Construction of a predictive model for acute liver failure after hepatectomy based on neutrophil-to-lymphocyte ratio and albuminbilirubin score

BACKGROUND Acute liver failure(ALF)is a common cause of postoperative death in patients with hepatocellular carcinoma(HCC)and is a serious threat to patient safety.The neutrophil-to-lymphocyte ratio(NLR)is a common inflammatory indicator that is associated with the prognosis of various diseases,and the albumin-bilirubin score(ALBI)is used to evaluate liver function in liver cancer patients.Therefore,this study aimed to construct a predictive model for postoperative ALF in HCC tumor integrity resection(R0)based on the NLR and ALBI,providing a basis for clinicians to choose appropriate treatment plans.AIM To construct an ALF prediction model after R0 surgery for HCC based on NLR and ALBI.METHODS In total,194 patients with HCC who visited The First People’s Hospital of Lianyungang to receive R0 between May 2018 and May 2023 were enrolled and divided into the ALF and non-ALF groups.We compared differences in the NLR and ALBI between the two groups.The risk factors of ALF after R0 surgery for HCC were screened in the univariate analysis.Independent risk factors were analyzed by multifactorial logistic regression.We then constructed a prediction model of ALF after R0 surgery for HCC.A receiver operating characteristic curve,calibration curve,and decision curve analysis(DCA)were used to evaluate the value of the prediction model.RESULTS Among 194 patients with HCC who met the standard inclusion criteria,46 cases of ALF occurred after R0(23.71%).There were significant differences in the NLR and ALBI between the two groups(P<0.05).The univariate analysis showed that alpha-fetoprotein(AFP)and blood loss volume(BLV)were significantly higher in the ALF group compared with the non-ALF group(P<0.05).The multifactorial analysis showed that NLR,ALBI,AFP,and BLV were independent risk factors for ALF after R0 surgery in HCC.The predictive efficacy of NLR,ALBI,AFP,and BLV in predicting the occurrence of ALT after R0 surgery for HCC was average[area under the curve(AUC)NLR=0.767,AUCALBI=0.755,AUCAFP=0.599,AUCBLV=0.718].The prediction model for ALF after R0 surgery for HCC based on NLR and ALBI had a better predictive efficacy(AUC=0.916).The calibration curve and actual curve were in good agreement.DCA showed a high net gain and that the model was safer compared to the curve in the extreme case over a wide range of thresholds.CONCLUSION The prediction model based on NLR and ALBI can effectively predict the risk of developing ALF after HCC R0 surgery,providing a basis for clinical prevention of developing ALF after HCC R0 surgery.

药源性高尿酸血症临床分析及风险管理

目的从临床实例出发探讨药源性高尿酸血症的发生特点,为临床用药安全及风险管理提供依据。方法检索建库至2022年12月31日医药期刊公开发表的药源性高尿酸血症的病例报道,同时收集我院2010—2022年上报的药源性高尿酸血症不良反应(ADR)报告,提取患者性别、年龄、怀疑药品、药品的用法用量、血尿酸水平、ADR诱导时间、治疗与转归等信息进行统计分析。结果共纳入病例45例,其中文献病例18例,我院ADR病例27例。男性25例,女性20例,年龄14~82岁,平均年龄(53.18±19.45)岁;引起高尿酸血症的药物主要涉及抗结核药、利尿药、抗感染药、复方降压药、抗血小板药、质子泵抑制剂、调节免疫功能药和抗精神病药。用药后血尿酸>420~480μmol·L^(-1)的4例,>480~540μmol·L^(-1)的13例,>540μmol·L^(-1)的28例。高尿酸血症的诱导时间最短为2 d,最长数年。经停药、对症治疗或药物减量后血尿酸水平下降或恢复正常。结论多种药物可引起高尿酸血症,服用易引起高尿酸血症药物的患者,尤其是老年患者,应定期监测血尿酸水平。医务人员应了解易引起高尿酸血症的药物,做好用药风险管理,减少药源性高尿酸血症的发生。

Differences in Non-suicidal Self-injury Behaviors between Unipolar Depression and Bipolar Depression in Adolescent Outpatients

Objective Non-suicidal self-injury(NSSI)has a higher prevalence in adolescents with depressive disorders than in community adolescents.This study examined the differences in NSSI behaviors between adolescents with unipolar depression(UD)and those with bipolar depression(BD).Methods Adolescents with UD or BD were recruited from 20 general or psychiatric hospitals across China.The methods,frequency,and function of NSSI were assessed by Functional Assessment of Self-Mutilation.The Beck Suicide Ideation Scale was used to evaluate adolescents’suicidal ideation,and the 10-item Kessler Psychological Distress Scale to estimate the anxiety and depression symptoms.Results The UD group had higher levels of depression(19.16 vs.17.37,F=15.23,P<0.001)and anxiety symptoms(17.73 vs.16.70,F=5.00,P=0.026)than the BD group.Adolescents with BD had a longer course of NSSI than those with UD(2.00 vs.1.00 year,Z=−3.39,P=0.001).There were no statistical differences in the frequency and the number of methods of NSSI between the UD and BD groups.Depression(r=0.408,P<0.01)and anxiety(r=0.391,P<0.01)were significantly and positively related to NSSI frequency.Conclusion Adolescents with BD had a longer course of NSSI than those with UD.More importantly,NSSI frequency were positively and strongly correlated with depression and anxiety symptoms,indicating the importance of adequate treatment of depression and anxiety in preventing and intervening adolescents’NSSI behaviors.

Identification of a novel mutation in the FGF10 gene in a Chinese family with obvious congenital lacrimal duct dysplasia in lacrimo-auriculo-dento-digital syndrome

AIM:To identify the pathogenic gene variant in a family with lacrimo-auriculo-dento-digital syndrome[LADD(MIM 149730)]showing congenital lacrimal duct dysplasia as the main clinical manifestation and lay the foundation for future research on the pathogenic gene.METHODS:Ophthalmological examinations,including slit-lamp biomicroscopy and lacrimal duct probing,and computed tomography dacryocystography(CT-DCG)were performed for all participants.The family pedigree was drawn,genetic features were analyzed,and the genomic DNA of the subjects was extracted.Pathogenic genes were screened via whole exome sequencing(WES)and confirmed using Sanger sequencing.RESULTS:Six patients belonged to this three-generation family,and their clinical manifestations included congenital nasolacrimal duct obstruction,congenital absence of lacrimal puncta and canaliculi,lacrimal fistulae,and limb deformities.This pattern indicates autosomal dominant inheritance.Diagnosis was based on the clinical characteristics of LADD syndrome,which presented in all the patients in this family.A novel frameshif t mutation in the FGF10 gene(NM_004465.1),c.234dup C(p.Trp79Leus*15),was identified in all patients via WES.The variant was confirmed by Sanger sequencing and classified as a“pathogenic mutation”according to the American College of Medical Genetics and Genomics(ACMG)variant interpretation guidelines.CONCLUSION:A novel frameshift mutation in the FGF10 gene is found in all patients.This finding helps this family with LADD syndrome receiving a more accurate clinical diagnosis and genetic counseling by extending the mutation range of the FGF10 gene.

Computed tomography perfusion in differentiating portal hypertension: A correlation study with hepatic venous pressure gradient

BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH),invasiveness and potential risks in the process of measurement limited its widespread use.AIM To investigate the correlation of computed tomography(CT)perfusion parameters with HVPG in PH,and quantitatively assess the blood supply changes in liver and spleen parenchyma before and after transjugular intrahepatic portosystemic shunt(TIPS).METHODS Twenty-four PH related gastrointestinal bleeding patients were recruited in this study,and all patients were performed perfusion CT before and after TIPS surgery within 2 wk.Quantitative parameters of CT perfusion,including liver blood volume(LBV),liver blood flow(LBF),hepatic arterial fraction(HAF),spleen blood volume(SBV)and spleen blood flow(SBF),were measured and compared before and after TIPS,and the quantitative parameters between clinically significant PH(CSPH)and non-CSPH(NCSPH)group were also compared.Then the correlation of CT perfusion parameters with HVPG were analyzed,with statistical significance as P<0.05.RESULTS For all 24 PH patients after TIPS,CT perfusion parameters demonstrated decreased LBV, increased HAF, SBV and SBF, with no statistical difference in LBF. Compared withNCSPH, CSPH showed higher HAF, with no difference in other CT perfusion parameters. HAFbefore TIPS showed positive correlation with HVPG (r = 0.530, P = 0.008), while no correlation wasfound in other CT perfusion parameters with HVPG and Child-Pugh scores.CONCLUSIONHAF, an index of CT perfusion, was positive correlation with HVPG, and higher in CSPH thanNCSPH before TIPS. While increased HAF, SBF and SBV, and decreased LBV, were found afterTIPS, which accommodates a potential non-invasive imaging tool for evaluation of PH.

角膜保护剂对2型糖尿病患者白内障超声乳化术后眼表的影响

目的:探讨白内障超声乳化术中应用角膜保护剂(2%HPMC)对年龄相关性白内障(ARC)伴2型糖尿病患者术后眼表泪膜稳定性的影响。方法:前瞻性平行对照试验。将我院2017-03/2018-05行白内障超声乳化术的ARC伴2型糖尿病患者107例(107眼)纳入该研究。按照随机数字表将患者分为HPMC组和平衡盐溶液(BSS)组,HPMC组纳入57眼,术中角膜表面均匀覆盖2%HPMC;BSS组纳入50眼,术中不断向角膜上滴注BSS。所有患者手术前1d及术后7、30、60、90d行泪膜破裂时间(BUT)、泪液分泌试验(SⅠt)、角膜荧光素染色(CFS)检查,并观察其变化。结果:白内障术后7、30、60d,与BSS组术眼比较,HPMC组术眼BUT明显延长,且CFS着色点明显减少;术后7d,HPMC组SⅠt值明显低于BSS组,术后30、60d时HPMC组SⅠt值高于BSS组(P<0.05)。术后60d,HPMC组BUT、SⅠt、CFS结果与术前比较无差异(P>0.05),BSS组BUT、SⅠt、CFS结果与术前比较有差异(P<0.05)。结论:白内障超声乳化术中应用2%HPMC对ARC伴2型糖尿病患者眼表泪膜稳定性有一定保护作用,术后60d泪膜稳定性各项指标可恢复至术前水平。

Mitochondrial ATP 6 and 8 polymorphisms in irritable bowel syndrome with diarrhea

AIM: To investigate mitochondrial ATP 6 and 8 poly-morphisms in the colon and ileum of patients with ir-ritable bowel syndrome with diarrhea (IBS-D). METHODS: Twenty-eight patients fulfilling the Rome Ⅲ criteria for IBS-D and 28 healthy subjects were in-vestigated. All study participants underwent screening colonoscopy and mucosal biopsies were obtained from the colon and/or terminal ileum. Genomic DNA was ex-tracted from specimens based on standard protocols. Mitochondrial ATP (MT-ATP) 6 and 8 genes in speci-mens were polymerase chain reaction amplified and sequenced. Sequencing data were analyzed via Variant Reporter Software and compared with the reference sequence from Genbank (accession No. NC_012920) to indicate possible polymorphisms. The protocol was registered at www.clinicaltrials.gov as NCT01028898. RESULTS: Twenty-five polymorphic sites of MT-ATP 6 and 8 genes were detected and 12 of them were missense mutations. A median of two polymorphic sites in MT-ATP genes was found in colon specimens of controls while a median of three polymorphic sites was noted in patients with IBS-D (Mann-Whitney test, P=0.012). The variants of the colon and ileum speci-mens from the same subjects were identical in all but one case. Symptom duration in IBS was not found to be a significant factor associated with the mtDNA polymorphism (Spearman correlation, P=0.592). The mitochondrial DNA change at 8860 was present in all cases of both groups. The frequency of the 8701 poly-morphism was found to be the second most frequent; however, no statistical difference was noted between the groups (χ2 test, P=0.584). CONCLUSION: Patients with IBS-D have a higher inci-dence of MT-ATP 6 and 8 polymorphisms than healthy subjects, implying that the mtDNA polymorphism may play a role in IBS-D.

Computed tomography perfusion in liver and spleen for hepatitis B virus-related portal hypertension:A correlation study with hepatic venous pressure gradient

BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH).However,its use can be limited because it is an invasive procedure.Therefore,it is necessary to explore a non-invasive method to assess PH.AIM To investigate the correlation of computed tomography(CT)perfusion of the liver with HVPG and Child-Pugh score in hepatitis B virus(HBV)-related PH.METHODS Twenty-eight patients(4 female,24 male)with gastroesophageal variceal bleeding induced by HBV-related PH were recruited in our study.All patients received CT perfusion of the liver before transjugular intrahepatic portosystemic stent-shunt(TIPS)therapy.Quantitative parameters of CT perfusion of the liver,including liver blood flow(LBF),liver blood volume(LBV),hepatic artery fraction,splenic blood flow and splenic blood volume were measured.HVPG was recorded during TIPS therapy.Correlation of liver perfusion with Child-Pugh score and HVPG were analyzed,and the receiver operating characteristic curve was analyzed.Based on HVPG(>12 mmHg vs≤12 mmHg),patients were divided into moderate and severe groups,and all parameters were compared.RESULTS Based on HVPG,18 patients were classified into the moderate group and 10 patients were classified into the severe group.The Child-Pugh score,HVPG,LBF and LBV were significantly higher in the moderate group compared to the severe group(all P<0.05).LBF and LBV were negatively associated with HVPG(r=-0.473,P<0.05 and r=-0.503,P<0.01,respectively),whereas splenic blood flow was positively associated with hepatic artery fraction(r=0.434,P<0.05).LBV was negatively correlated with Child-Pugh score.Child-Pugh score was not related to HVPG.Using a cutoff value of 17.85 mL/min/100 g for LBV,the sensitivity and specificity of HVPG≥12 mmHg for diagnosis were 80%and 89%,respectively.CONCLUSION LBV and LBF were negatively correlated with HVPG and Child-Pugh scores.CT perfusion imaging is a potential non-invasive quantitative predictor for PH in HBV-related liver cirrhosis.

Research status of peri-menopausal insomnia based on bibliometrics

Objective:To reflect the current situation and development level of the treatment of peri-menopausal insomnia,to provide ideas and basis for the treatment of peri-menopausal insomnia,and to lay a scientific foundation.Methods:The relevant literatures about peri-menopausal insomnia in the past 20 years from January 1,2000 to September 30,2020 were searched in full-text database,and the publication time distribution,periodical distribution and research types were statistically analyzed with the help of NoteExpress 4.2.0,Excel 2010 and UCINET 6.2 software.Bibliometrics and social network analysis were used to grasp the research status and research hotspots.Results:979 articles about insomnia in peri-menopausal period were included.The number of literatures showed an upward trend and decreased from 2018 to 2020.The top three journals are Inner Mongolia traditional Chinese Medicine,Guangming traditional Chinese Medicine and Sichuan traditional Chinese Medicine,with 30,25 and 22 articles respectively.A total of 1,846 authors participated in the publication.The top three authors were Hong Li(14,0.63%),Jun-Shan Huang(9,0.40%)and Ying Chen(9,0.40%).The social network map shows that“insomnia”,“peri-menopausal period”,“perimenopausal insomnia”,“peri-menopausal syndrome”,“traditional Chinese medicine therapy”and“acupuncture”are the research hotspots and have the strongest correlation.Conclusion:The number of articles about peri-menopausal insomnia shows a downward trend in recent years,and the“core author group”has not been formed.The clinical research in this field is relatively perfect,but a more complete theoretical system has not been formed yet.Most of the treatment of insomnia in peri-menopausal period is based on traditional Chinese medicine,which shows that traditional Chinese medicine is more effective in clinical use,and the curative effect of syndrome differentiation of traditional Chinese medicine has been affirmed.However,there are relative deficiencies,such as the lack of strict experimental research and evaluation standards,the lack of unilateral prescription research,and so on.Future researchers should pay more attention to the experimental research of traditional Chinese medicine in the treatment of peri-menopausal insomnia and unilateral empirical prescription research.

Close association between abnormal expressed enzymes of energy metabolism and diarrhea-predominant irritable bowel syndrome

Background:Irritable bowel syndrome (IBS) is one of the most common functional intestinal diseases, but its pathogenesis is still unknown.The present study aimed to screen the differentially expressed proteins in the mucosa of colon between IBS with diarrhea (IBS-D) patients and the healthy controls.Methods:Forty-two IBS-D patients meeting the Rome III diagnostic criteria and 40 control subjects from July 2007 to June 2009 in Chinese PLA General Hospital were enrolled in the present study.We examined the protein expression profiles in mucosa of colon corresponding to IBS-D patients (n=5) and controls (n=5) using 2-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS).Secondly, Western blot and immunohistochemical analysis were carried out to validate the screened proteins in 27 IBS-D patients and 27 controls.Thirdly, high-performance liquid chromatography (HPLC) was further carried out to determine ATP concentration in the mucosa of colon between 10 IBS-D patients and 8 controls.Comparisons between 2 groups were performed by Student's t-test or Mann-Whitney U-test.Results:Twelve differentially expressed proteins were screened out.The α-enolase (ENOA) in the sigmoid colon (0.917 ± 0.007 vs.1.310 ± 0.100, t=2.643, P=0.017) and caecum (0.765 ± 0.060 vs.1.212 ± 0.122, t=2.225, P=0.023), Isobutyryl-CoA dehydrogenase (ACAD8) in the sigmoid colon (1.127 ± 0.201 vs.1.497 ± 0.392, t=7.093, P=0.008) of the IBS-D group were significantly lower while acetyl-CoA acetyltransferase (CT) in the caecum (2.453 ± 0.422 vs.0.931 ± 0.652, t=8.363, P=0.015) and ATP synthase subunit d (ATP5H) in the sigmoid (0.843 ± 0.042 vs.0.631 ± 0.042, t=8.613,P=0.007) of the IBS-D group was significantly higher, compared with the controls.The ATP concentration in the mucosa of the sigmoid colon in IBS-D group was significantly lower than that of control group (0.470 [0.180, 1.360] vs.5.350 [2.230, 7.900], U=55, P<0.001).Conclusions:Many proteins related to energy metabolism presented differential expression patterns in the mucosa of colon of the IBS-D patients.The abnormalities in energy metabolism may be involved in the pathogenesis of IBS which deserves more studies to elucidate.

Two cases of corona virus disease 2019(COVID-19)treated with the combination of acupuncture and medication in bedridden patients

The paper reports the experiences in treatment of two cases of corona virus disease 2019(COVID-19)with the combination of acupuncture and medication in bedridden patients confirmed in C7 Inpatient Ward,Wuhan Leishenshan Hospital,China.The combined treatment of acupuncture with the oral administration of"Shanghai leishen No.1 formula"was given every day.The prescription was modified weekly according the symptoms of the patients.Besides,the antivirus,anti-infectious and symptomatic treatment of western medicine was combined.Both of the two cases were improved and discharged.It is anticipated that the treatment experiences in these two cases may provide the instruction and enlightenment for the prevention and treatment of COVID-19.

Synergistic effect of chloride ion and albumin on the corrosion of pure magnesium

In this work, we report on synergistic effect of chloride ion and albumin on the corrosion of pure magnesium through corrosion tests. We show that the adsorption of albumin mainly affects the anodic polarization behavior of pure magnesium in NaCl solution. Low concentration of albumin enhances the reaction reactivity of pure magnesium and the initial evolvement of hydrogen at the initial immersion time. Addition of I glL albumin provides limited corrosion control for pure magnesium in NaCl solution. In comparison with low concentration albumin, addition of 10 g/L albumin can effectively inhibit the further dissolution of pure magnesium in test solutions with NaCI concentration of 0.2-0.8 wt. %, but this effect lowers gradually with increasing the concentration of chloride ion.

Risk factors for Clostridioides difficile infection in children and adolescents with inflammatory bowel disease: a systematic review and meta-analysis

Background Risk factors and consequences associated with Clostridioides difficile infection(CDI)in children and adolescents with inflammatory bowel disease(IBD)are still uncertain.We conduct a systematic review and meta-analysis to assess risk factors and outcomes associated with CDI in children and adolescents with IBD.Methods PubMed,EMBASE and Cochrane Library databases were searched from inception to 24th February,2021.Studies investigating risk factors,bowel surgery rate in pediatric IBD patients with and without CDI were included.Random-effects model was used for calculating summary estimates.Newcastle–Ottawa scale(NOS)was used for quality assessment.Results Fourteen studies,comprising 17,114 patients,were included.There was a significant association between 5-aminosalicylic acid(5-ASA)use and CDI[odds ratio(OR)=1.95,95%confidence interval(CI)1.26–3.03],with minimal heterogeneity(I^(2)=0.00%).Increased risk of active disease(OR=4.66,95%CI 2.16–10.07)were associated with CDI in those studies performed in high quality score(NOS>6)and significantly higher CDI rates in studies conducted outside USA(OR=2.94,95%CI 1.57–5.58).The bowel surgery rate in IBD with CDI was 3.8–57.1%,compared to that in IBD without CDI(0–21.3%).All studies were of moderate to high quality.Conclusions 5-ASA use and active disease might be risk factors associated with CDI in children and adolescents with IBD.Bowel surgery rates associated with CDI in IBD patients varied greatly.Large-scale clinical studies on CDI in children and adolescents with IBD are still needed to verify risk factors and outcomes.

Boc-phenylalanine Grafted Poly(3,4-propylenedioxythiophene) Film for Electrochemically Chiral Recognition of 3,4-Dihydroxyphenylalanine Enantiomers

To prepare chiral monomer with single chiral center and higher stereospecificity, a pair of amino-functionalized chiral 3,4-propylenedioxythiophene(ProDOT) derivatives, chiral(3,4-dihydro-2 H-thieno[3,4-b][1,4]dioxepin-3-yl)methyl 2-[(tert-butoxycarbonyl)amino]-3-phenylpropanoate(ProDOT-Boc-Phe), were synthesized. Chiral poly[(3,4-dihydro-2 H-thieno[3,4-b][1,4]dioxepin-3-yl)methyl2-[(tert-butoxycarbonyl)amino]-3-phenylpropanoate](PProDOT-Boc-Phe) modified electrodes were synthesized via potentiostatic polymerization of chiral ProDOT-Boc-Phe. Chiral PProDOT-Boc-Phe films displayed good reversible redox activities. The enantioselective recognition between chiral PProDOT-Boc-Phe modified glassy carbon electrodes and DOPA enantiomers was achieved by different electrochemical technologies, including cyclic voltammetry(CV), square wave voltammetry(SWV), and differential pulse voltammetry(DPV).(D)-PProDOT-Boc-Phe and(L)-PProDOT-Boc-Phe showed higher peak current responses toward L-DOPA and DDOPA, respectively.

Enzymatic synthesis of nucleosides by nucleoside phosphorylase co-expressed in Escherichia coli

Nucleoside phosphorylase is an important enzyme involved in the biosynthesis of nucleosides. In this study, purine nucleoside phosphorylase and pyrimidine nucleoside phosphorylase were co-expressed in Escherichia coli and the intact cells were used as a catalyst for the biosynthesis of nucleosides. For protein induction, lactose was used in place of isopropyl β-D-l-thiogalactopyranoside （IPTG）. When the concentration of lactose was above 0.5 mmol/L, the ability to induce protein expression was similar to that of IPTG. We determined that the reaction conditions of four bacterial strains co-expressing these genes （TUD, TAD, DUD, and DAD） were similar for the biosyntheses of 2,6-diaminopurine nucleoside and 2,6-diaminopurine deoxynucleoside. When the substrate concentration was 30 mmol/L and 0.5% of the recombinant bacterial cell volume was used as the catalyst （pH 7.5）, a greater than 90% conversion yield was reached after a 2-h incubation at 50℃. In addition, several other nucleosides and nucleoside derivatives were efficiently synthesized using bacterial strains co-expressing these recombinant enzymes.