ObjectiveTo analyze the distribution characteristics of traditional Chinese medicine （TCM） syndrome elements in different risk populations of heart failure complicated with type 2 diabetes. MethodsClinical data of 675 type 2 diabetes patients were retrospectively collected. Lasso-multivariate Logistic regression was used to construct a clinical prediction nomogram model. Based on this， 441 non-heart failure patients were divided into a low-risk group （325 cases） and a high-risk group （116 cases） according to the median risk score of heart failure complicated with type 2 diabetes. TCM diagnostic information （four diagnostic methods） was collected for both groups， and factor analysis was applied to summarize the distribution of TCM syndrome elements in different risk populations. ResultsLasso-multivariate Logistic regression analysis identified age， disease duration， coronary heart disease， old myocardial infarction， arrhythmia， absolute neutrophil count， activated partial thromboplastin time， and α-hydroxybutyrate dehydrogenase as independent risk factors for heart failure complicated with type 2 diabetes. These were used as final predictive factors to construct the nomogram model. Model validation results showed that the area under the curve （AUC） of the receiver operating characteristic （ROC） curve for the modeling group and validation group were 0.934 and 0.935， respectively. The Hosmer-Lemeshow test （modeling group P = 0.996， validation group P = 0.121） indicated good model discrimination. Decision curve analysis showed that the curves for All and None crossed in the upper right corner， indicating high clinical utility. The low-risk and high-risk groups each obtained 14 common factors. Preliminary analysis revealed that the main disease elements in the low-risk group were qi deficiency （175 cases， 53.85%）， dampness （118 cases， 36.31%）， and heat （118 cases， 36.31%）， with the primary locations in the spleen （125 cases， 38.46%） and lungs （99 cases， 30.46%）. In the high-risk group， the main disease elements were yang deficiency （73 cases， 62.93%）， blood stasis （68 cases， 58.62%）， and heat （49 cases， 42.24%）， with the primary locations in the kidney （84 cases， 72.41%） and heart （70 cases， 60.34%）. ConclusionThe overall disease characteristics in different risk populations of type 2 diabetes patients with heart failure are a combination of deficiency and excess， with deficiency being predominant. Deficiency and heat are present throughout. The low-risk population mainly shows qi deficiency with dampness and heat， related to the spleen and lungs. The high-risk population shows yang deficiency with blood stasis and heat， related to the kidneys and heart.

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).

Objective To investigate the current status of hepatitis B virus (HBV) infection among hospitalized patients aged 1-18 years, as well as the status of immunity after hepatitis B vaccination. Methods Related data were collected from the patients aged 1-18 years who were hospitalized in Henan Provincial People's Hospital from July 2020 to July 2021, including serological markers for hepatitis B (HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc) and hepatitis B vaccination. The epidemiological situation of HBV infection was analyzed, as well as the immune effect after vaccination. The trend chi-square test was used for trend analysis. Results A total of 10 658 hospitalized patients were collected, among whom there were 6 372 male patients (59.79%) and 4 286 female patients (40.21%). In this population, the patients with positive HBsAg accounted for 0.28% (30/10 658), with a relatively high proportion of 0.68% and 0.62%, respectively, in the 17-and 18-year age groups; the patients with positive anti-HBs accounted for 51.82% (5 523/10 658), with a relatively high proportion of > 63% in the 1-4 years age groups, and there was a reduction in the proportion of patients with positive anti-HBs (fluctuating around 40%) in the 5-18 years age groups. With the increase in age, the positive rate of anti-HBs tended to decrease in both male and female patients (male: χ 2 =8.217, P =0.004; female: χ 2 =10.048, P =0.002). Conclusion Based on the data of hospitalized patients, HBV infection in the population aged 1-18 years in Henan Province has the characteristics of low prevalence rate and high immunity, and the reduction in the proportion of patients with positive anti-HBs at more than five years after vaccination should be taken seriously in this region.

Objective:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.Methods:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKI SCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL·min -1·1.73 m -2, and AoCKD was defined as meeting the KDIGO-AKI SCr standard and baseline eGFR was 15-59 mL·min -1·1.73 m -2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis. Results:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients ( n = 322), AoCKD patients ( n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL·min -1·1.73 m -2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio ( HR) = 4.458, 95% confidence interval (95% CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU ( HR = 5.181, 95% CI was 2.033-13.199, P = 0.001), and AoCKD ( HR = 5.377, 95% CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days. Conclusion:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKI SCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.

Objective To explore the regulatory effects of cucumin onoxidation and antioxidation in non-alcoholic steatohepatitis (NASH ) .Methods Fifty-six clean male rats were randomly divided into 7 groups by random numbers table .Eight rats in normal control group were fed by normal diet for 12 weeks .Twenty-four rats in model group were fed by choline dificinet (CD) diet and randomly sacrificedat week 4 ,8 and 12 with 8 rats each time point .Twenty-four rats incucumin treatment group were given cucumin at high (500 mg/[kg · d]) ,medium (100 mg/[kg · d]) and low (50 mg/[kg · d]) dosages with 8 rats each dosage from week 5 of CD diet for 8 weeks ,and the rats were sacrificed at week 12 .The liver tissues were reserved for pathology test and detections of thiobarbituric acid reactive substances (TBARS) ,glutathione (GSH) ,the activities of superoxide dismutase (SOD) ,manganese superoxide dismutase (MnSOD) ,glutathione peroxidase (GPx) ,and levels of triglyceride (TG) and total cholesterol (TC) .The measurement data with normal distribution were analyzed using t test ,and the data with non-normal distribution were analyzed using rank sum Z test .Results The liver of rats presented with the performance of NASH when fed with CD diet for 4 weeks ,and presented with early fibrosis after 8 weeks of CD diet ,even progressed to cirrhosis after 12 weeks of CD diet .The NAS scores of medium and high dose curcumin treatment groups were 6 .50 (5 .25 ,7 .00) and 6 .00 (5 .00 ,6 .75) ,respectively ,which were both lower than that model group at week 12 (8 .00 [7 .00 ,8 .00])(Z=2 .441 and 2 .728 ,respectively , both P< 0 .01) ,while fibrosis stages at week 12 were not significantly different compared with model group (Z=0 .795 and 1 .807 ,respectively ,both P> 0 .05) .TG and TC levels in liver tissues of rats in low ,medium and high doses treatment group were not significantly different compared with model group at week 12(TG :t=0 .54 ,1 .18 and 1 .66 ,respectively ;TC :t=0 .11 ,0 .59 and 0 .62 ,respectively ;all P>0 .05) .The GSH contentin liver of rats in high dose group was (1185 .82+204 .01) mg/g ,which was significantly different from that in model group at week 12 (735 .29 + 35 .08) (t=4 .97 ,P<0 .01) .The TBARS contents in the liver of the middle and high doses curcumin treatment group were significantly different from that of model group at week 12 (t=7 .58 and 11 .62 ,respectively ,both P< 0 .01) .The SOD activities in liver of rats in low ,medium and high doses curcumin treatment group were statistically different from that in model group (t=4 .17 ,4 .32 and 6 .10 ,respectively ,all P<0 .01) .MnSOD activity in liver of rats in high dose group was significantly different from model group at week 12 (t=8 .42 ,P<0 .01) .The live GPx contents in low ,medium and high doses curcumin treatment group were all not significantly different from that in model group at week 12 (t=0 .27 ,0 .21 and 0 .60 ,respectively ,all P>0 .05) .Conclusions CD diet in SD rats could induce hepatic lipid deposition in liver ,and cause liver antioxidative system disorders ,GSH exhaustion ,and decreases of SOD and GPx activities .Curcumin treatment could improve liver NAS score of NASH rats ,and might play a protective role by upregulating the SOD activity and increasing liver GSH content .But curcumin has no effects on liver GPx activity and fat deposition in liver of NASH rats .

Objective: To investigate the influence of hepatitis B virus X gene (HBx) on apoptosis of hepatic cells mediated by Fas in HePG2 cells. Methods: HBx eukaryotic vector pcDNA3.1(+)-X was transfected into HEPG2 cells with lipofectamine, and the null vector pcDNA3.1(+) and untransfected HEPG2 were used as normal controls. The cells were collected 72 h after transfection, and the expression of HBx mRNA and protein was determined using RT-PCR and Western blot, respectively. The mRNA expression of apoptosis-related genes Bcl-2 and Bax mRNA was also determined using RT-PCR. Cytotoxicity and apoptosis were evaluated using CCK-8 and flow cytometry, respectively, after HepG2-HBx and HepG2-3.1 cells were treated with stimulatory monoclonal antibody anti-Fas CH11. The t test was used for pairwise comparison. Results: The cell line HepG2-HBx was successfully established, as confirmed by RT-PCR and Western blot, and RT-PCR results showed that HepG2-HBx cells had significantly higher expression of Bcl-2 mRNA than HepG2-3.1 and HepG2 cells (P < 0.05), but had significantly lower expression of Bax mRNA than HepG2-3.1 and HepG2 cells (P < 0.05); CCK-8 and flow cytometry showed that anti-Fas CH11 had a lower cytotoxicity to HepG2-HBx cells and allowed for a lower apoptosis rate of HepG2-HBx cells compared with HepG2-3.1 and HepG2 cells. Conclusions HBx can inhibit apoptosis of hepatic cells mediated by the Fas pathway.

OBJECTIVETo explore the clinical features and gene mutation profiles of patients with chronic hepatitis B (CHB) and Gilbert's syndrome.

METHODSThirty-three patients with CHB and Gilbert's syndrome were enrolled in the study. Serum markers of liver function and histological features of disease-related liver injury were assessed by standard methods. Gene mutations were detected by PCR and direct DNA sequencing.Statistical analysis was carried out with the chi-square and t tests.

RESULTSSequencing of the Gilbert syndrome-associated gene, UGT 1A 1, revealed mutations in the upstream promoter phenobarbital-responsive element module (PBREM) (-3279 mutation, 23 cases), in the promoter TATA box (a TA insertion mutation, 21 cases), and in the coding region of exon 1 (a GGA-AGA Gly71Arg mutation, 18 cases); there was no statistical difference found for any of the three mutations among this patient population (x2 =1.640, P more than 0.05).

CONCLUSIONThe traditional methods of diagnosis for patients with CHB and Gilbert's syndrome remain a technical challenge in the clinic, and gene detection may represent a more favorable method for diagnosing this patient population.

Base Sequence ; Exons ; Gilbert Disease ; Glucuronosyltransferase ; Hepatitis B, Chronic ; Humans ; Mutagenesis, Insertional ; Mutation ; Polymerase Chain Reaction ; Promoter Regions, Genetic ; TATA Box

Objective To explore the sensitivity and accuracy of directly sequenced core and non-structrural protein (NS)5B regions for hepatitis C virus (HCV)genotyping.Methods Fifty-one serum samples from chronic hepatitis C patients were collected in the study.Reverse transcription-polymerase chain reaction was used to amplify core and NS5B regions.Genotypes or subtypes were determined by the phylogenetic analysis of directly sequenced core and NS5B regions.Results Among the 51 samples,49 (96.1 %)were successfully typed by phylogenetic analysis of directly sequenced core region.There were overall five genotypes determined in the area,including 1b (61 .2%,30/49 ),2a (20.4%,10/49 ),2b (2.0%,1/49),3a (4.1 %,2/49 )and 6a (12.2%,6/49 ).The positive rate of HCV genotying was 88.2% (45/51 )on the basis of NS5B region.HCV genotypes 1b,2a,2b,3a and 6a were found in 62.2% (28/45),20.0% (9/45 ),2.2% (1/45 ),4.4% (2/45 )and 11 .1 % (5/45 )of the patients, respectively.Conclusion The HCV genotyping based on core regions,compared with that based on NS5B,shows the advantages of primer design,amplification efficiency and accuracy,suggesting that it has the priority to be used in the epidemiological and clinical study of HCV genotyping.

Objective To explore the correlation between adiponectin and liver fibrosis in patients with chronic hepatitis B virus infection.Methods 60 patients with chronic hepatitis B were divided into mild liver fibrosis group (n =28),severe liver fibrosis group (n =17)and cirrho-sis group (n =15),and 20 healthy volunteers were designed as the control group.The serum adiponectin level was detected in all the groups.Results There were significant differences of serum adiponectin levels among the four groups (P <0.05),and there was a positive correlation be-tween serum adiponectin level and liver fibrosis grade (r =0.967,P <0.05).The expression rate of liver tissue adiponectin in cirrhosis group was 93.33%,which was significantly higher than the mild group (14.29%)and severe fibrosis group (41.18%)(P <0.05).Conclusion Adiponectin is closely related to the liver fibrosis in patients with chronic hepatitis B virus infection.

Objective To explore the correlation between adiponectin and liver fibrosis in patients with chronic hepatitis B virus infection.Methods 60 patients with chronic hepatitis B were divided into mild liver fibrosis group (n =28),severe liver fibrosis group (n =17)and cirrho-sis group (n =15),and 20 healthy volunteers were designed as the control group.The serum adiponectin level was detected in all the groups.Results There were significant differences of serum adiponectin levels among the four groups (P <0.05),and there was a positive correlation be-tween serum adiponectin level and liver fibrosis grade (r =0.967,P <0.05).The expression rate of liver tissue adiponectin in cirrhosis group was 93.33%,which was significantly higher than the mild group (14.29%)and severe fibrosis group (41.18%)(P <0.05).Conclusion Adiponectin is closely related to the liver fibrosis in patients with chronic hepatitis B virus infection.