Objective:To construct a predict model based on ultrasomics parameters that can identify moderate acute hypoxemic respiratory failure patients at risk of non-invasive respiratory strategies(NIRS) failure and evaluate its value.Methods:This is a prospective observational trial.The patients with moderate acute respiratory failure (100 mmHg≤PaO 2/FiO 2≤200 mmHg) in intensive care unit(ICU) ,emergency and respiratory ward of Changshu Hospital Affiliated to Soochow University from Oct 2020 to Jan 2023 were included, NIRS failure is defined as death or intubation while on therapy.At admission time and 24 h after treatment vital signs,biological and ultrasound parameters were determined.The study subjects were randomly ( random number) divided into a development group (70%) and a validation group (30%).Univariate and multivariate logistic regression was performed.The treatment failure prediction models were constructed according to ultrasonic parameters combined with clinical parameters.The models were also validated by ROC curves, calibration curves, NRI index and decision curve analysis (DCA).The nomograms were drawn. Results:A total of 193 patients were included in the study, 137 were allocated to the development group, and 56 to the validation group, there was no statistically significant difference between the two groups. NIRS failed in 112 (58%) of 193 patients..Univariate analysis revealed that PaO 2/FiO 2, DE at the time of admission and 24 h in the failure group were found to be statistically lower than the success group, RV/LV was higher (all P<0.05). RR, LUS at 24 h in the failure group were higher and ROX index was lower (all P<0.01). In addition, more patients in the failure group received vasopressors ( P= 0.001). Use of vasopressors( OR=4.709, P=0.012), RR( OR=1.254, P=0.035), LUS( OR=1.250, P=0.037), RV/LV( OR=1.057, P=0.008), PaO 2/FiO 2 ( OR=0.950, P=0.001), DE ( OR=0.107, P=0.001) in the development group were independent risk factors for NIRS failure.ROC analysis revealed that model B achieved a larger area under curve (AUC) than model A in the development group, with their AUC values of 0.928 and 0.872 ( P=0.009), AUC of model A and model B in the validation group were 0.867 and 0.932 respectively ( P=0.07).Two prediction models showed a good degree of calibration (all P>0.05). NRI analysis showed significant improvement in the predictive power of model B ( P<0.01). DCA showed that the model B had a good net benefit between the threshold probabilities of 0-80%. Conclusions:Ultrasomics parameters combined with Clinical parameters can effectively predict NIRS failure in moderate acute hypoxemic respiratory failure patients.

Objective To investigate the prevalence rate of occult HBV infection (OBI) in patients with autoimmune hepatitis (AIH) and the influence of OBI in the clinical condition and prognosis of AIH patients. Methods A total of 103 patients with a confirmed diagnosis of AIH who were admitted to Beijing YouAn Hospital from April 2012 to March 2019 were enrolled. Nested PCR and real-time PCR were used to confirm the diagnosis of OBI, and real-time PCR was used to measure HBV pgRNA. Clinical features, laboratory markers, and follow-up analysis of prognosis were compared between the OBI group with 24 patients and the non-OBI group with 79 patients. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the Cox regression model was used to perform univariate and multivariate analyses. Hazard ratio and its 95% confidence interval were calculated. Results The detection rate of OBI was 23.30% (24/103) in AIH patients, with an HBV DNA viral load of < 200 IU/mL, among whom 9 patients with OBI (9/24, 37.50%) were found to have HBV pgRNA in serum. Compared with the non-OBI group, the OBI group had a significantly higher positive rate of the three antibodies anti-HBs, anti-HBc, and anti-HBe ( χ 2 =5.906, P =0.016). The univariate analysis showed that OBI, hypoproteinemia, splenomegaly, and ascites were risk factors for adverse events in AIH (all P < 0.05) and were associated with disease progression, and the multivariate Cox regression analysis showed that hypoproteinemia and ascites were independent risk factors for adverse events (all P < 0.05). Conclusion There is a relatively high detection rate of OBI in AIH patients, and the presence of OBI may accelerate the progression of AIH.

Autoimmune liver disease is a group of diseases mainly caused by autoimmune abnormalities, including autoimmune hepatitis dominated by hepatocellular injury, primary biliary cholangitis and primary sclerosing cholangitis dominated by bile duct injury, and overlap syndrome with the main features of the above two diseases. Recently, IgG4-related hepatobiliary diseases have also been included in this category, and without timely diagnosis and treatment, it can progress to liver cirrhosis and even liver failure. Different autoimmune liver diseases have their own features, and with the popularization of the knowledge on autoimmune liver diseases, physicians have gradually increased their understanding of such diseases and can achieve the early diagnosis and timely treatment of most typical autoimmune liver diseases. However, some patients may have atypical manifestations or laboratory markers, which may easily delay the diagnosis, and therefore, it is of great importance to identify atypical autoimmune liver disease and give timely diagnosis and treatment as soon as possible.

Objective:To analyze the characteristics of clinical and laboratory indexes in patients with liver disease with positive anti-liver cytosol antibody type 1 (anti-LC1), in order to provide references for clinical and differential diagnosis.Methods:The clinical data of 23 832 inpatients and outpatients with positive anti-LC1 autoantibodies detected in routine autoantibody test from January 2010 to January 2020 were retrospectively analyzed, and their clinical and laboratory indexes were compared. Western blotting was used to detect anti-LC1, anti-soluble liver antigen antibody (anti-SLA), anti-glycoprotein 210 antibodies and anti-nucleosome 100 antibodies. Indirect immunofluorescence assay was used to detect anti-nuclear antibody (ANA), anti-mitochondrial antibody, anti-Smooth muscle antibody (ASMA), anti-liver and kidney microsomal antibody (anti-LKM) and other autoantibodies. Normally distributed measurement data between the two groups were compared by independent-sample t-test, and the multiple groups comparison were compared by one-way analysis of variance. Non-normally distributed measurement data were compared by non-parametric rank sum test.Results:38 anti-LC1 positive patients were detected in 23832 autoantibody tests. The age of initial diagnosis ranged from 11.0 to 84.0 (50.6 ± 16.0) years. There were 8 males (21.1%) and 30 females (78.9%). A total of 31 cases (81.6%) were positive for anti-LC1 and ANA, and the dominant karyotype was speckled pattern, accounting for 54.8%. Five cases (13.2%) were positive for ASMA, and no simultaneous positive with anti-LKM or anti-SLA. Among the 38 anti-LC1 positive patients, 9 were diagnosed with autoimmune hepatitis (AIH), 6 with possible AIH, 6 with primary biliary cholangitis (PBC), 8 with hepatitis B, 2 with hepatitis C, 1 with alcoholic liver disease, 2 with non-alcoholic fatty liver disease, 1 with drug-induced liver injury, 1 with hepatolenticular degeneration, and 2 with tumor. Confirmed and probable AIH cases accounted for 39.5% (15/38) of anti-LC1 positive cases. Among anti-LC1 positive patients, 47.4% (18/38) had entered the stage of liver cirrhosis. AIH group globulin level was higher than HBV group ( P = 0.006) and other disease groups ( P = 0.001). AIH group IgG level was higher than PBC group ( P = 0.027), HBV group ( P = 0.009) and other disease groups ( P = 0.004). the of the PBC group IgM level was higher than AIH group ( P = 0.003), HBV group ( P = 0.003) and other disease groups ( P = 0.006). Conclusion:Anti-LC1 is not only detected in AIH, but also observed in patients with primary biliary cholangitis, hepatitis B and C, alcoholic and non-alcoholic liver disease, drug-induced liver injury, hereditary metabolic liver disease and tumor. In addition, it is mainly female gender dominance and nearly half of ANA-positive young, middle-aged and elderly patients develop liver cirrhosis. For the diagnosis of type 2 autoimmune hepatitis, whether anti-LC1 is a specific antibody needs further research, but if AIH is highly suspected, this antibody can be used as a substitute.

Autoimmune hepatitis (AIH) is a chronic liver inflammatory disease with unknown etiology, and at present, both genetic and environmental factors are thought to be involved in the pathogenesis of AIH. Environmental exposure has an important impact on the development of AIH. Autoimmune ecology is the study of the interactions between individuals and their environment, the development of imbalance between individuals and environment, and the mechanism of such imbalance in promoting the development of autoimmune disease. This article reviews the research advances in the role of autoimmune ecology in the pathogenesis of AIH.

Overgrowth of intestinal bacteria, change in intestinal flora, translocation between bacteria and their products, and bile acid metabolism are the important pathways for the development and progression of liver diseases. Hepatocytes are persistently exposed to intestinal metabolites and various antigens and antibodies via the portal vein system, and the constituents or metabolites of some intestinal bacteria can activate the autoimmune mechanism targeting hepatocytes through several mechanisms, including molecular mimicry. Therefore, intestinal flora plays an important role in the development/progression and treatment of autoimmune liver diseases, including autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis. This article reviews the related research advances in recent years.

Objective To analyze the prognosis and appropriate treatment modalities of the patients with recurrence of early stage (Ⅰb-Ⅱa) cervical squamous cancer primarily treated with radical hysterectomy. Methods This retrospective study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰb and Ⅱa recurrent cervical squamous cancer who underwent radical hysterectomy primarily from January 2007 to July 2015. Kaplan-Meier method and Cox regression analysis were performed to analyze related prognostic factors of overall survival and progression-free survival, which included age, postoperative therapy, the site of recurrence, therapy-free interval (TFI) and treatment modality. The patients who were treated with palliative chemotherapy after recurrence were selected as a subgroup. The responses of palliative chemotherapy were evaluated and analyzed among different factors, included TFI, the site of recurrence and chemotherapy regime. Results Of the 2 071 patients, 116 relapsedⅠb-Ⅱa cervical squamous cancer were included in the study with the average age of (45.6±7.2) years old. 3-year progression-free survival rate and 3-year overall survival rate after recurrence were 30.2% and 42.2%, respectively. Univariate analysis implied that postoperative radiotherapy, recurrence site, TFI and treatment modality were associated with progression-free survival (P<0.05), while postoperative radiotherapy, TFI and treatment modality with overall survival (P<0.05). Multivariate analysis showed that TFI and treatment modality were independent prognostic factors for progression-free survival (P<0.05), while postoperative radiotherapy at initial treatment, TFI and treatment modality were independent prognostic variables for overall survival (P<0.05). In the analysis of treatment modality, 3-year progression-free survival rate and 3-year overall survival rate of 47 patients who were treated with definitive local therapy were significantly higher than that of 69 patients who were treated with palliative chemotherapy (P<0.01). In the subgroup analysis of palliative chemotherapy, 15 patients achieved complete response (21.7%) and 16 displayed partial response (23.2%). The overall response rate (ORR) was 44.9%. TFI (P<0.01) and chemotherapy regime (P<0.05) were significant factors associated with ORR. The ORR of TFI≥12 months was significantly higher than that of TFI <12 months. Besides, the ORR of paclitaxel plus platinum chemotherapy was prominently higher than that of other regimens, while there was no significant difference between the ORR of paclitaxel plus cisplatin and other platinum (P=0.408). Conclusions For recurrent stageⅠb-Ⅱa cervical squamous carcinoma treated with radical hysterectomy, use of definitive local therapy for suitable patients is advised to achieve better prognosis. In terms of palliative chemotherapy, longer TFI may mean better ORR and the combination of paclitaxel plus platinum is preferred.

ObjectiveTo investigate the clinical features and treatment outcome of children with autoimmune hepatitis (AIH). MethodsA retrospective analysis was performed for the clinical data, liver pathology, treatment outcome, and follow-up data of 10 children with AIH who were treated in Beijing YouAn Hospital, Capital Medical University, from December 2008 to December 2017. ResultsThe children were aged 3-16 years (median 10 years), and girls accounted for 70%. Of all patients, 5 had type 1 AIH, and 5 had type 2 AIH; 3 (30%) had an acute onset, 2 (20%) had a subacute onset, and 5 (50%) had a chronic onset. Elevation of aminotransferases was found in 8 children (80%), and elevations of bilirubin, gamma-glutamyl transpeptidase, and immunoglobulin G were found in 7 children (70%), 7 children (70%), and 6 children (60%), respectively. Among the 7 children who underwent liver biopsy, 3 had grade ≥3 liver inflammation, 4 had stage ≥3 liver fibrosis, 5 had interface hepatitis, 5 had plasma cell infiltration, 4 had rosette-like annulation of hepatocytes, and 7 had lymphocyte infiltration. One child died, and one was lost to follow-up; among the other 8 children, 6 had good response, 1 experienced recurrence, and one had poor response. 4 patients with type 2 AIH were treated with glucocorticoids combined with azathioprine, the disease was effectively controlled. ConclusionChildren with AIH have diverse clinical manifestations, and some children have serious conditions. Most patients with type 2 AIH need the treatment of glucocorticoids combined with azathioprine.

A neuroinflammatory response is commonly involved in the progression of many neurodegenerative diseases. Potassium 2-(1-hydroxypentyl)-benzoate (PHPB), a novel neuroprotective compound, has shown promising effects in the treatment of ischemic stroke and Alzheimer׳s disease (AD). In the present study, the anti-inflammatory effects of PHPB were investigated in the plasma and brain of C57BL/6 mice administered a single intraperitoneal (i.p.) injection of lipopolysaccharide (LPS). Levels of iNOS and the cytokines TNF, IL-1and IL-10 were elevated in plasma, cerebral cortex and hippocampus after LPS injection and the number of microglia and astrocytes in cortex and hippocampus were increased. LPS also upregulated the expression of heme oxygenase-1 (HO-1) in the cortex and hippocampus. PHPB reduced the levels of iNOS and cytokines in the plasma and brain, decreased the number of microglia and astrocytes and further enhanced the upregulation of HO-1. In addition, PHPB inhibited the LPS-induced phosphorylation of ERK, P38 and JNK. These results suggest that PHPB is a potential candidate in the treatment of neurodegenerative diseases through inhibiting neuroinflammation.

Objective To analyze the CT findings of pulmonary cryptococcosis (PC)in patients without HIV infection.Methods CT data of 26 patients with PC proved by pathology were analyzed retrospectively.All cases underwent plain CT scan,8 of whom underwent contrast-enhanced CT scan.Results 26 patients (17 male and 9 female),single lesion on CT was found in 11 cases,multiple nodules or masses in 10 cases,and mixed-type lesions in 5 cases.The lesion was located in left lung in 1 1 cases,in right lung in 7 cases and bilateral lungs in 8 cases.The lesions with burr sign were found in 1 9 cases,with cavities or vacuoles in 10 cases,and with halo sign in 8 cases.Enhanced CT showed marked heterogeneity in 1 case,moderate heterogeneity in 2 cases,slight enhancement in 3 cases and nonenhancement in 2 cases.Conclusion Lesions of PC with various CT findings are easy to be misdiagnosed as lung carcinoma or other lesions.CT-guided percutaneous lung biopsy is an effective method for diagnosis.