Objective To discuss the clinical application of controlling nutritional status(CONUT)score in predicting the prognosis of hepatocellular carcinoma(HCC)patients who are treated with transarterial chemoembolization(TACE),and to construct a nomogram model integrated with multiple prognostic factors which help clinicians to accurately predict the prognosis of each patient.Methods The clinical data of 155 primary HCC patients,who were treated with TACE at the Third Affiliated Hospital of Soochow University of China between January 2017 and June 2020,were retrospectively analyzed.The optimal cutoff point of CONUT score was identified by receiver operation characteristics(ROC)curve and its prognostic significance was analyzed by Kaplan-Meier curve.The univariate and multivariate Cox survival analysis was performed to determine the independent prognostic factors for HCC patients treated with TACE.A nomogram model was constructed based on the significant variables which were obtained from the multivariate analysis,and its ability in predicting overall survival(OS)in HCC patients receiving TACE treatment was evaluated by using the consistency index(C-index).The calibration curves were plotted to evaluate the consistency between the predicted probability and the actual probability.Results The optimal cutoff point of CONUT score for predicting OS was 4,with an AUC value of 0.766(95％CI=0.691-0.841).The patients of high CONUT score group(≥4)had larger tumor diameter(P=0.014),higher serum AFP level(P=0.002),poorer hepatic function(P＜0.01),poorer response to TACE treatment(P＜0.01),and shorter median OS(P＜0.01).Child-Pugh grade,maximum tumor diameter,serum AFP level,BCLC stage,therapeutic response to TACE,and CONUT score were the independent predictors of OS in HCC patients after TACE treatment(all P＜0.05).Based on the above variables,the nomogram model was constructed,and its C-index was 0.785(95％CI=0.691-0.879).The calibration curves showed that a good consistency existed between the predicted probability of the model and the actual probability.Conclusion CONUT score is a simple and feasible tool for predicting the prognosis of HCC patients who are treated with TACE.The nomogram model integrated with tumor biological characteristics,therapeutic response to TACE treatment and CONUT score carries a reliable predictive ability,therefore,this model is worth further promotion and verification.(J Intervent Radiol,2023,32:1190-1196)

Objective:This meta-analysis was conducted to systematically evaluate the short-term efficacy and safety of indocyanine green fluorescence imaging guided laparoscopic liver tumor resection (FIGLTR).Methods:A systematic search was made for the literature on indocyanine green fluorescence image-guided laparoscopic hepatectomy in randomized, semi-randomized controlled trials and observational studies, and manually search published materials and conference papers in Chinese and English and trace references included in the literature. The retrieval period was up to September 2021. The quality of included studies was evaluated, then the meta-analysis was conducted using Review Manager 5.1 software.Results:Ten studies were included with 803 patients, including 341 in the FIGLTR group and 462 in the non-FIGLTR group. Meta results showed that: Compared to the traditional resection group, indocyanine green fluorescence imaging can significantly shorten the operative time ( MD=-22.61, 95% CI: -34.20--11.03, P<0.001), reduce intraoperative bleeding ( MD=-49.17, 95% CI: -84.99--13.36, P<0.01), shorter hospital stay ( MD=-0.89, 95% CI: -7.72--0.06, P<0.05), Improve the removal rate of R 0 edge ( OR=8.80, 95% CI: 1.96-39.44, P<0.05) and reduce the incidence of postoperative complications ( OR=0.55, 95% CI: 0.34-0.87, P<0.05) of laparoscopic liver tumor resection. There were no differences found in portal block time and transfusion rate. Conclusion:Indocyanine green fluorescence imaging technology provides a new way for safe and accurate laparoscopic resection of liver tumors.

Objective : To investigate the role of endoplasmic reticulum stress in hepatic insulin resistance induced by intermittent hypoxia in rats． Methods : Twenty-four SD rats were randomly divided into control group ( NC group) and intermittent hypoxia group ( CIH group) ．The NC group was placed in a normoxia environment for 12 weeks，and the CIH group was given intermittent hypoxia for 8 weeks，and then returned to normoxia until the 12th week．In both groups，fasting blood glucose (FBG) ，fasting insulin (FINS) ，and liver inositol-requiring enzyme- 1 α(IRE1 α) ，X-box binding protein 1s(XBP1s) ，forkhead box transcription factor O1 (FoxO1) ，activating transcription factor-6(ATF6) ，cAMP-response element binding protein( CREB) ，CREB-regulated transcription coacti- vator-2( CRTC2) ，double-stranded RNA-dependent protein kinase-like ER kinase ( PERK) ，eukaryotic initiation factor 2 α(eIF2 α) ，protein kinase B ( AKT) ，phosphoenolpyruvate carboxykinase ( PEPCK) ，glucose-6-phosphat- ase( G6Pase) mRNA were measured at baseline，week 8，and week 12 . Results : There was no significant differ- ence in each observation index between the two groups at baseline ; at 8 weeks，the levels of FBG，FINS and the mRNA levels of IRE1α , XBP1s，ATF6，PERK，eIF2 α , PEPCK and G6Pase in the CIH group were higher than those in the NC group (P＜0. 05) ，while the mRNA levels of CREB，CRTC2 and AKT were lower than those in the NC group (P＜0. 05) ; at 12 weeks，there was no significant difference in each observation index between the two groups．Pearson correlation analysis showed(8th week of intermittent hypoxia group) : homeostasis model as- sessment-insulin resistance(HOMA-IR) was positively correlated with FoxO1，CREB，CRTC2 and PERK，eIF2 α mRNA levels (r = 0. 172，0. 595，0. 183，0. 702，0. 608 ; P＜0. 05) while it was negatively correlated with IRE1α , XBP1s，ATF6，AKT mRNA levels (r = －0. 422 ，－0. 327 ，－0. 309 ，－0. 399 ; P＜0. 05) ． Conclusion Intermittent hypoxia can lead to insulin resistance，and endoplasmic reticulum stress may mediate this effect.

Objective:To investigate the short-term clinical effect of using fibular flap with preserving the continuity of fibula in hip preservation surgery for femoral head necrosis.Methods:From September, 2017 to November, 2020, 13 cases of femoral head necrosis were repaired with fibular flap. The fibular flaps were cut with an improved method for preserving the continuity of the fibular cortex, and the donor sites were sutured directly. The fibuls were inserted into the femoral heads with single or double segment folding support. Autogenous iliac crest combined with platelet-rich plasma(PRP) was used for impaction of bone grafting in femoral head, and the fibular flaps were anastomosed with 1 artery and 2 veins. All follow-up data were obtained, including bone union by X-ray and CT as well as the functional recovery of the hip joint and donor site. Statistical analysis was performed. P<0.05 was considered statistically significant. Results:The followed-up time ranged from 6 to 23 months. The fibular bones were significantly thicker and the incisions healed well at the donor sites. There was neither abnormal sensation in toes, dorsal foot, and lateral of the leg, nor significant influence on foot function. The hip joint activities were normal. The outcome was proved to be remarkable according to the Harris score(from 58.9±10.6 points before surgery to 81.7±10.6 points after surgery), the difference was statistically significant ( P<0.05) . Conclusion:The method of the improved fibular flap in hip preservation surgery is beneficial to the repair and reconstruction of the necrotic femoral head since the donor area is less traumatic, and a satisfactory clinical effect can be obtained.

Cholangiocarcinoma is the most common malignant tumor of the biliary tract, with a relatively high mortality rate and an incidence rate increasing year by year. Due to atypical symptoms in the early stage and complex anatomical location, it is often difficult for patients with cholangiocarcinoma to be diagnosed in the early stage, and therefore, they often miss the optimal treatment period and tend to have poor prognosis. In recent years, studies have shown that miRNAs play a key role in the pathophysiological process of the development and progression of cholangiocarcinoma. This article reviews the regulatory role of miRNAs in the development, invasion, metastasis, drug resistance, and tumor microenvironment of cholangiocarcinoma and introduces the latest advances in exosome miRNA and cholangiocarcinoma, so as to provide potential treatment strategies for cholangiocarcinoma.

Objective:To explore a clinical discipline-oriented teaching model for laboratory diagnostics and evaluate its effect in medical education.Methods:changed the arrangement of traditional teaching content, re-edited the content of the teaching materials under the guidance of clinical subjects, compiled innovative textbooks and introduced new teaching methods such as CBL and PBL. The procedure could be briefly described below. 78 students from two natural classes in batch 2015 were selected as the observation group, and 77 students from other two natural classes were selected as the control group. The new teaching model and traditional teaching model were applied respectively in the students to compare the teaching effect in the way of formative evaluation.Results:The total score of theoretical exams in the observation group was significantly higher than that of control group ( P<0.01). It was found that the scores of the observation group were significantly higher than of the control group in terms of practical techniques, clinical application type and the selection and evaluation of test items ( P<0.01). However, there was no significant difference in terms of the scores of basic knowledge and theory between the observation group and the control group ( P=0.470). Conclusion:The clinical discipline-oriented teaching method of laboratory diagnostics can promote the students in the assessment of applied and improved knowledge as well as the selection and evaluation of clinical disease examination items, which is helpful to cultivate students' clinical thinking ability, and the ability to reasonably select the test items and analyze the test results scientifically.

Objective To analyze the problems existing in the implementation of the hierarchical medical system in China under the new situation .Methods The Smith policy implementation process model was used as an analytic framework.By means of literature analysis ,stakeholder analysis and PEST analysis ,the analysis was conducted in terms of such elements as the Smith policy implementation process model ,namely ,the idealized policy ,the implementing organization ,the target group and the environmental factors ,as well as its mechanism of action .Results The literature review found that the main obstacle that hinders the smooth implementation of the hierarchical medical system was the lagging of relevant supporting measures ,which accounted for 16.6％ (161)of the problems.In addition ,defects in policy design(the lack of division and cooperation mechanism etc .)and constraints in existing institutional mechanism (separation of revenue and expenditure ,unclear orientation ,etc .) were suggested to accelerate the introduction of supporting policies ,respectively accounting for 6.0％(58) and 9.3％ (90 ) of the results .Conclusions In the process of policy implementation ,the relationship between the four elements of the ideal policy outcomes ,the implementing organization ,the target group and the environmental factors needs to be coordinated to ensure the effective implementation of the hierarchical medical system .

Objective To analyze the current situation of the official micro-blogs of the health and family planning commissions of provincial level, and to understand its application approaches.Methods The internet crawler software was used to collect the 102 899 micro-blog posts published by 24 official micro-blogs of health and family planning commissions of provincial level,and analyze the information of crawling by using content analysis method.Results At present, except for a number of provinces in the eastern regions where such micro-blogs were active and interactive,most of these official micro-blogs were found poor in operation management, especially in the spreading capacity; their micro-blog content was focused on science popularization(59.50%).Part of the content lacked scientific basis,and was short of planning in their information release form and content.Conclusions These micro-blogs need optimization in operations management,service positioning,information release specifications,and content audit.Such efforts can help improve their spreading capacity,influence and user viscosity, in order to better serve the public, achieve the goal of a service-oriented government.

Objective To evaluate the current deployment of general practitioners and residents′utilization of services in China, for reference of their optimal allocation across the country. Methods The methods of HRDI and TOPSIS were used to comprehensively evaluate their deployment and residents′utilization of their services in China. Results General practitioners fall short of demand in general, averaging 0.137 1 GP per 1 000 population in China, with unbalanced regional distribution as well. Utilization of residents of general practitioners service remains at a low level, with unbalanced regional distribution as well. As shown in the comprehensive evaluation results, 87.10% of the regions were found with defective deployment and service utilization, featuring " low resources, low utilization" . Conclusions Sizable gapes are found between the eastern, the central and the western regions, in terms of allocation of resources and service utilization. The government should rationalize deployment of general practitioners and minimize such gaps among different regions, in view of local population, geography and health service needs.

Objective To systematic review the influence of case-based payment on inpatient costs since China′s new medical reform. Methods Studies about inpatient costs before and after the implementation of case-based payment were collected. The literature collected underwent a meta-analysis by RevMan 5. 0. Results A total of 11 articles in compliance were included in the study. The meta-analysis of random effect model showed the overall effect size (SMD) was -1. 54 with 95% CI being -1. 79, -1. 29, showing a significant difference (P<0. 05). The subgroup analysis showed that the overall effect size (MD) in the low-cost disease group was -585. 57 yuan with 95% CI being -750. 34, -420. 80, showing a significant difference (P < 0. 05). The overall effect size (MD) in the high-cost disease group was-4 172.65 yuan with 95% CI being -5 368. 21, -2 977. 10, showing a significant difference ( P <0.05). The funnel plot was approximately symmetrical, suggesting a publication bias as less likely in the study. Conclusions The implementation of case-based payment has reduced the inpatient costs to some extent thanks to China′s new healthcare reform. And the effect in the high-cost disease group was more obvious than that in the low-cost disease group.