Objective To explore the value of curvature value of liver surface nodularity(LSN)based on MRI in evaluating liver function in patients with liver cirrhosis.Methods A retrospective analysis was made on the patients who underwent upper abdomen MR examination at 3.0T.The normal liver function patients and cirrhosis patients were enrolled in the study and then the Child-Pugh score of the patients were calculated.The patients were divided into three groups:normal liver group,compensated cirrhosis group and decompensated cirrhosis group.The water phase imaging of 3D modified Dixon fast field echo(mDixon-FFE)sequence was copied in DICOM format.ITK software was used to manually draw the full-thickness liver edge by two observers.The curvature value of LSN was obtained by using matlab self compiled code for follow up analysis.Kruskal-Wallis H test was used to compare the curvature value between the groups.The receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was obtained.Spearman test was used for the correlation analysis.Results The curvature values of LSN among the normal liver,compensated cirrhosis and decompensated cirrhosis groups gradually increased(P<0.05).Comparing normal liver with compensated cirrhosis,the AUC of diagnosing compensated cirrhosis was 0.84,with the sensitivity of 72.7%and the specificity of 89.3%.Comparing compensated cirrhosis with decompensated cirrhosis,the AUC of diagnosing decompensated cirrhosis was 0.91,with the sensitivity of 80%and the specificity of 90.9%.There was a moderate positive correlation between the curvature value of LSN and liver function score in patients with cirrhosis(r=0.63,P=0.002).Conclusion The curvature value of LSN based on MRI can be used for preliminary evaluation of liver function of liver cirrhosis,with the AUC more than 0.80 and higher sensitivity and specificity.

With the increasing understanding of the unique tumor microenvironment in the brain, immunotherapy have emerged as a new and promising treatment for brain metastases. Radiotherapy and immunotherapy have a synergistic effect, and it is of great value to understand its mechanism in the treatment of breast cancer brain metastases. At present, the study of immune checkpoint inhibitors combined with radiotherapy in breast cancer brain metastases is being actively carried out, bringing new hope to patients with breast cancer brain metastases.

Objective:To evaluate the relationship between the Panton-Valentine leukocidin (pvl) strain and clinical characteristics, and to describe the molecular biological characteristics of invasive Staphylococcus aureus ( S. aureus) infected clinical isolates. Methods:The isolates of S. aureus caused by invasive infection were collected in Beijing Children's Hospital Affiliated to Capital Medical University from January 2016 to December 2019, and the clinical data of the corresponding children were collected retrospectively using electronic medical records. Multilocus sequence typing, spa typing and pvl gene were analyzed using the PCR. In addition, the minimum inhibitory concentrations (MIC) of antibiotics of all isolates were detected by the micro-broth dilution method, and the isolates were divided into the pvl+ and pvl- groups according to whether or not the S. aureus isolates carried pvl. The t test and the Mann-Whitney U test were used to compare the clinical symptoms between the pvl+ and pvl- groups. Chi-square test was used to compare the drug susceptibility between the two isolates. Results:A total of 127 cases of invasive S. aureus infection were collected during the study period. The white blood cell count, neutrophil count, and C-reaction protein level in the pvl+ group were significantly higher than those in the pvl- group ( P=0.001, P=0.001, P=0.005). The rate of pvl carrier was 44.9%. Among 57 pvl+ pathogenic strains, 64.9% (37/57) were MRSA. The multidrug resistance rate of pvl- isolates was higher than that of pvl+ isolates (70% vs. 49.12%, P=0.02). Conclusions:In invasive S. aureus infection, pvl+ strain is associated with elevated inflammatory markers in children. the positive rate of pvl is higher in clinical isolates, and the multidrug resistance rate of pvl- S. aureus is higher.

Objective:To investigate the clinical efficacy, safety and compliance of Voriconazole suspension formula on the prevention and treatment of invasive fungal infection (IFI) in children with allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:Clinical data of 25 children treated Voriconazole suspension formula for the prevention and treatment of IFI during the period of allo-HSCT in the Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University from August 1, 2020 to April 30, 2021 were retrospectively analyzed.The plasma trough concentration of Voriconazole was detected by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), and the genotype of CYP2C19 was detected by polymerase chain reaction-restriction fragment length polymorphism (RFLP). The effect of CYP2C19 genotype on Voriconazole trough concentration was analyzed by rank-sum test, and Fisher′ s accurate test was used to analyze the influence of severity of gastrointestinal mucositis on serum trough concentration of Voriconazole in children with allo-HSCT. Results:A total of 25 children, including 18 males and 7 females were recruited.The median age at allo-HSCT was 6 (2-13) years.After initial administration of conventional dose of Voriconazole suspension formula during transplantation, plasma trough concentration of Voriconazole was intermittently monitored.Only 13 cases (52.0%) reached the target plasma trough concentration, 11 cases(44.0%) reached the target plasma trough concentration after adjusting the dose according to the plasma concentration, and 1 cases(4.0%) failed to reach it after increasing the dose twice.Genotype detection of CYP2C19 was performed in 20 children, involving 4 cases of poor metabolizers (PM), 9 cases of intermediate metabolizers (IM), 6 cases of extensive metabolizers (EM), and 1 case of ultra extensive metabolizer (UEM). A significant difference in plasma trough concentration was detected among all groups ( F=24.012, P<0.01). During the transplantation, 12 cases developed mild to moderate gastrointestinal mucositis, and 7 cases had severe gastrointestinal mucositis.The stan-dard rate of plasma trough concentration in children with severe gastrointestinal mucositis (1/7 cases, 14.3%)was significantly lower than those with mild to moderate gastrointestinal mucositis (9/12 cases, 75.0%) ( P=0.02). Five children (71.4%) with severe gastrointestinal mucositis could reach the target trough concentration after increasing the drug dose, suggesting that severe gastrointestinal mucositis had a great influence on the plasma concentration of Vorico-nazole suspension.The incidence of IFI in 25 children with allo-HSCT was 0, and the compliance of children taking Voriconazole dry suspension was 100.0%.The incidence of adverse reactions was 24.0% and all adverse reactions were relieved after symptomatic treatment. Conclusions:The plasma concentration of Voriconazole varies greatly among children and in different states of the same patient.Therefore, it is necessary to monitor the trough concentration of the drug and adjust the drug dose.The use of Voriconazole suspension formula for the prevention and treatment of fungal infection during allo-HSCT in children is clinically safe and effective, with a good compliance in children.

The policy implementation model of G. C. Edwards was used to analyze the public policy health impact assessment in Zhejiang province, and summarize its practice and existing problems in four aspects of policy implementation standards, policy resources, policy executors′ intention and management organization structure, so as to provide reference for promoting the national health impact assessment pilot work. The analysis results showed that Zhejiang province has initially established the public policy health impact assessment mechanism and achieved phased results, but there were still some problems, including the imperfection of policy content and implementation strategy, the inadequacy of leadership decision-making and top-level design, the difference in attitude, understanding and implementation preference of policy implementation subjects, and the ambiguity of the authority and responsibility system of each department in cooperation. In order to further promote the smooth development of public policy health impact assessment, Zhejiang province should actively promote the top-level design to strengthen policy support, integrate and optimize policy resources, gradually establish and improve the health governance mechanism of multiple and overall coordination, and promote the high-quality development of public policy health impact assessment by taking cross departmental cooperation as the path of health co-construction.

Objective:To analyze the satisfaction of referral patients for the medical services provided by the countywide medical community, for reference in further improving its quality and continuity of medical services.Methods:From April to July 2021, a systematic sampling method was adopted to selected the survey subjects from the outpatients from the leading hospitals and three affiliated units of two medical communities, as well as those from two county-level hospitals of non medical communities and five grass-roots medical and health institutions. A total of 660 patients were included in the questionnaire survey. The questionnaire covered key demographic information and 15 satisfaction questions under 4 dimensions. The propensity score matching method was used to reduce confounding factors, factor analysis was used to calculate the satisfaction of referral patients in the medical community group and the non-medical community group, and the systematic dynamics approach was used to analyze the effect of patient satisfaction on referral intention.Results:A total of 641 valid questionnaires were collected. Based on a 1∶2 propensity score matching, 591 patients were finally enrolled, consisting of 102 up-referral cases from the non-community group and 273 such cases from the community group, as well as 76 down-referral cases from the non-community group and 140 such cases from the community group. The overall satisfaction scores by both up and down referral patients were 4.26(1.01)and 4.29(1.14)respectively.The overall satisfaction, medical service satisfaction, technical service quality satisfaction and non-technical service quality satisfaction of up-referral patients, as well as the overall satisfaction, non-technical service quality satisfaction of down-referral patients of the community group were higher than those from the non-community group, with differences statistically significant( P<0.05). The higher satisfaction of patients with their referral in the community, the stronger their referral willingness. Conclusions:The overall satisfaction of refrerral patients in the medical community group is higher than that of the non medical community group. The construction of county medical community has promoted the improvement of satisfaction of referral patients. However, it is still imperative to encourage high-quality medical resources to support primary institutions, to enhance the service level of primary medical and health institutions, to implement differentiated medical insurance reimbursement policies, and to improve the continuity of medical services within the community.

Toll-like receptor 4 (TLR4) is a key regulator of innate and adaptive immune response. The role of TLR4 in pancreatic diseases is a research hotspot in recent years, and a large number of studies have shown that TLR4 is closely associated with pancreatic cancer. This article mainly discusses the abnormal expression and regulation mechanism of TLR4 in pancreatic cancer and its potential in cancer treatment, so as to provide new ideas for the pathogenesis and treatment of pancreatic cancer.

ObjectiveTo investigate the clinical effect of laparoscopic splenectomy and pericardial devascularization (LSPD) in patients with portal hypertension and the long-term effect of LSPD. MethodsA total of 40 portal hypertension patients with Child-Pugh A/B liver function who received LSPD in The First Hospital of Jilin University from August to December 2017 were enrolled as surgical group, and 44 portal hypertension patients with Child-Pugh A/B liver function who received conservative treatment during the same period of time was enrolled as internal medicine group. The patients were followed up to June 30, 2019, and liver function parameters, upper gastrointestinal bleeding, and portal vein thrombosis were recorded for all patients at each time point. The t-test was used for comparison of normally distributed continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the Bonferroni test was used for further comparison between two groups. The Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution; between multiple groups, and the Mann-Whitney U test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. ResultsAt 6, 12, and 24 months after discharge, compared with the internal medicine group, the surgical group had a significantly higher level of cholinesterase (t=3.527, 3.849, and 5.555, all P＜0.05) and a significantly lower Child-Pugh score (t=2.498, 2.138, and 2.081, all P＜0.05). Compared with the internal medicine group at 12 and 24 months after discharge, the surgical group had a significantly higher level of albumin (t=3.120 and 2.587, both P＜0.05) and a significantly lower incidence rate of upper gastrointestinal bleeding (χ2=4.947 and 5.155, both P＜0.05). At 24 months after discharge, the surgical group had a significantly lower number of patients who had a significant increase in alpha-fetoprotein level than the internal medicine group (χ2=4.648, P=0.031). At 12 months after discharge, the surgical group had a significantly higher incidence rate of portal vein thrombosis than the internal medicine group (χ2=4.395, P=0.036). The surgical group had significant improvements in albumin (F=2.959, P=0.013), cholinesterase (F=11.022, P＜0001), prothrombin time (H=94.100, P＜0.001), and Child-Pugh score (F=3.742, P=0.003) from admission to 12 and 24 months after surgery. ConclusionIn portal hypertension patients with Child-Pugh A/B liver function, LSPD can improve liver function and reduce the incidence rate of upper gastrointestinal bleeding, and the high incidence rate of portal vein thrombosis can be effectively reduced by oral aspirin and rivaroxaban.

Common bile duct stones are a common of digestive system disease, and as one of the long-term complications after Billroth II subtotal gastrectomy, it has attracted more and more attention from clinicians. Common bile duct stones after Billroth II subtotal gastrectomy have a complex pathogenesis, including neurological, humoral, and mechanical factors. Even though there are many methods to remove stones, there are still controversies over the selection of digestive endoscopy, surgical operation, or percutaneous transhepatic approach. Clinicians should fully evaluate the specific conditions of patients and formulate individualized treatment regimens to achieve the best treatment outcome.

Objective:To analyze the clinical characteristics and long-term outcome of Langerhans cell histiocytosis with multisystem involvement (MS-LCH) in children, and to evaluate the efficacy of modified DAL-HX83/90 protocol.Methods:This retrospective study included 53 patients with MS-LCH admitted to the Department of Pediatric Hematology and Oncology, First Affiliated Hospital of Zhengzhou University from January 2011 to May 2019. Modified DAL-HX83/90 protocol was used in all patients as an initial treatment. The patients were divided into the group with (RO+) or without (RO-) risk organ involvement. The RO+group was further divided into two groups, as RO+Ⅰ group (lung involvement only) and RO+Ⅱ group (extra-pulmonary, with or without lung involvement). The clinical characteristics and the long-term outcome were summarized. Event-free survival (EFS) and overall survival (OS) curves were analyzed with Kaplan-Meier method. Univariate and multivariate analysis of prognostic factors including age, sex, risk organ involvement and response to 6-week induction were analyzed with Log-Rank test and Cox proportional hazards models.Results:Among the 53 children with MS-LCH, 34 were male and 19 were female. The age of onset was 21 months (3 months-13 years). There 22 were in RO+group, with 12 in RO+Ⅰ group and 10 in RO+Ⅱ group, and 31 in RO-group. The follow-up period was 51 (12-144) months. The overall response rate of 6-week induction was 89% (47/53), and the recurrence rate was 30% (16/53). The 5-year EFS and OS were (67±6) % and (83±5) %, respectively. Univariate analysis showed that the 5-year EFS and OS of patients who responded well to 6-week induction chemotherapy were significantly higher than those who had no response ((76±6) % vs. 0, (88±4) % vs. (41±22) %, χ 2 = 34.743, 10.608, both P<0.05). The 5-year EFS and OS of RO-group were significantly higher than that of RO+group ((80±7) % vs. (49±10) %, (93±4) % vs. (70±10) %, χ 2=6.022, 4.793, both P<0.05). And the 5-year EFS of RO+Ⅰ group was significantly higher than that of RO+Ⅱ group ((83±10) % vs. (10±9) %, χ 2=9.501, P=0.002). While age and sex were not significantly associated with 5-year EFS and OS (all P>0.05). Cox proportional hazard regression model showed that response to 6-week induction chemotherapy was the independent risk factor for EFS ( HR=13.114, 95% CI3.759-45.742, P<0.01) and OS ( HR=7.748, 95% CI 1.542-38.920, P=0.013). Conclusions:Most of the children without risk organ involvement treated with modified DAL-HX83/90 protocol could achieve long-term survival. However, the children involved liver, spleen, or hematopoietic system had a high risk of disease progression and recurrence.