrate the relative accuracy of CT fistulography for the preoperative assessment of fistula in ano. CT fistulography and MR imaging have their own advantages for preoperative evaluation of perianal fistula, and can be applied to complement one another when necessary.
Adult ; Anal Canal/anatomy & histology ; Female ; Humans ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Rectal Fistula/diagnosis/*radiography/surgery ; Tomography, X-Ray Computed ; Young Adult

Objective To examine the effect of labouring in water on analgesia of vaginal delivery.Methods From June 2009 to February 2011,38 women who had volunteered to deliver in water in the obstetrical department were set as the observation group,another 70 women who chose vaginal delivery were named as the control group in the corresponding period.The items of labor pain,satisfaction with the birth experience,length of labor and neonatal outcomes were compared.Results The pain level of the observation group after labouring in water decreased compared with that before immersion in water.The delivery course was not influenced with a high rate of vaginal delivery.Conclusions Labouring in water can alleviate delivery pain,increase rate of vaginal delivery with no influence on delivery course and outcome of mothers and infants.It is a safe and effective analgesia method which should be widely applied.

Objective To explore the gender differences of brain activation between patients with depression in recognition of dynamically sad expression with magnetoencephalography (MEG) technology and the paradigm of expressional experiment,and further to examine its neurological basis. Methods Brain activities were detected using MEG during the recognition of dynamic facial video with 12 female depressed patients, 11 male depressed patients, and their corresponding normal controls matched by age and education. Results Compared with male depression,female depression showed increased activation during different time periods were in turn as follows: bilateral inferior frontal gyrus ( x, y, z = 58/- 60,12/22,20/20, T = 2.17,1.88 ), left anterior cingulate gyrus ( x, y, z = 64,12,4, T = 2.37 ), bilateral superior frontal gyrus ( x, y, z= 30/-24,64/- 4,0/50, T = 2.86,2.36 ),the left brainstem( x, y,z = - 12, - 16, - 18 ,T = 1.96) ,right middle frontal gyrus( x,y,z =40,60,4,T = 2.22 ),bilateral precentral gyrus(x,y,z = -62/56, 16/10, 10/8. T = 1.99,2.65 ) ,left hippocampus ( x,y,z = - 26,- 14, -20,T = 1.77) ,left parahippocampal gyrus(x,y,z = - 16, - 12, -20,T = 1.72) ,right middle occipital gyrus( x ,y ,z = 50, -76, -14 ,T = 1. 75 ),while the decreased brain activation were in turn in right superior temporal gyrus ( x, y, z = 68, - 18,2, T = 1.85 ), right parahippocampal gyrus ( x, y, z = 20, - 36, - 14, T = 1.92 ), left cuneus( x,y,z = -6, -98,14,T =2.46) ,bilateral temporal middle gyrus( x,y,z =52/-34, - 80/-62,20/28,T = 1.95,2.57 ), left pre-cuneus ( x, y, z = - 40, - 74,38, T = 2.58 ), right hippocampus( x, y, z = 24, - 32, - 18,T = 2.05 ) in recognition of dynamically sad expression. ( p ＜ 0. 05, corrected). Conclusion The data suggest that there may be significant gender differences of functional network in depressed patients during recognizing dynamical sad facial expression.

Objective To investigate the variation of brain inhibitory function of depressed patients during the processes of the Stroop color-word interference task with the Magnetic source imaging ( MSI) technology. Methods Twenty-three depressed patients and twenty age-,gender- and education- matched healthy controls were involved in the Stroop word-color interference test to detect the variation of brain inhibitory function by magnetoen-cephaloraphy scanning. Results Compared with the healthy controls,the abnormal activities in depressed patients during different time periods were separately as follows: increased activation in the bilateral thalamus( t = 2.46, t = 2.92 ) ,the right temple fusiform gyrus ( t = 1. 81) , the right middle temporal gyrus ( t = 1. 76) , the right inferior frontal gyrus( t = 2.28) , the left anterior cingulate( t = 2.00) , the left caudate head( t=1.81) ,the precentral gy-rus( t = 2.17) ,the right parahippocampal gyrus( t = 2.04) ,the left superior temporal gyrus(t = 2.47) ; decreased activation in the right superior temporal gyrus( t=1.76) ,the bilateral middle frontal gyrus(t=1.95, t = 2.09), the right cuneus( t=1.97) ,the cingulate gyrus( t=1.70, t = 2.08) ,the postcentral gyrus( t = 2.57, t = 2.65) , the left supramarginal gyrus( t = 2. 16) ,the left lentiform nucleus putamen( t = 2.39) ,the bilateral middle temporal gyrus (t = 2.22, t= 1.90) ,the left insula( t= 1. 81) ,the left superior temporal gyrus( t= 1.90) ,the right parietal lobe( t= 3.26). Conclusion The abnormal activation inefficiency in the brain regions related with inhibition function is reflected in depressed patients,and the ability against interference information declines.

ObjectiveTo investigate the variation of executive function of fronto-cingulate cortex in spatio-temporal sequence in recurrent depressed patients.MethodsEighteen recurrent depressed patients and twenty-one age-,gender- and education- matched healthy controls were involved in the Stroop word-color interference test to detect the executive function of anterior cingulate and prefrontal regions by magnetoencephaloraphy scanning.Results 1.Compared to healthy controls,the increased activation of brain regions in depressed patients during different time periods were separately shown as follows( t represents activation strength):( 1 ) 100 ～ 200 ms:the right anterior cingulate gyrus ( t =1.81,T value means activation strength),the bilateral medial frontal gyrus ( t =1.91,t =1.86),the left superior frontal gyms( t =1.79 ),the right middle frontal gyrus( t =1.82 ),the right inferior frontal gyrus ( t =1.82 ).( 2 ) 200 ～ 300 ms:the left anterior cingulate gyrus ( t =1.82 ).( 3 ) 250 ～ 350 ms:the left anterior cingulate gyrus ( t =2.67 ),the left medial frontal gyrus ( t =2.43 ),the left inferior frontal gyrus ( t=1.91 ).(4)300 ～400ms:the left anterior frontal gyrus(t=2.26),the bilateral inferior gyrus( t=1.97,t=2.66),the left medial frontal gyrus(t=2.35).(5)350 ～450ms:the left anterior cingulate gyrus(t=2.02),the left medial frontal gyrus ( t =2.00),the bilateral inferior frontal gyrus ( t =1.74,t =1.78 ).( 6 ) 400 ～ 500 ms:the left anterior cingulate gyrus( t=2.01 ),the left medial frontal gyrus( t =1.97).2.Compared to healthy controls,patients showed decreased activation in the left middle frontal gyms ( t =1.79) and the left superior gyrus(t =1.76) in 200 ～ 300 ms.ConclusionExecutive dysfunction is reflected in depressed patients with the activation inefficiency in anterior cingulate and prefrontal regions in spatio-temporal sequence.

Objective To explore the features of functional networks about recognizing dynamically positive expression with using magnetoencephalography (MEG) technology and the paradigm of expressional experiment, and further to examine its neurological basis. Methods Twelve depressed patients and twelve age,education-matched healthy controls participated to recognize the dynamically positive expression in the MEG scans. Results In comparison with the healthy,the abnormally activities regions in depressed patients during different time periods were separately as follow;decreased activation in the right inferior parietal lobule(t = 3.94),the right su-pramarginal gyms(t = 3.59),the bilateral posterior cingulated(t = 5. 04, t = 4. 85) ,the bilateral precuneus(t = 3.84) ,the left cuneus(t = 3.58) and increased activation in the bilateral hippocampus(t = 2. 13, t = 2.56) ,the left amygdale(t = 2.41), the bilateral uncus gyrus(t = 2.33, t = 2.44) , the right anterior cingulated (t = 2. 15) , the left fusiform gyms (t = 3. 33) (P < 0. 05, unconnected). Conclusion The results indicate, compared with healthy controls,abnormal brain activities as the weakened function of the medial temporal cortex,parietal lobe and the enhanced function of limbic system were distributed extensively in depressed patients during recognizing dynamically positive expression. These abnormalities may prompt the dynamic characteristics of the magnetic source imaging about recognizing dynamically positive expression,and further reveals the mechanisms of emotional symptoms in depression.