Background/Aims: Metabolic dysfunction-associated steatohepatitis (MASH) is a significant risk factor for gallstone formation, but mechanisms underlying MASH-related gallstone formation remain unclear. Golgi membrane protein 1 (GOLM1) participates in hepatic cholesterol metabolism and is upregulated in MASH. Here, we aimed to explore the role of GOLM1 in MASH-related gallstone formation. Methods: The UK Biobank cohort was used for etiological analysis. GOLM1 knockout (GOLM1-/-) and wild-type (WT) mice were fed with a high-fat diet (HFD). Livers were excised for histology and immunohistochemistry analysis. Gallbladders were collected to calculate incidence of cholesterol gallstones (CGSs). Biles were collected for biliary lipid analysis. HepG2 cells were used to explore underlying mechanisms. Human liver samples were used for clinical validation. Results: MASH patients had a greater risk of cholelithiasis. All HFD-fed mice developed MASH, and the incidence of gallstones was 16.7% and 75.0% in GOLM1-/- and WT mice, respectively. GOLM1-/- decreased biliary cholesterol concentration and output. In vivo and in vitro assays confirmed that GOLM1 facilitated cholesterol efflux through upregulating ATP binding cassette transporter subfamily G member 5 (ABCG5). Mechanistically, GOLM1 translocated into nucleus to promote osteopontin (OPN) transcription, thus stimulating ABCG5-mediated cholesterol efflux. Moreover, GOLM1 was upregulated by interleukin-1β (IL-1β) in a dose-dependent manner. Finally, we confirmed that IL-1β, GOLM1, OPN, and ABCG5 were enhanced in livers of MASH patients with CGSs. Conclusions In MASH livers, upregulation of GOLM1 by IL-1β increases ABCG5-mediated cholesterol efflux in an OPN-dependent manner, promoting CGS formation. GOLM1 has the potential to be a molecular hub interconnecting MASH and CGSs.

Background/Aims: Metabolic dysfunction-associated steatohepatitis (MASH) is a significant risk factor for gallstone formation, but mechanisms underlying MASH-related gallstone formation remain unclear. Golgi membrane protein 1 (GOLM1) participates in hepatic cholesterol metabolism and is upregulated in MASH. Here, we aimed to explore the role of GOLM1 in MASH-related gallstone formation. Methods: The UK Biobank cohort was used for etiological analysis. GOLM1 knockout (GOLM1-/-) and wild-type (WT) mice were fed with a high-fat diet (HFD). Livers were excised for histology and immunohistochemistry analysis. Gallbladders were collected to calculate incidence of cholesterol gallstones (CGSs). Biles were collected for biliary lipid analysis. HepG2 cells were used to explore underlying mechanisms. Human liver samples were used for clinical validation. Results: MASH patients had a greater risk of cholelithiasis. All HFD-fed mice developed MASH, and the incidence of gallstones was 16.7% and 75.0% in GOLM1-/- and WT mice, respectively. GOLM1-/- decreased biliary cholesterol concentration and output. In vivo and in vitro assays confirmed that GOLM1 facilitated cholesterol efflux through upregulating ATP binding cassette transporter subfamily G member 5 (ABCG5). Mechanistically, GOLM1 translocated into nucleus to promote osteopontin (OPN) transcription, thus stimulating ABCG5-mediated cholesterol efflux. Moreover, GOLM1 was upregulated by interleukin-1β (IL-1β) in a dose-dependent manner. Finally, we confirmed that IL-1β, GOLM1, OPN, and ABCG5 were enhanced in livers of MASH patients with CGSs. Conclusions In MASH livers, upregulation of GOLM1 by IL-1β increases ABCG5-mediated cholesterol efflux in an OPN-dependent manner, promoting CGS formation. GOLM1 has the potential to be a molecular hub interconnecting MASH and CGSs.

Background/Aims: Metabolic dysfunction-associated steatohepatitis (MASH) is a significant risk factor for gallstone formation, but mechanisms underlying MASH-related gallstone formation remain unclear. Golgi membrane protein 1 (GOLM1) participates in hepatic cholesterol metabolism and is upregulated in MASH. Here, we aimed to explore the role of GOLM1 in MASH-related gallstone formation. Methods: The UK Biobank cohort was used for etiological analysis. GOLM1 knockout (GOLM1-/-) and wild-type (WT) mice were fed with a high-fat diet (HFD). Livers were excised for histology and immunohistochemistry analysis. Gallbladders were collected to calculate incidence of cholesterol gallstones (CGSs). Biles were collected for biliary lipid analysis. HepG2 cells were used to explore underlying mechanisms. Human liver samples were used for clinical validation. Results: MASH patients had a greater risk of cholelithiasis. All HFD-fed mice developed MASH, and the incidence of gallstones was 16.7% and 75.0% in GOLM1-/- and WT mice, respectively. GOLM1-/- decreased biliary cholesterol concentration and output. In vivo and in vitro assays confirmed that GOLM1 facilitated cholesterol efflux through upregulating ATP binding cassette transporter subfamily G member 5 (ABCG5). Mechanistically, GOLM1 translocated into nucleus to promote osteopontin (OPN) transcription, thus stimulating ABCG5-mediated cholesterol efflux. Moreover, GOLM1 was upregulated by interleukin-1β (IL-1β) in a dose-dependent manner. Finally, we confirmed that IL-1β, GOLM1, OPN, and ABCG5 were enhanced in livers of MASH patients with CGSs. Conclusions In MASH livers, upregulation of GOLM1 by IL-1β increases ABCG5-mediated cholesterol efflux in an OPN-dependent manner, promoting CGS formation. GOLM1 has the potential to be a molecular hub interconnecting MASH and CGSs.

Objective:To analyze the clinical curative effects of wire-to-port drainage and put-aside drainage after incision and hanging on perianal abscess.Methods:Eighty-two patients with perianal abscess admitted to Anqing Municipal Hospital between November 2019 and November 2022 were enrolled. The patients were divided into group A (41 cases, incision and hanging wire-to-port drainage) and group B (41 cases, incision and hanging put-aside drainage) by random digits table method. The clinical curative effect, operation time, wound healing time, postoperative recovery time and hospitalization time in the two groups were compared. The pain and anal function were evaluated by visual analogue score (VAS) and Wexner continence grading score (Wexner score) before surgery and 1, 7 d after surgery. The occurrence of complications within 1 month after surgery was statistically analyzed.Results:There was no significant difference in total clinical response rate between group A and group B ( P>0.05). There was no significant difference in operation time between the two groups ( P>0.05). The wound healing time, postoperative recovery time and hospitalization time in group A were significantly shorter than those in group B: (21.34 ± 2.21) d vs. (27.86 ± 2.84) d, (23.12 ± 2.42) d vs. (28.36 ± 2.91) d, (8.12 ± 0.83) d vs. (13.25 ± 1.47), P<0.05. At 1 and 7 d after surgery, the VAS and Wexner score in group A were lower than those in group B: (6.11 ± 0.62) points vs. (6.54 ± 0.67) points, (2.39 ± 0.25) points vs. (3.21 ± 0.33) points, (7.54 ± 0.77) points vs. (8.96 ± 0.91) points, (4.22 ± 0.43) points vs. (5.68 ± 0.58) points, P<0.05. There was no significant difference in total incidence of complications between the two groups within 1 month after surgery ( P>0.05). Conclusions:Compared with incision and hanging put-aside drainage, incision and hanging wire-to-port drainage can promote wound healing, shorten hospitalization time, relieve postoperative pain and improve anal function in patients with perianal abscess, with certain safety.

Objective:To evaluate the efficacy of adjusted Narcotrend Index (NI) value guidancecombined with small-dose esketamine for program-controlled closed-loop target-controlled infusion (TCI) system.Methods:Forty-eight American Society of Anesthesiologists Physical Status classificationⅠ or Ⅱpatients, regardless of gender, aged 18-55 yr, with body mass index of 18-25 kg/m 2, scheduled for elective laparoscopic surgery under general anesthesia, were assigned to control group (group C, NI baseline value median 36) and esketamine group(group E, NI baseline value median 46) using a random number table method, with 24 cases in each group. Anesthesia induction and maintenance were carried out using effect-site concentration TCI(Schnider model for propofol infusion and Minto model for remifentanil infusion). After the NI value was maintained at 26-46 during anesthesia maintenance, a small dose of esketamine was given (as an intravenous bolus 0.2 mg/kg, followed by an infusion of 5 μg·kg -1·min -1for 30 min) in group E, and the equal volume of normal saline was given instead in group C. Program-controlled closed-loop TCI was then started, and the target effect-site concentrations of propofol and remifentanil were adjusted every 5 min according to the corresponding preset NI baseline value. The main outcome measures were the percentage of time of NI value maintained in the target range within 1 h after administration of esketamine. Secondary outcome measures were the consumption of propofol and remifentanil, postoperative recovery time, incidence of nausea and vomiting, pain and shivering within 1 h after surgery. Patients were followed for intraoperative awareness on 2nd day after operation. Results:The performance of the program-controlled closed-loop TCI systems was within the safe clinical threshold, with no intraoperative awareness occurred in both groups. The consumption of propofol and remifentanil was significantly reduced in group E as compared to group C( P<0.05). There were no statistically significant differences in the percentage of time of NI value maintained in the target range, postoperative recovery time and incidence of adverse reactions between the two groups ( P>0.05). Conclusions:Adjusted NI value guidance combined with small-dose esketamine provides better efficacy when used for program-controlled closed-loop TCI system.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

Objective:To study the learning curve of percutaneous patent foramen ovale (PFO) occlusion guided solely by transthoracic echocardiography (TTE), as well as the success rate and safety of the learning curve.Methods:To retrospectively analyze these patients with indications for PFO occlusion admitted in our department from April 2021 to April 2022, and obtained 100 samples the author's initial cases guided solely by TTE, including 25 men and 75 women, with a mean age of (48.22±10.44) years old.Analyze preoperative baseline data: gender, age, height, weight, body mass index, the tunnel length and size of the PFO measured by transesophageal echocardiography, the grade of contrast-transcranial doppler test, combined atrial septal aneurysm, etc.Operation time, success rate, and complications were analyzed in all patients.Results:With the accumulation of cases, the operation time gradually shortened, accumulated to about 50 cases, the operation time has significantly shortened ( P<0.05), and the learning curve was leveled off after 50 cases ( P<0.05), there was statistical difference.The comparison of the success rate and complication of cases within the learning curve and those after completing the learning curve was no statistical significance( P>0.05). Conclusion:The learning curve of percutaneousc closure of patent foramen ovale guided solely by TTE is long, requiring about 50 cases to complete the learning curve. The success rate and safety of the learning curve are high. This procedure is worth popularizing.

Objective To investigate the effects and mechnism of abnormal stress promoting macrophage mobility inhibitory factor(MIF),cyclooxygenase 2(COX2)and prostaglandin E2(PGE2)in the progression of temporomandibular joint osteoarthritis(TMJOA).Methods From January 2020 to December 2021,TMJOA and temporomandibular joint internal derangement(TMJID)patients(30 cases in each group,we divided the TMJOA into group TMJ Ⅰ,Ⅱ,Ⅲ according to the stage)who were admitted to TMJOA special clinic of the First Affiliated Hospital of Xinjiang Medical University and accompanied by abnormal occlusion were collected.The pain score of the occlusal state of the patients was evaluated by visual analogue scale.The expression levels of MIF,COX2 and PGE2 in synovial fluid were detected by ELISA.We used the unilateral anterior crossbite for TMJOA(UAC)rats model(the grouped into:UAC-4 weeks,UAC-8 weeks and UAC-12 weeks group),and control group at the same time(grouped into:Ctrl-4 weeks,Ctrl-8 weeks and Ctrl-12 weeks group),each group had 6 rats.The expression levels of MIF,COX2 and PGE2 in serum and synovial fluid of rats were detected by ELISA.The expression levels of IL-1β,IL-18,MIF,COX2 and PTGER2 in temporomandibular joint of rats were detected by Western blotting.The fluid flow shear stress(FFSS)model of fibroblast-like synovial cells(FLSs)was established,and the mRNA and protein expression levels of above indexes were detected by RT-PCR and Western blotting.Results Visual analogue scale evaluation showed that the pain score of TMJOA Ⅰ and Ⅱ group was significantly higher than that of TMJID(P<0.001).ELISA results showed that the expression levels of MIF,COX2 and PGE2 in synovial fluid in TMJOA group were higher than those in TMJID group(P<0.05),and the expression levels were the highest in TMJOA Ⅱ group.Compared with control group,the expressions of MIF,COX2 and PGE2 in serum and synovial fluid at UAC-4 weeks,8 weeks and 12 weeks were slightly higher,and significantly higher at UAC-8 weeks in rat TMJOA model(P<0.05).In addition,the expression trend of protein levels in temporomandibular joint tissues was similar,which showed higher expression levels of IL-1β,IL-18,MIF,COX2 and PTGER2(P<0.05).In the cell model where FFSS interfered with FLSs,with the increase of FFSS,cell with deformation,incomplete cell membrane and reduced number.Compared with control group,the expression levels of IL-1β,IL-18,MIF,COX2 and PGE2(PTGER2)of FLSs were increased in 1,3,5 and 10 dyn/cm2 intervention groups(P<0.05).Conclusion MIF,COX2 and PGE2 were highly expressed in temporomandibular joint synovial fluid of TMJOA patients with malocclusion.And these three factors were also highly expressed in serum and synovial fluid of UAC rats.The abnormal fluid shear stress promotes the secretion of MIF,COX2 and PGE2 by FLSs to participate in joint microenvironment inflammation and accelerate disease progression.

A significant proportion of patients with chorea-acanthocytosis (ChAc) fail to respond to standard therapies. Recent evidence suggests that globus pallidus internus (GPi) deep brain stimulation (DBS) is a promising treatment option; however, reports are few and limited by sample sizes. We conducted a systematic literature review to evaluate the clinical outcome of GPi-DBS for ChAc. PubMed, Embase, and Cochrane Library databases were searched for relevant articles published before August 2021. The improvement of multiple motor and nonmotor symptoms was qualitatively presented. Improvements in the Unified Huntington’s Disease Rating Scale motor score (UHDRS-MS) were also analyzed during different follow-up periods. A multivariate linear regression analysis was conducted to identify potential predictors of clinical outcomes. Twenty articles, including 27 patients, were eligible. Ninety-six percent of patients with oromandibular dystonia reported significant improvement. GPi-DBS significantly improved the UHDRS-motor score at < 6 months (p < 0.001) and ≥ 6 months (p < 0.001). The UHDRS-motor score improvement rate was over 25% in 75% (15/20 cases) of patients at long-term follow-up (≥ 6 months). The multiple linear regression analysis showed that sex, age at onset, course of disease, and preoperative movement score had no linear relationship with motor improvement at long-term follow-up (p > 0.05). GPi-DBS is an effective and safe treatment in most patients with ChAc, but no reliable predictor of efficacy has been found. Oromandibular dystonia-dominant patients might be the best candidates for GPi-DBS.

AIM: To investigate the choice of surgical approach, therapeutic effect and complications of orbital cavernous hemangioma(OCH)in different positions of orbit.METHODS: The clinical data of 128 patients of 128 eyes with OCH whose were surgically removed and pathologically diagnosed in the department of ophthalmology of the Second Affiliated Hospital of Air Force Military Medical University from January 2016 to August 2021 were retrospectively analyzed. The position of OCH in the orbit was determined by preoperative imaging examination(CT/MRI), so as to select different surgical approaches and analyze the postoperative curative effect and the incidence of complications.RESULTS: The location of OCH in the orbit: 82 eyes in the muscle cone and 46 eyes outside the muscle cone. According to the quadrant of the orbit where the tumor was located, there were 24 eyes in the upper-outer quadrant, 38 eyes in the lower-outer quadrant, 28 eyes in the upper-inner quadrant, 12 eyes in the lower-inner quadrant, and 26 eyes the intraconal central space. The selection of surgical approach: 1)OCH in the muscle cone: conjunctival approach surgery in 53 eyes, lateral orbital approach surgery in 22 eyes, lateral combined medial conjunctiva orbital approach surgery in 5 eyes, skin approach surgery in 1 eye, transnasal approach under nasal endoscope surgery in 1 eye; 2)OCH outside the muscle cone: skin approach in 29 eyes, conjunctival approach in 12 eyes and lateral orbital approach in 5 eyes. Postoperative efficacy: except for 1 eye of postoperative tumor residue, the other 127 eyes were completely removed. Postoperative complications: 1)Ocular motility disorder: 16 eyes, including conjunctival approach surgery in 11 eyes, lateral orbital approach surgery in 4 eyes, lateral combined medial conjunctiva orbital approach surgery in 1 eye; 2)Visual acuity decreased in 9 eyes: conjunctival approach surgery in 3 eyes, lateral orbital approach surgery in 6 eyes; 3)Mydriasis occurred in 9 eyes, including 4 eyes via conjunctival approach surgery and 5 eyes via lateral orbital approach surgery; 4)Intraorbital hemorrhage occurred in 3 eyes: all occurred through conjunctival approach surgery; 5)Visual acuity was lost in 2 eyes, including conjunctival approach surgery in 1 eye and lateral orbital opening approach surgery in 1 eye; 6)There were 2 eyes of ptosis, including conjunctival approach surgery in 1 case and skin approach surgery in 1 eye; 7)Tumor residue occurred in 1 eye: multiple intraorbital tumors were treated by lateral orbital approach surgery.CONCLUSION: The accurate location of OCH combined with imaging examination and the selection of appropriate surgical approaches according to different locations can successfully remove the tumor and reduce the incidence of complications.