Objective:To investigate the correlation between the clinical features and endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) in patients with cirrhosis.Methods:A total of 148 patients with cirrhosis and portal hypertension who underwent EUS-PPG measurement at the Third Xiangya Hospital of Central South University from March 15, 2022 to June 20, 2023 were selected. The clinical data of patients collected before EUS-PPG measurement were analyzed. Variations in the EUS-PPG across different clinical data subgroups were analyzed. Multivariate linear regression analysis was used to explore the independent factors influencing EUS-PPG.Results:The EUS-PPG was significantly elevated in patients exhibiting red signs (16.62±5.33 mmHg VS 13.44±5.34 mmHg, t=3.616, P<0.001), gastroesophageal varices (15.78±5.30 mmHg VS 9.70±4.77 mmHg, t=4.247, P<0.001), hepatic encephalopathy (20.83±7.52 mmHg VS 14.92±5.35 mmHg, t=2.606, P=0.010), thrombocytopenia (15.66±5.39 mmHg VS 13.29±5.83 mmHg, t=2.136, P=0.034), hypoproteinemia (16.13±5.86 mmHg VS 14.12±5.03 mmHg, t=2.230, P=0.027), and an increased international normalized ratio (16.25±6.00 mmHg VS 14.40±5.11 mmHg, t=2.022, P=0.045). Conversely, the EUS-PPG was significantly reduced in patients with a history of splenectomy and devascularization (13.17±5.88 mmHg VS 15.73±5.34 mmHg, t=-2.379, P=0.019). The EUS-PPG in patients with varying degrees of ascites (no VS slight VS moderate or severe: 13.40±5.48 mmHg VS 15.90±5.49 mmHg VS 16.69±5.17 mmHg, F=5.188, P=0.007) and different Child-Pugh classifications (A VS B VS C: 14.07±5.05 mmHg VS 15.69±5.74 mmHg VS 17.64±5.99 mmHg, F=3.066, P=0.049) increased gradually. Multivariable linear regression analysis showed that red signs ( β=2.44, t=2.732, P=0.007), gastroesophageal varices ( β=4.45, t=2.990, P=0.003), ascites ( β=1.75, t=2.368, P=0.019), and hepatic encephalopathy ( β=5.82, t=2.644, P=0.009) were independent factors for the elevated EUS-PPG. Conclusion:There is a significant correlation between EUS-PPG and the clinical features related to the severity of cirrhotic portal hypertension, which indicates the feasibility of EUS-PPG in evaluating cirrhotic portal hypertension.

Methods: The median sagittal diameter and transverse diameter of the spinal canal from C2 to C7 were measured on CT images. The ratio of the median sagittal diameter to the transverse diameter was calculated. Accordingly, the spinal canal shape of each segment was classified into four, and the specific criteria of lunar phase classification were determined through linear discriminant analysis based on the ratio of the median sagittal diameter to the transverse diameter. The inter-rater reliability of the classification was explored using Kappa coefficients. Finally, the morphology of the different segments of the cervical spinal canal in healthy volunteers was revised and compared. Results: According to the ratio of the median sagittal diameter and the transverse diameter of the cervical spinal canal, the lunar phase classification of the cervical bony spinal canal was determined as follows: full-moon >0.65, 0.55< convex-moon ≤0.65, 0.46≤ quarter-moon ≤0.55, and residual-moon <0.46. The Kappa values of C2–C7 were 0.851, 0.958, 0.823, 0.927, 0.793, and 0.946, and the Kappa value of all C2–C7 segments was 0.854 that mainly presented two forms of full-moon (76.5%) and convex-moon (23.0%). A quarter-moon spinal canal was mainly distributed in C3, C4, C5, and C6; a residual-moon spinal canal was mainly distributed in C4 and C5; and the morphological distribution of C4 and C5 were similar (p>0.05). The frequency of the spinal canal of the residual-moon type was the highest, and the full-moon (6.5%) and residual-moon (7.5%) types of C7 were rare. Conclusions The morphological classification of the cervical spinal canal was established to present anatomical variations. The classification showed good inter-rater reliability.

Objective:To investigate the diagnostic efficacy of MRI-based or CT-based measurements and the combined evaluation methods for preoperative bone quality assessment in patients with cervical degenerative diseases.Methods:Patients who underwent spine surgery for cervical degenerative diseases at the Department of Orthopedics, Huashan Hospital, Fudan University from September 2020 to March 2022 with available preoperative X-ray, CT, MRI and dule energy X-Ray absorptiometry (DEXA) data were included in this study. Vertebral bone quality score (VBQ) based on MRI T1-weightedimages and CT Hounsfiled unit (HU) values of the cervical spine were measured, and a combined diagnostic formula based on the binary logistic regression was constructed. The patients were divided into normal bone mass (T≥-1.0) and osteopenia/osteoporosis groups (T<-1.0). The student's t-test and Chi-square test were performed for comparisons between groups. The Pearson correlation coefficient was also used to investigate the correlation between DEXA-T scores, cervical VBQ and CT HU values. In addition, receiver operating characteristic curve (ROC) were plotted to explore the diagnostic efficacy of VBQ, CT HU and their combined diagnosis. Meanwhile, the corresponding sensitivity and specificity were obtained. Results:A total of 71 patients were included in this study (17 in the normal group and 54 in the osteopenia/osteoporosis group). The student's t-test showed that VBQ (2.90±0.70 vs. 3.83±0.83, t=4.23, P<0.001) and CT HU values (370.26±85.38 vs. 295.20±67.96, t=3.73, P=0.002) were significantly different between the two groups. The area under the ROC curve (AUC) for VBQ and CT values of the cervical spine were 0.81 and 0.75, respectively, and the AUC for the combined diagnostic value constructed on the basis of both was 0.85. Applying VBQ scores alone had a diagnostic sensitivity of 80% and a specificity of 70%, and the combined diagnosis with VBQ and CT HU had a sensitivity of 90% and a specificity of 75%. Person correlation analysis showed a significant correlation between DEXA T value, cervical VBQ value and CT HU value. The detailed formula was: DEXA T score=-0.63×cervical VBQ+0.64 ( r=-0.55, P<0.001), CT HU value=-40.20×cervical VBQ+458.40 ( r=-0.45, P<0.001), DEXA T score=0.006×CT HU-3.47 ( r=0.45, P<0.001). Conclusion:This study confirmed the feasibility of using cervical VBQ values, CT HU values and combined diagnostics for preoperative bone density screening in patients with degenerative cervical spine diseases. This method allows surgeons to perform an initial preoperative bone density screening based on the patient's existing imaging data, and thus could aid in confirming the indication and scheme of surgery. The method could be a powerful tool for preoperative bone density assessment screening in patients with cervical degenerative diseases.

Objective To explore the effect of " hospital informationized blood glucose management" on perioperative diabetic patients. Methods Three hundred patients with type 2 diabetes mellitus, who underwent selective operations from orthopedics, general surgery, urological surgery, and thoracic surgery were divided into two groups: 150 cases of blood glucose information management group and 150 cases of traditional blood glucose monitoring and management group. The blood glucose on target rate, percent of hypoglycemic events, percent of hyperglycemic events, the blood glucose level on the first postoperative day, the average hospitalization day, perioperative infection rate were evaluated for efficacy. Results The blood glucose on target rate in informationized blood glucose management group was significantly higher than that of the control group [(52.52 ± 18.31)%vs (14.88 ± 8.39)%, P＜0.01]. The frequency of hyperglycemia, the average daily blood glucose, the average blood glucose on fasting, after three meals and at night, the fasting and postprandial blood glucose level on the first postoperative day in informationized blood glucose management group were significantly lower than that of the control group [( 45. 31 ± 18.87)%vs (84.41±8.86)%, (8.59±1.34 vs 12.47±2.37) mmol/L, (7.33±1.41 vs 10.01±1.99)mmol/L, (8.89 ±2.34vs13.61±3.47)mmol/L,(9.47±1.94vs13.46±2.77)mmol/L,(9.40±2.72vs13.28±2.94)mmol/L, (8.28±2.11vs11.31±2.89)mmol/L,(8.29±2.51vs11.58±3.52)mmol/L,(8.25±3.67vs17.65±19.68) mmol/L, all P＜0.01]. In addition, the average hospitalization day of the informationized blood glucose management group was significantly shorter than that of the control group [(16±7 vs 21±15)d, P＜0.05]. The infection rate of the management group and the control group were 41. 2% and 58. 8% respectively. There was no significant difference between two groups (P＞0.05). Conclusion The " hospital informationized blood glucose management" is simple and practical, which may significantly improve the rate of blood glucose control in each period, reduce the average hospitalization day, and decrease perioperative infection tendency.

Objective:To analyze the characteristics of long non-coding RNA (lncRNA) expression in nonalcoholic fatty liver disease (NAFLD).Methods:lncRNA-mRNA microarray was conducted on the liver tissue samples from 10 patients with simple gallbladder stone (5 NAFLD liver samples and 5 normal liver samples),and the differentially expressed lncRNA was analyzed by bioinformatics technology.Results:Compared with the normal liver samples,there were abnormal expression of 1 735 lncRNAs and 1 485 mRNAs in NAFLD liver samples.Among them,535 lncRNAs and 760 mRNAs were up-regulated,1 200 lncRNAs and 725 mRNAs were down-regulated.Conclusion:Compared with normal liver,the expression oflncRNA in NAFLD tissues is obviously abnormal.These lncRNAs may play an important role in the occurrence and development of NAFLD.

Ascites formation represents a hallmark of decompensated liver cirrhosis.It predicts a poor outcome.Patients with ascites are at high risk of developing complications such as SBP (spontaneous bacterial peritonitis),hyponatremia and HRS (hepatorenal syndrome).Adequate treatment of cirrhotic ascites increases survival and betters quality of life.Despite improved current medical treatment of ascites,liver transplantation remains the ultimate treatment of refractory ascites.This paper summarizes the treatment of liver cirrhosis with ascites.

Objective To explore the application value of anatomical hepatectomy for children with severe liver trauma. Methods Clinical data of 11 patients with severe liver trauma in the First Afifliated Hospital of Hunan Normal University from January 2010 to January 2013 were retrospectively analyzed. There were 7 males, 4 females with the age ranging from 1 to 12 years old and the median of 7 years old. The informed consents of all patients were obtained and local ethical committee approval had been received. The patients underwent anatomical hepatectomy with regional hepatic portal occlusion. The intraoperative and postoperative situation including operation time, intraoperative blood loss and perioperative complications were observed. Results All the 11 cases underwent anatomical hepatectomy successfully. The operations included segment Ⅳb hepatectomy (n=1), left lateral lobectomy (n=2), left hemihepatectomy (n=1), segment Ⅵ hepatectomy (n=2), segment Ⅷ hepatectomy (n=1), right posterior lobectomy (n=1), right hemihepatectomy (n=3). One of the cases combined with posthepatic inferior vena cava injury underwent inferior vena cava repair successfully after anatomical right hemihepatectomy. Three cases complicated with spleen rupture underwent splenectomy. Five cases with biliary injury underwent repair and drainage during the operation. The median operation time was 3(1-8) h. The intraoperative blood loss was 50(5-600) ml. One case suffered from bile leakage after operation, and 1 cases suffered from subphrenic infection and pulmonary infection, septicemia. All recovered after symptomatic treatments. Conclusion Anatomical hepatectomy is a safe and effective method for children with severe liver trauma.

OBJECTIVECombined the optical principle with automatic control technology and computer real-time image detection technology to develop a non-contact system for noninvasive esophageal varices pressure measurement.

METHODSThe system included the adjustable air pump, laser device, image collection and analysis program. The feasibility and accuracy of the system were verified by in vitro experiments.

RESULTSThe bionic vascular pressure measured by this system had good correlation and repeatability with the actual pressure.

CONCLUSIONSThis system is accurate, feasible and has good application prospects.

Objective Combined the optical principle with automatic control technology and computer real-time image detection technology to develop a non-contact system for noninvasive esophageal varices pressure measurement.Methods The system included the adjustable air pump, laser device, image colection and analysis program. The feasibility and accuracy of the system were verifi ed by in vitro experiments.Results The bionic vascular pressure measured by this system had good correlation and repeatability with the actual pressure.Conclusions This system is accurate, feasible and has good application prospects.

BACKGROUND:There are many preliminary studies on the survival, metaptosis, and correlation characteristics of human amniotic epithelial cel s after transplanted into the animals, but there are no reports on the quantitative analysis of the transplantation effect. OBJECTIVE:To make quantitative analysis on serum biochemical function of liver and the expression of human albumin in mice received passaged human amniotic epithelial cel s transplantation in spleen. METHODS:Forty nude mice were randomly divided into four groups (n=10 in each group):hepatectomy+cel transplantation 2 weeks group, hepatectomy+cel transplantation 4 weeks group, hepatectomy+normal saline group (treated with partial hepatectomy) and hepatectomy+cel transplantation group (transplanted with 0.2 mL passaged human amniotic epithelial cel s with 5×106 under spleen, and the blood were col ected at 2 and 4 weeks after transplantation). The mice in the hepatectomy+normal saline group were treated with splenic injection of 0.2 mL normal saline;the cel transplantation group did not receive hepatectomy, and transplanted with 0.2 mL passaged human amniotic epithelial cel s with 5×106 under spleen. The histological and morphological changes of the liver and spleen in each group as wel as the expressions of serum alanine aminotransferase, aspartate aminotransferase and human serum albumin in each group were detected, and the quantitative analysis of human serum albumin expression was performed. RESULTS AND CONCLUSION: There was no obvious morphological change after human amniotic epithelial cel s transplanted into the acute liver injury mice for 4 weeks, but specific cel s could be detected by histological method. The serum levels of alanine aminotransferase, aspartate aminotransferase and human serum albumin were improved obviously, and the human albumin could be detected in serum, the level of human albumin at 4 weeks after transplantation was significantly increased than 2 weeks after transplantation. Human amniotic epithelial cel s can survive for more than 4 weeks after transplanted into the liver injury mice, and can stil express partial characteristics and functions of hepatocyte-like cel s, improve the liver function, thus treating acute liver injury.