ObjectiveTo investigate the difference in the risk of cardiovascular diseases between patients with different subtypes of non-alcoholic fatty liver disease （NAFLD） from the perspective of metabolism， since cardiovascular events induced by metabolic disorders are the leading cause of death in NAFLD. MethodsThe cluster sampling method was used to conduct a multicenter cross-sectional study among three representative hospitals in Pudong New Area of Shanghai， China. A total of 37 122 sets of physical examination data from July 2022 to June 2023 were collected and stratified according to body mass index （BMI）. The chi-square test was used for comparison of continuous data between groups， and a multivariable Logistic regression analysis was used to investigate the association between NAFLD subtypes and cardiometabolic risk factors. ResultsA total of 9 372 cases of NAFLD were detected， with a detection rate of 25.25%， and more than 97% of these patients were diagnosed with metabolic associated fatty liver disease （MAFLD）. The subgroup analysis showed that the detection rates of lean， overweight， and obese NAFLD were 7.72%， 33.99%， and 63.56%， respectively. Compared with the patients with lean or overweight NAFLD， the patients with obese NAFLD showed a significantly higher proportion of patients with abnormalities in blood pressure， blood glucose， triglyceride （TG）， high-density lipoprotein （HDL） or uric acid （all P<0.001）. Among related risk factors， lean NAFLD was associated with the increase in total cholesterol （TC）（P<0.05）， while overweight NAFLD and obese NAFLD were not associated with TC abnormalities （P>0.05）； obese NAFLD was not associated with TG abnormalities， while lean NAFLD and overweight NAFLD were associated with TG abnormalities （both P<0.05）； all types of NAFLD were associated with the abnormalities of waist-hip ratio， blood pressure， blood glucose， low-density lipoprotein， HDL， and uric acid （all P<0.05）. ConclusionThe detection rates of different subtypes of NAFLD in Shanghai Pudong are close to those reported in China and globally， and the epidemiologic data of NAFLD can be used analogously for MAFLD. There are certain differences in the distribution and association of cardiometabolic risk factors between different subtypes of NAFLD， and targeted interventions should be formulated based on the metabolic characteristics of each type of NAFLD.

ObjectiveTo assess the predictive value of the bladder deformation index (BDI) in determining upper urinary tract (UUT) damage among patients with neurogenic bladder (NB). MethodsClinical data of 132 NB patients admitted to Beijing Bo'ai Hospital from January, 2015 to December, 2018 were retrospectively analyzed. Patients were divided into UUT damage group and normal UUT group according to the presence or absence of hydronephrosis. The demographics, biochemical parameters and video-urodynamics (VUDS) findings were collected, and BDI was calculated. Receiver operating characteristic (ROC) curves were utilized to evaluate the predictive capability. ResultsThere were 54 patients in UUT damage group and 33 in normal UUT group. The course of disease, creatinine level and BDI were siginificantly different between two groups (P < 0.05), while the area under the curve were 0.686, 0.836 and 0.928, respectively. ConclusionCourse of disease, creatinine level and BDI are associated with UUT damage in NB patients, and BDI demonstrates the highest sensitivity and specificity, which may play a role in diagnosis of UUT damage.

Objective:To summarize the clinical characteristics of children carrying the m.8344A>G variant of MT-TK gene.Methods:A case series study was conducted to retrospectively collect data of 22 children with mitochondrial disease caused by MT-TK gene m.8344A>G variation who were treated at the Department of Neurology of Beijing Children′s Hospital of Capital Medical University from January 2012 to January 2024. Their clinical data, laboratory tests, muscle pathology, genetic testing, and the follow-up results were analyzed. Pearson correlation analysis was used for correlation analysis.Results:Among the 22 children, there were 13 boys and 9 girls. The age of onset was 5.00 (2.75, 9.00) years. Fifteen children had myoclonic epilepsy with ragged-red fibers (MERRF), 3 had Leigh syndrome (LS), and 4 had LS-MERRF overlap syndrome (LS-MERRF). Myoclonus presented and worsened progressively in all 15 MERRF children, with 10 as the initial symptom and 5 developing progressively during the disease course. Myoclonus was predominantly focal, worsening with fine motor tasks or stress. Electroencephalogram monitoring in the 15 MERRF children revealed myoclonic seizures in 10 children, with 6 classified as myoclonic epilepsy, and 4 as subcortical myoclonus. Two children had generalized myoclonic seizures, and 1 each had absence seizures and generalized seizures. Twelve children had cerebellar ataxia, 10 children exhibited exercise intolerance, and 8 children had muscle weakness. Magnetic resonance imaging (MRI) revealed periventricular white matter involvement in 1 child and bilateral hippocampal involvement in 1 child, likely due to frequent seizures. All 3 children with LS exhibited developmental regressions, accompanied with 2 symptoms include cerebellar ataxia, muscle weakness, and dysphagia. The clinical manifestations of 4 LS-MERRF overlap children presented with combined features of MERRF and LS. Cranial MRI in the 7 LS and LS-MERRF children showed brainstem involvement (all affecting the midbrain) in 6 children and basal ganglia involvement in 4 children. Among the 22 children, 12 had m.8344A>G variant levels >90%, 3 had >80%-90%, 4 had >70%-80%, and 3 had >60%-70%. Higher variant level correlated with the LS phenotype and earlier onset age ( r=0.47, -0.50; P=0.018 and 0.029, respectively). Sanger sequencing in 19 mothers revealed m.8344A>G variations in 18, with 4 showing exercise intolerance. Follow-up of 13 children on antimyoclonic treatment showed>75% reduction in seizures with levetiracetam monotherapy in 2 children, with combination therapy required in others. Most achieved >50% seizures reduction within 2 years, but the effectiveness declined with disease progression. Conclusions:The m.8344A>G variant is rare, with MERRF being the most common phenotype, while LS and LS-MERRF are less common. Children with higher ratio of the m.8344A>G variant are more likely to present LS phenotype. Myoclonus, primarily focal, is a key feature, with levetiracetam as the first-line treatment and benzodiazepines recommended for refractory cases.

Objective:To explore the regulatory effects of Qinghua Liangxue Huluo Decoction on oxidative stress and inflammation in acute radiation enteritis in rats, as well as its impact on the PI3K/Akt pathway. Methods:A total of 36 SD rats were randomly divided into four groups using block randomization, namely the control, model, low-dose group (6.17 g/kg), and high-dose (24.68 g/kg) groups, with nine rats in each group. These rats were exposed to X-ray irradiation at a dose of 17.5 Gy to induce acute radiation enteritis, followed by continuous intragastric administration for seven days pre- and post-irradiation. Seven days post-irradiation, the perianal and fecal conditions of rats in each group were observed, and rectal tissues were collected and ground. Enzyme-linked immunosorbent assay (ELISA) was employed to assess the activity of superoxide dismutase (SOD), catalase (CAT) expression, and malondialdehyde (MDA) levels indicative of lipid peroxidation. Quantitative real-time polymerase chain reaction (qRT-PCR) was utilized to analyze the mRNA expression of tumor necrosis factor-ɑ (TNF-ɑ), interleukin-6 (IL-6), and interleukin-1β (IL-1β) in the rectal tissues of each group. Additionally, Western blot was conducted to examine the expression of proteins associated with the PI3K/Akt signaling pathway in rectal tissues. The IEC-6 cells were categorized into the control, radiation, blank, and drug administration groups, with all these groups except for the control group subjected to 10 Gy single irradiation. ELISA was then employed to determine the concentrations of SOD, CAT, MDA, TNF-ɑ, IL-6, and IL-1β in cell supernatants, while Western blot was utilized to assess the expression of PI3K/Akt signaling pathway-related proteins in each group.Results:Compared to the model group, rats in the low-dose and high-dose groups exhibited a trend toward normal perianal and fecal conditions, increased SOD activity ( t = 4.86, 8.50, P < 0.05), elevated CAT expression ( t = 8.72, 14.28, P<0.05), and decreased MDA level ( t = 6.94, 10.66, P < 0.05). Furthermore, the mRNA expression of TNF-ɑ, IL-6, and IL-1β in rectal tissues was significantly inhibited in both low-dose and high-dose groups ( t = 5.60, 2.95, 4.31, 9.16, 4.66, 13.35, P < 0.05), along with lower p-PI3K/PI3K and p-Akt/Akt ratios in rectal tissues compared to the model group ( t = 22.35, 13.56, 18.23, 13.85, P < 0.05). Compared to the radiation group, the drug administration groups (10% drug-containing serum) exhibited increased SOD and CAT expressions ( t = 6.85, 10.44, P < 0.05), as well as decreased MDA expression ( t = 10.44, P < 0.05), in the supernatant. Furthermore, compared to the radiation group, this group displayed significantly inhibited TNF-ɑ, IL-6, and IL-1β concentrations in the cell supernatant ( t = 12.07, 6.87, 14.80, P < 0.05), while lowering p-PI3K/PI3K and p-Akt/Akt ratios in cells ( t = 10.95, 5.59, P < 0.05). Conclusions:Qinghua Liangxue Huluo Decoction demonstrates the potential for mitigating oxidative stress-induced injury and suppressing the expressions of inflammatory factors in rats with acute radiation enteritis. The mechanism behind the potential is likely associated with the negative regulation of the PI3K/Akt signaling pathway.

Radiotherapy, as an important means of tumor treatment, plays a significant role in the treatment of cervical cancer. However, the ovaries are highly sensitive to radiation, which is prone to appear radiation-related injuries, leading to ovarian dysfunction and loss of fertility in young female patients, seriously affecting their physical and mental health. The degree of ovarian injury is influenced by various factors such as the dose, volume, and duration of radiation exposure to the ovaries, as well as the patient's age. Ovarian displacement and advancements in radiotherapy techniques can significantly relieve radiation-related ovarian injury. Currently, drug protection techniques are still immature, and new fertility preservation methods are receiving increasing attention but require further improvement. This article reviewed the research progress in the molecular mechanisms, prevention strategies, and new fertility preservation techniques for ovarian injury related to cervical cancer radiotherapy, aiming to provide a reference for ovarian function protection during radiotherapy for young cervical cancer patients.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Nonalcoholic steatohepatitis (NASH) is a spectrum of chronic liver disease characterized by hepatic lipid metabolism disorder. Recent reports emphasized the contribution of triglyceride and diglyceride accumulation to NASH, while the other lipids associated with the NASH pathogenesis remained unexplored. The specific purpose of our study was to explore a novel pathogenesis and treatment strategy of NASH via profiling the metabolic characteristics of lipids. Herein, multi-omics techniques based on LC-Q-TOF/MS, LC-MS/MS and MS imaging were developed and used to screen the action targets related to NASH progress and treatment. A methionine and choline deficient (MCD) diet-induced mouse model of NASH was then constructed, and Schisandra lignans extract (SLE) was applied to alleviate hepatic damage by regulating the lipid metabolism-related enzymes CES2A and CYP4A14. Hepatic lipidomics indicated that MCD-diet led to aberrant accumulation of phosphatidylethanolamines (PEs), and SLE could significantly reduce the accumulation of intrahepatic PEs. Notably, exogenous PE (18:0/18:1) was proved to significantly aggravate the mitochondrial damage and hepatocyte apoptosis. Supplementing PE (18:0/18:1) also deteriorated the NASH progress by up regulating intrahepatic proinflammatory and fibrotic factors, while PE synthase inhibitor exerted a prominent hepatoprotective role. The current work provides new insights into the relationship between PE metabolism and the pathogenesis of NASH.

Patients with severe or critical coronavirus disease 2019 (COVID-19) are at high risk of death primarily due to respiratory failure caused by the cytokine storm in pulmonary tissues. The treatment response of these patients remains limited. Recently, low-dose radiation therapy (LDRT) has been clinically adopted to treat severe or critical COVID-19 patients in multiple medical centers abroad, indicating high feasibility and effectiveness. However, the mechanism and optimal radiation dose are still incompletely clear. This paper reviews the radiobiological mechanism, effectiveness, adverse reactions, and radiotherapy dose of LDRT in the treatment of severe or critical COVID-19 patients, aiming to better understand the clinical benefits and adverse reactions of LDRT.

Objective:To investigate the effect of biofeedback combined with pelvic floor training on stress urinary incontinence in elderly men.Methods:This study was prospective and Patients with urinary incontinence after radical prostatectomy from China Rehabilitation Research Center were enrolled. The patients who could not complete or refused the study, had a history of other urinary diseases, and central nervous system diseases were excluded. Patients were divided by random number table method into 3 groups. They were Kegel training group (Group A)which underwent anus contraction training with each contraction for 5 seconds and a rest interval of 2 seconds. Biofeedback combined with Kegel training group (Group B), which was biofeedback combined with anus contraction training and the biofeedback combined Pilates group (Group C) which received the biofeedback combined Pilates training. In group B and group C, patients were placed in the right lateral position and the surface electrode of the rectal probe was inserted into the anus. The reference electrode was fixed at the adductor muscle of the right thigh. The patient is asked to squeeze the electrode as hard as possible by constricting the anus so that the electromyographic signals produced by constricting the anus are synchronized with those on the computer screen. In the electrical stimulation stage of biofeedback therapy, rhomboid waves with current intensity of 30-50 Hz and pulse width of 300μs were used, and the electrical stimulation intensity was determined by the subtle muscle contraction visible. Each of the three training sessions lasted 45 minutes a day for 8 weeks. 1 hour pad test, daily incontinence times, (International Incontinence Counseling Questionnaire, ICIQ), and Oxford Score Scale were recorded every weekend. The 1-hour pad test, the number of incontinent episodes, ICIQ, Oxford Score scale before and after treatment were compared among the three groups, as well as the differences between the groups.Results:There were no significant differences in age, height, weight, history of diabetes or hypertension before treatment, time from postoperative to training, operation method, retention of nerve tract during surgery, Gleason score, 1-hour pad test, the number of episodes of incontinence, ICIQ and Oxford Grading Scale among the 3 groups. The 1-hour pad test results of group A, B and C were (37.4±7.2), (22.2±4.7) and (18.3±2.4) g, respectively, with statistical significance among the three groups ( P<0.01), and the difference between the three groups and before treatment was statistically significant ( P<0.01). The results of the number of episodes of incontinence in group A, B and C after treatment were (4.6±0.7), (3.4±0.6) and (3.0±0.8), respectively, and the difference among the three groups was statistically significant ( P<0.01), and the difference between the three groups and before treatment was statistically significant ( P<0.01). The results of The ICIQ in group A, B and C after treatment were 12(11, 14), 8(7, 9) and 6(5, 8), respectively, and the differences among the three groups were statistically significant ( P<0.01), and the differences between the three groups were statistically significant compared with before treatment ( P<0.01). The results of Oxford Grading Scale in group A, B and C after treatment were 3(3, 3), 4(3, 4) and 4(4, 4), respectively, and the difference between the three groups was statistically significant ( P<0.01), and the difference between the three groups was statistically significant compared with before treatment ( P<0.01). Conclusions:Biofeedback combined with pelvic floor training and biofeedback combined with Pilates training can improve urinary control, pelvic floor muscle strength, and stress urinary incontinence symptoms in male patients with stress urinary incontinence.

Objective To observe the clinical effect of Mirabegron combined with Silodosin on detrusor hyperactivity with impaired contractile (DHIC).Methods From September, 2019 to December, 2021, 40 patients with DHIC in the Department of Urology of Beijing Bo'ai Hospital were selected and randomly divided into control group and experimental group, with 20 cases in each group. The control group took Silodosin only, and the experimental group took Mirabegron in addition, for four weeks. The urinary diary, residual urine volume, Overactive Bladder Symptom Score (OABSS) and quality of life (QOL) score were compared before and after treatment.Results A total of 18 patients in the control group and 19 in the experimental group finished the trial. After treatment, the number of night urination per day, the residual urine volume and QOL score improved in the control group (P<0.01); the number of urination per 24 hours, the number of night urination per day, the volume per urination, the residual urine volume, the daily urgency score, the OABSS score and QOL score improved in the experimental group (P<0.01). The number decrease of urination per 24 hours, the volume decrease of per urination, the daily urgency score decrease, the OABSS score decrease and QOL score decrease were more in the experimental group than in the control group (P<0.01). The adverse reactions included palpitations, increased heart rate, dyspareunia, increased blood pressure, gastric discomfort, postural hypotension, and retrograde ejaculation, and there was no significant difference between two groups (P > 0.05).Conclusion The efficacy of Mirabellone combined with Silodosin on DHIC is better than Silodosin only, and there was no significant increase in drug-related adverse effects.