Development of a new Cox model for predicting long-term survival in hepatitis cirrhosis patients underwent transjugular intrahepatic portosystemic shunts

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)placement is a procedure that can effectively treat complications of portal hypertension,such as variceal bleeding and refractory ascites.However,there have been no specific studies on predicting long-term survival after TIPS placement.AIM To establish a model to predict long-term survival in patients with hepatitis cirrhosis after TIPS.METHODS A retrospective analysis was conducted on a cohort of 224 patients who un-derwent TIPS implantation.Through univariate and multivariate Cox regression analyses,various factors were examined for their ability to predict survival at 6 years after TIPS.Consequently,a composite score was formulated,encompassing the indication,shunt reasonability,portal venous pressure gradient(PPG)after TIPS,percentage decrease in portal venous pressure(PVP),indocyanine green retention rate at 15 min(ICGR15)and total bilirubin(Tbil)level.Furthermore,the performance of the newly developed Cox(NDC)model was evaluated in an in-ternal validation cohort and compared with that of a series of existing models.RESULTS The indication(variceal bleeding or ascites),shunt reasonability(reasonable or unreasonable),ICGR15,post-operative PPG,percentage of PVP decrease and Tbil were found to be independent factors affecting long-term survival after TIPS placement.The NDC model incorporated these parameters and successfully identified patients at high risk,exhibiting a notably elevated mortality rate following the TIPS procedure,as observed in both the training and validation cohorts.Additionally,in terms of predicting the long-term survival rate,the performance of the NDC model was significantly better than that of the other four models[Child-Pugh,model for end-stage liver disease(MELD),MELD-sodium and the Freiburg index of post-TIPS survival].CONCLUSION The NDC model can accurately predict long-term survival after the TIPS procedure in patients with hepatitis cirrhosis,help identify high-risk patients and guide follow-up management after TIPS implantation.

可见光诱导Z型V_(2)O_(5)/g-C_(3)N_(4)异质结催化未活化烯烃串联反应

半导体光催化剂是一种极具前景的绿色催化剂,广泛用于污染物降解、水解制氢和有机合成等领域,有望利用太阳能来解决能源和环境问题,是当前的研究前沿和热点.然而,单组分半导体光催化剂的光生电子和空穴容易复合,导致量子效率差和光催化效率低.近年人们发现,将两种或多种催化材料结合,构建异质结光催化体系可有效促进光生电子-空穴分离.但传统的异质结体系中光生电子的还原性和光生空穴的氧化性通常在电荷转移后变弱,因此,很难同时具备高电荷转移效率和强氧化还原能力.研究发现,构建Z型异质结光催化体系不仅可以减少本体电子-空穴的复合,使其在不同半导体材料上实现空间分离,具有光谱响应宽、电荷分离效率高和稳定性高等优势,而且能保持良好的氧化还原能力.在半导体材料领域,石墨相氮化碳(g-C_(3)N_(4))作为一种无金属聚合物半导体,具有良好的热化学稳定性、电学和光学特性,但存在量子效率低和适用范围窄等局限性.而五氧化二钒(V_(2)O_(5))是一种重要的过渡金属氧化物半导体,由于具有良好的电学和光学性能被广泛用于锂离子电池、气敏传感器和光电器件.V_(2)O_(5)能带间隙(~2.19 e V)窄,具有合适的能量频带边缘(ECB=0.81 e V,EVB=3.0 e V),可以与g-C_(3)N_(4)(ECB=1.14 e V,EVB=1.59 e V)很好地匹配,形成稳定状态的Z型光催化体系,并提高光催化有机合成反应的效率.本文以三聚氰胺和偏钒酸铵为原料,采用热处理法分别制备g-C_(3)N_(4)和V_(2)O_(5),采用水热法制备Z型V_(2)O_(5)/g-C_(3)N_(4)二元复合材料.X射线衍射(XRD)、傅里叶变换红外光谱(FTIR)、扫描电子显微镜(SEM)、X射线光电子能谱(XPS)和紫外-可见光吸收光谱(UV-Vis)等结果表明,成功制备了Z型V_(2)O_(5)/g-C_(3)N_(4).UV-Vis结果表明,V_(2)O_(5)/g-C_(3)N_(4)具有较宽的光吸收范围,从而提高了复合半导体材料的光学性能.在温和条件下,以未活化烯烃修饰的喹唑啉酮和芳基氧膦为反应物,V_(2)O_(5)/g-C_(3)N_(4)为多相光催化剂,进行膦酰化自由基偶联反应,制得一系列环合的膦酰化喹唑啉酮,收率为63%-83%.该反应具有原料易得、条件温和、底物范围广、产品收率及区域选择性良好等优点,同时催化剂循环使用性能良好.值得注意的是,不同吸电子取代基、供电子取代基修饰的喹唑啉酮和非对称结构的芳基氧膦均能兼容于该反应体系,并以中等至良好的收率得到了各种膦酰化喹唑啉酮化合物.本文采用的合成策略同样适用于三氟甲基化、二氟烷基化和芳基磺酰化等自由基串联环化反应,且具有良好的催化性能.机理研究结果表明,V_(2)O_(5)/g-C_(3)N_(4)被光激发后,V_(2)O_(5)导带(CB)上的光生电子与g-C_(3)N_(4)价带(VB)上的光生空穴迅速复合,导致g-C_(3)N_(4)的导带上无法与本体空穴复合的电子发生单电子转移(SET)过程,且与分子氧(空气中)反应生成超氧阴离子自由基(O_(2)·^(-)).V_(2)O_(5)价带上的空穴氧化芳基氧膦产生自由基阳离子,去质子化产生氧膦自由基,随后加成到未活化烯烃生成新的自由基物种,最后发生分子内环化反应,得到目标产物.V_(2)O_(5)/g-C_(3)N_(4)成本较低,且该光催化反应策略可实现克级制备,循环使用5次后催化活性保持不变.综上,本文可为光催化自由基串联环化反应,杂环化合物合成研究和Z型异质结的光催化应用提供参考.

Improving dynamic characteristics for IGBTs by using interleaved trench gate

A novel trench insulated gate bipolar transistor(IGBT) with improved dynamic characteristics is proposed and investigated. The poly gate and poly emitter of the proposed IGBT are arranged alternately along the trench. A self-biased p-MOSFET is formed on the emitter side. Owing to this unique three-dimensional(3D) trench architecture, both the turnoff characteristic and the turn-on characteristic can be greatly improved. At the turn-off moment, the maximum electric field and impact ionization rate of the proposed IGBT decrease and the dynamic avalanche(DA) is suppressed. Comparing with the carrier-stored trench gate bipolar transistor(CSTBT), the turn-off loss(E_(off)) of the proposed IGBT also decreases by 31% at the same ON-state voltage. At the turn-on moment, the built-in p-MOSFET reduces the reverse displacement current(I_(G_dis)), which is conducive to lowing dI_(C)/d_(t). As a result, compared with the CSTBT with the same turn-on loss(E_(on)), at I_(C) = 20 A/cm^(2), the proposed IGBT decreases by 35% of collector surge current(I_(surge)) and 52% of dI_(C)/d_(t).

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.

Short-term efficacy assessment of transarterial chemoembolization combined with radioactive iodine therapy in primary hepatocellular carcinoma

BACKGROUND Transarterial chemoembolization(TACE)is an effective treatment for primary hepatocellular carcinoma(PHC).Radioactive iodine therapy has been used in the treatment of advanced PHC,especially in patients with portal vein tumor thrombosis.However,data on the therapeutic effect of TACE combined with radioactive iodine therapy in PHC are scarce.AIM To investigate the clinical efficacy of TACE combined with radioactive iodine implantation therapy in advanced PHC via perfusion computed tomography(CT).METHODS For this study,98 advanced PHC patients were recruited and divided randomly into the study and control groups.Patients in the study group were treated with TACE combined radioactive iodine implantation therapy.Patients in the control group were treated with only TACE.The tumor lesion length,clinical effect,serum alpha-fetoprotein(AFP)and CT perfusion parameters were compared before and after therapy,and statistical analysis was performed.RESULTS There was no significant difference in tumor length and serum AFP between the study and control groups(P>0.05)before treatment.However,the tumor length and serum AFP in the study group were lower than those in the control group 1 mo and 3 mo after therapy.After 3 mo of treatment,the complete and partial remission rate of the study group was 93.88%,which was significantly higher than the control group(77.55%)(P<0.05).Before treatment,there were no significant differences between the two groups on the perfusion CT variables,including the lesion blood volume,permeability surface,blood flow,hepatic artery flow and mean transit time(P>0.05).After 3 mo of treatment,all perfusion CT variables were lower in the study group compared to the control group(P<0.05).The survival time of patients in the study group was 22 mo compared to 18 mo in the control group,which was significantly different[log rank(Mantel-Cox)=4.318,P=0.038].CONCLUSION TACE combined with radioactive iodine implantation in the treatment of advanced PHC can inhibit the formation of blood vessels in tumor tissue and reduce the perfusion level of tumor lesions,thereby improving the clinical efficacy and prolonging the survival time of patients.

Hepatic venous pressure gradient: Inaccurately estimates portal venous pressure gradient in alcoholic cirrhosis and portal hypertension

BACKGROUND Portal hypertension(PHT)in patients with alcoholic cirrhosis causes a range of clinical symptoms,including gastroesophageal varices and ascites.The hepatic venous pressure gradient(HVPG),which is easier to measure,has replaced the portal venous pressure gradient(PPG)as the gold standard for diagnosing PHT in clinical practice.Therefore,attention should be paid to the correlation between HVPG and PPG.METHODS Between January 2017 and June 2020,134 patients with alcoholic cirrhosis and PHT who met the inclusion criteria underwent various pressure measurements during transjugular intrahepatic portosystemic shunt procedures.Correlations were assessed using Pearson’s correlation coefficient to estimate the correlation coefficient(r)and determination coefficient(R^(2)).Bland-Altman plots were constructed to further analyze the agreement between the measurements.Disagreements were analyzed using paired t tests,and P values<0.05 were considered statistically significant.RESULTS In this study,the correlation coefficient(r)and determination coefficient(R2)between HVPG and PPG were 0.201 and 0.040,respectively(P=0.020).In the 108 patients with no collateral branch,the average wedged hepatic venous pressure was lower than the average portal venous pressure(30.65±8.17 vs.33.25±6.60 mmHg,P=0.002).Hepatic collaterals were identified in 26 cases with balloon occlusion hepatic venography(19.4%),while the average PPG was significantly higher than the average HVPG(25.94±7.42 mmHg vs 9.86±7.44 mmHg;P<0.001).The differences between HVPG and PPG<5 mmHg in the collateral vs no collateral branch groups were three cases(11.54%)and 44 cases(40.74%),respectively.CONCLUSION In most patients,HVPG cannot accurately represent PPG.The formation of hepatic collaterals is a vital reason for the strong underestimation of HVPG.

Stents combined with iodine-125 implantation to treat main portal vein tumor thrombus

AIM To evaluate the efficacy of main portal vein stents combined with iodine-125(^(125)Ⅰ) to treat main portal vein tumor thrombus.METHODS From January 1, 2010 to January 1, 2015, 111 patients were diagnosed with liver cancer combined with main portal vein tumor thrombus. They were non-randomly assigned to undergo treatment with transarterial chemoembolization(TACE)/transarterial embolization(TAE) + portal vein stents combined with ^(125)Ⅰ implantation(Group A) and TACE/TAE + portal vein stents only(Group B). After the operation, scheduled follow-up was performed at 6, 12 and 24 mo. The recorded information included clinical manifestations, survival rate, and stent restenosis rate. Kaplan–Meier curves, log-rank test and Cox regression were used for data analyses. RESULTS From January 1, 2010 to January 1, 2015, 54 and 57 patients were allocated to Groups A and B, respectively. The survival rates at 6, 12 and 24 mo were 85.2%, 42.6% and 22.2% in Group A and 50.9%, 10.5% and 0% in Group B. The differences were significant [log rank P < 0.05, hazard ratio(HR): 0.37, 95%CI: 0.24-0.56]. The rates of stent restenosis were 18.5%, 55.6% and 83.3% in Group A and 43.9%, 82.5% and 96.5% in Group B. The differences were significant(log rank P < 0.05, HR: 0.42, 95%CI: 0.27-0.63). Cox regression identified that treatment was the only factor affecting survival rate in this study.CONCLUSION Main portal vein stents combined with ^(125)Ⅰ can significantly improve survival rate and reduce the rate of stent restenosis.

Iodine-125 implantation with transjugular intrahepatic portosystemic shunt for main portal vein tumor thrombus

BACKGROUND Main portal vein tumor thrombus(MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma(HCC).Therefore, attention should be paid to the treatment of MPVTT and its complications.AIM To evaluate the efficacy of transarterial chemoembolization/transarterial embolization(TACE/TAE)+^(125)I seeds implantation with transjugular intrahepatic portosystemic shunt(TIPS) in treating MPVTT and its complications.METHODS From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and ^(125)I implantation(TIPS-^(125)I group) or TACE/TAE + TIPS only(TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-^(125)I.RESULTS During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-^(125)I group,whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively(P < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%,respectively, in the TIPS-^(125)I group, whereas those in the TIPS only group were31.1%, 62.2%, and 82.2%(P < 0.05). The rates of stent restenosis were 12.5%,27.5%, and 42.5%, respectively, in the TIPS-^(125)I group, and 42.2%, 68.9%, and84.4%, respectively, in the TIPS only group(P < 0.05). TIPS-^(125)I was found to be significantly favorable in treating MPVTT and its complications in patients with HCC.CONCLUSION TACE/TAE+^(125)I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality.

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.

Comparative study of indocyanine green-R15,Child-Pugh score,and model for end-stage liver disease score for prediction of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

BACKGROUND Hepatic encephalopathy(HE)remains an enormous challenge in patients who undergo transjugular intrahepatic portosystemic shunt(TIPS)implantation.The preoperative indocyanine green retention rate at 15 min(ICG-R15),as one of the liver function assessment tools,has been developed as a prognostic indicator in patients undergoing surgery,but there are limited data on its role in TIPS.AIM To determine whether the ICG-R15 can be used for prediction of post-TIPS HE in decompensated cirrhosis patients with portal hypertension(PHT)and compare the clinical value of ICG-R15,Child-Pugh score(CPS),and model for end-stage liver disease(MELD)score in predicting post-TIPS HE with PHT.METHODS This retrospective study included 195 patients with PHT who underwent elective TIPS at Beijing Shijitan Hospital from January 2018 to June 2019.All patients underwent the ICG-R15 test,CPS evaluation,and MELD scoring 1 wk before TIPS.According to whether they developed HE or not,the patients were divided into two groups:HE group and non-HE group.The prediction of one-year post-TIPS HE by ICG-R15,CPS and MELD score was evaluated by the areas under the receiver operating characteristic curves(AUCs).RESULTS A total of 195 patients with portal hypertension were included and 23%(45/195)of the patients developed post-TIPS HE.The ICG-R15 was identified as an independent predictor of post-TIPS HE.The AUCs for the ICG-R15,CPS,and MELD score for predicting post-TIPS HE were 0.664(95%confidence interval[CI]:0.557-0.743,P=0.0046),0.596(95%CI:0.508-0.679,P=0.087),and 0.641(95%CI:0.554-0.721,P=0.021),respectively.The non-parametric approach(Delong-Delong&Clarke-Pearson)showed that there was statistical significance in pairwise comparison between AUCs of ICG-R15 and MELD score(P=0.0229).CONCLUSION The ICG-R15 has appreciated clinical value for predicting the occurrence of post-TIPS HE and is a choice for evaluating the prognosis of patients undergoing TIPS.

Neat1 decreases neuronal apoptosis after oxygen and glucose deprivation

Studies have shown that downregulation of nuclear-enriched autosomal transcript 1(Neat1)may adversely affect the recovery of nerve function and the increased loss of hippocampal neurons in mice.Whether Neat1 has protective or inhibitory effects on neuronal cell apoptosis after secondary brain injury remains unclear.Therefore,the effects of Neat1 on neuronal apoptosis were observed.C57 BL/6 primary neurons were obtained from the cortices of newborn mice and cultured in vitro,and an oxygen and glucose deprivation cell model was established to simulate the secondary brain injury that occurs after traumatic brain injury in vitro.The level of Neat1 expression in neuronal cells was regulated by constructing a recombinant adenovirus to infect neurons,and the effects of Neat1 expression on neuronal apoptosis after oxygen and glucose deprivation were observed.The experiment was divided into four groups:the control group,without any treatment,received normal culture;the oxygen and glucose deprivation group were subjected to the oxygen and glucose deprivation model protocol;the Neat1 overexpression and Neat1 downregulation groups were treated with Neat1 expression intervention techniques and were subjected to the in oxygen and glucose deprivation protocol.The protein expression levels of neurons p53-induced death domain protein 1(PIDD1,a pro-apoptotic protein),caspase-2(an apoptotic priming protein),cytochrome C(a pro-apoptotic protein),and cleaved caspase-3(an apoptotic executive protein)were measured in each group using the western blot assay.To observe changes in the intracellular distribution of cytochrome C,the expression levels of cytochrome C in the cytoplasm and mitochondria of neurons from each group were detected by western blot assay.Differences in the cell viability and apoptosis rate between groups were detected by cell-counting kit 8 assay and terminal deoxynucleotidyl transferase dUTP nick-end labeling assay,respectively.The results showed that the apoptosis rate,PIDD1,caspase-2,and cleaved caspase-3 expression levels significantly decreased,and cell viability significantly improved in the Neat1 overexpression group compared with the oxygen and glucose deprivation group;however,Neat1 downregulation reversed these changes.Compared with the Neat1 downregulation group,the cytosolic cytochrome C level in the Neat1 overexpression group significantly decreased,and the mitochondrial cytochrome C level significantly increased.These data indicate that Neat1 upregulation can reduce the release of cytochrome C from the mitochondria to the cytoplasm by inhibiting the PIDD1-caspase-2 pathway,reducing the activation of caspase-3,and preventing neuronal apoptosis after oxygen and glucose deprivation,which might reduce secondary brain injury after traumatic brain injury.All experiments were approved by the Animal Ethics Committee of the First Affiliated Hospital of Chongqing Medical University,China,on December 19,2020(approval No.2020-895).

Medical student depression and its correlates across three international medical schools

BACKGROUND Medical students have high rates of depression, anxiety, and burnout that have been found to affect their empathy, professional behaviors, and performance as a physician. While studies have examined predictors for burnout and depression in the United States (US), no study, to our knowledge, has compared depression in medical students cross-culturally, or has attempted to examine the effect of factors influencing rates including burnout, exercise, stress, unmet mental health needs, and region. AIM To examine rates of depression in three international cohorts of medical students, and determine variables that may explain these differences. METHODS Convenience samples of medical students from three countries (US, China, and a Middle Eastern country whose name remains anonymous per request from the school) were surveyed in this observational study. Using the Patient Health Questionnaire-2 (PHQ-2) and a modified Maslach Burnout Inventory, depression and burnout were examined among medical students from the three cohorts (n = 473). Chi-square test and analysis of variance were used to examine differences in demographics, behavioral, and psychological variables across these three schools to identify potentially confounding descriptive characteristics. Analysis of covariance compared depression and the emotional exhaustion component of burnout identified through Principal Component Analysis across countries. Multiple linear regression was used to analyze the impact of demographic, behavioral, and psychological variables on screening positive for depression. RESULTS Medical students from the Middle Eastern country had the highest rates of positive depression screens (41.1%), defined as a PHQ-2 score of ≥ 3, followed by China (14.1 %), and then the US (3.8%). More students in the Middle Eastern school had unmet mental health needs (50.8%) than at the medical school in China (34.8%) or the school in the US (32.8%)(Pearson chi-square significance < 0.05). Thus, PHQ-2 scores were adjusted for unmet mental health needs;however, the Middle Eastern country continued to have the highest depression. Adjusting for PHQ-2 score, medical students from the US scored the highest on emotional exhaustion (a measure of burnout). Demographic variables did not significantly predict medical student depression;however, lack of exercise, unmet mental health needs, stress, and emotional exhaustion predicted nearly half of depression in these cohorts. In comparison to the US, coming from the Middle Eastern country and China predicted higher levels of depression. CONCLUSION Depression rates differ in three international cohorts of medical students. Measured factors contributed to some observed differences. Identifying sitespecific prevention and intervention strategies in medical student mental health is warranted.

Correlation of pressure gradient in three hepatic veins with portal pressure gradient

BACKGROUND The liver is one of the most important organs in the human body,with functions such as detoxification,digestion,and blood coagulation.In terms of vascular anatomy,the liver is divided into the left and the right liver by the main portal vein,and there are three hepatic efferent veins(right,middle,and left)and two portal branches.Patients with impaired liver function have increased intrahepatic vascular resistance and splanchnic vasodilation,which may lead to an increase in the portal pressure gradient(PPG)and cause portal hypertension(PHT).In order to measure the increased pressure gradient of portal vein,the hepatic venous pressure gradient(HVPG)can be measured to reflect it in clinical practice.The accuracy of PPG measurements is directly related to patient prognosis.AIM To analyze the correlation between HVPG of three hepatic veins and PPG in patients with PHT.METHODS From January 2017 to December 2019,102 patients with PHT who met the inclusion criteria were evaluated during the transjugular intrahepatic portosystemic shunt procedure and analyzed.RESULTS The mean HVPG of the middle hepatic vein was 17.47±10.25 mmHg,and the mean HVPG of the right and left hepatic veins was 16.34±7.60 and 16.52±8.15 mmHg,respectively.The average PPG was 26.03±9.24 mmHg.The correlation coefficient and coefficient of determination of the right hepatic vein,middle hepatic vein,and left hepatic vein were 0.15 and 0.02(P=0.164);0.25 and 0.05(P=0.013);and 0.14 and 0.02(P=0.013),respectively.The mean wedged hepatic vein/venous pressure(WHVP)of the middle and left hepatic veins was similar at 29.71±12.48 and 29.1±10.91 mmHg,respectively,and the mean WHVP of the right hepatic vein was slightly lower at 28.01±8.95 mmHg.The mean portal vein pressure was 34.11±8.56 mmHg.The correlation coefficient and coefficient of determination of the right hepatic vein,middle hepatic vein,and left hepatic vein were 0.26 and 0.07(P=0.009);0.38 and 0.15(P<0.001);and 0.26 and 0.07(P=0.008),respectively.The average free hepatic venous pressure(FHVP)of the right hepatic vein was lowest at 11.67±5.34 mmHg,and the average FHVP of the middle and left hepatic veins was slightly higher at 12.19±4.88 and 11.67±5.34 mmHg,respectively.The average inferior vena cava pressure was 8.27±4.04 mmHg.The correlation coefficient and coefficient of determination of the right hepatic vein,middle hepatic vein,and left hepatic vein were 0.30 and 0.09(P=0.002);0.18 and 0.03(P=0.078);and 0.16 and 0.03(P=0.111),respectively.CONCLUSION Measurement of the middle hepatic vein HVPG could better represent PPG.Considering the high success rate of clinical measurement of the right hepatic vein,it can be the second choice.

Deep original information preservation by applying in-situ film formation technology during coring

Accurately obtaining the original information of an in-situ rock via coring is a significant guiding step for exploring and developing deep oil and gas resources.It is difficult for traditional coring technology and equipment to preserve the original information in deep rocks.This study develops a technology for insitu substance-preserved(ISP),moisture-preserved(IMP),and light-preserved(ILP)coring.This technology stores the original information in real time by forming a solid sealing film on the in-situ sample during coring.This study designed the ISP-IMP-ILP-Coring process and tool.In addition,an ISP-IMP-ILPCoring process simulation system was developed.The effects of temperature,pressure,and film thickness on the quality of the in-situ film were investigated by performing in-situ film-forming simulation experiments.A solid sealing film with a thickness of 2-3 mm can be formed;it completely covers the core sample and has uniform thickness.The film maintains good ISP-IMP-ILP properties and can protect the core sample in the in-situ environment steadily.This study verifies the feasibility of“film formation during coring”technology and provides strong support for the engineering application of ISP-IMP-ILPCoring technology.

GCP载钯颗粒复合材料的制备及其电化学合成氨性能研究

使用疏水性石墨烯复合粉末(GCP)为碳载体,通过硼氢化钠还原制备GCP载钯颗粒催化剂(PdNPs@GCP)进行氮还原反应(NRR)研究,在-0.2 V vs.RHE电位下,氨气产率为5.2μg·h^(-1)·mg^(-1),合成氨法拉第效率在-0.1 V vs.RHE电位下高达9.77%。通过与纯钯相和GCP对比研究发现,催化剂NRR活性主要得益于钯颗粒与GCP的构效关系。GCP二维结构提高了电子传输效率,并提供较大的比表面积,促进NRR动力学,同时GCP的疏水表面可以一定程度地抑制析氢反应(HER)。另外,GCP表面钯颗粒有利于氮气吸附活化,为NRR提供了丰富的活性位点,而且催化剂的金属-载体作用力微调钯颗粒电子结构,优化中间产物的吸脱附,加速NRR。

Hepatic amyloidosis leading to hepatic venular occlusive disease and Budd-Chiari syndrome: A case report

BACKGROUND Systemic amyloidosis in which multiple systems can be involved has become a common clinical disease.When the liver is affected,symptoms such as abdominal distension,fatigue,edema,liver,and jaundice could appear.To date,hepatic amyloidosis combined with hepatic venular occlusive disease and Budd-Chiari syndrome has not been reported.CASE SUMMARY A 54-year-old female patient was admitted to the Beijing Shijitan Hospital with hepatic amyloidosis leading to hepatic venular occlusion and Budd-Chiari syndrome in 2018.The patient underwent surgery 1 mo previously for liver rupture and hemorrhage after Budd-Chiari syndrome was diagnosed.She was diagnosed with hepatic venular occlusion,liver amyloidosis,and Budd-Chiari syndrome(i.e.extensive hepatic vein occlusion).Transjugular intrahepatic portosystem shunt was performed.After the treatment,the clinical symptoms improved markedly with increase in urine volume.CONCLUSION Hepatic amyloidosis with hepatic venous occlusion and Budd-Chiari syndrome is relatively rare clinically,and transjugular intrahepatic portosystem shunt is an effective treatment for this disease.

Accurate ultrasonography-based portal pressure assessment in patients with hepatocellular carcinoma

BACKGROUND Portal pressure is of great significance in the treatment of hepatocellular carcinoma(HCC),but direct measurement is complicated and costly;thus,noninvasive measurement methods are urgently needed.AIM To investigate whether ultrasonography(US)-based portal pressure assessment could replace invasive transjugular measurement.METHODS A cohort of 102 patients with HCC was selected(mean age:54±13 years,male/female:65/37).Pre-operative US parameters were assessed by two independent investigators,and multivariate logistic analysis and linear regression analysis were conducted to develop a predictive formula for the portal pressure gradient(PPG).The estimated PPG predictors were compared with the transjugular PPG measurements.Validation was conducted on another cohort of 20 non-surgical patients.RESULTS The mean PPG was 17.32±1.97 mmHg.Univariate analysis identified the association of the following four parameters with PPG:Spleen volume,portal vein diameter,portal vein velocity(PVV),and portal blood flow(PBF).Multiple linear regression analysis was performed,and the predictive formula using the PVV and PBF was as follows:PPG score=19.336-0.312×PVV(cm/s)+0.001×PBF(mL/min).The PPG score was confirmed to have good accuracy with an area under the curve(AUC)of 0.75(0.68-0.81)in training patients.The formula was also accurate in the validation patients with an AUC of 0.820(0.53-0.83).CONCLUSION The formula based on ultrasonographic Doppler flow parameters shows a significant correlation with invasive PPG and,if further confirmed by prospective validation,may replace the invasive transjugular assessment.

Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension

BACKGROUND Patients with hepatocellular carcinoma complicated with main portal vein tumor thrombosis(mPVTT) and cirrhotic portal hypertension(CPH) have an extremely poor prognosis, and there is a lack of a clinically effective treatment paradigm.AIM To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS)combined with radioactive seed strand for the treatment of mPVTT patients with CPH.METHODS The clinical data of 83 consecutive patients who underwent TIPS combined with 125I seed strand placement for mPVTT and CPH from January 2015 to December 2018 were retrospectively reviewed. Procedure-related data(success rate, relief of portal vein pressure and CPH symptoms,and adverse events), PVTT response, and patient survival were assessed through a 2-year followup.RESULTS The success rate was 100.0% without perioperative death or procedure-related severe adverse events. The mean portal vein pressure was significantly decreased after the procedure(22.25 ± 7.33mmHg vs 35.12 ± 7.94 mmHg, t = 20.61, P < 0.001). The symptoms of CPH were all effectively relieved within 1 mo. The objective response rate of PVTT was 67.5%. During a mean follow-up of 14.5 ± 9.4 mo(range 1-37 mo), the cumulative survival rates at 6, 12 and 24 mo were 83.1%, 49.7%,and 21.8%, respectively. The median survival time was 12.0 ± 1.3 mo(95% confidence interval: 9.5-14.5). In multivariate Cox regression analysis, body mass index, Child-Pugh grade, cTNM stage,and PVTT response were independent prognostic factors(P < 0.05).CONCLUSION TIPS combined with radioactive seed strand might be effective and safe in treating mPVTT patients with CPH.

Effects of sleep status on renal function in patients with chronic kidney disease: a systematic review

Objective:To systematically evaluate the effects of sleep status on renal function in patients with chronic kidney disease (CKD).Methods: To search the relevant literature related to the effects of sleep status on renal function of CKD patients on PubMed database, EMBase database, the Cochrane Library database, CNKI database, Chinese Biomedical Literature Database, VIP and Wanfang database from the initial to June 2018, all literature that met the criteria were included. According to the type of studies, the quality of the literature was evaluated by NOS scale in the cohort study and AHRQ scale in the cross-sectional study, and systematically evaluated the outcome indicators, the main outcome indicators were estimated glomerular filtration rate (eGFR) and endogenous creatinine clearance rate (Ccr), while the secondary indicators were Pittsburgh Sleep Quality Index (PSQI), Sleep Quality (SQ), Serum Creatinine (Scr), Hemoglobin (Hb), Albumin (ALB) and Urine Protein/Creatinine Ratio (UPCR).Results: Four literature and one meeting abstract were included in this study, of which four were cohort studies, three of them the NOS quality evaluations were high, one of them was medium, the remaining one was cross-sectional study, and the AHRQ quality evaluation was medium. This study shows that sleep status has a certain correlation with renal function. Shorter sleep time or poor sleep quality can lead to deterioration of renal function. Among them, the research data of Sabbatinit research team in Italy showed that Ccr gradually decreased with the increased of the PSQI;studies of Cohen research team and the Ricardo research team in the United States showed that eGFR decreased with the increased of the PSQI;the study of Kumar research team in the United States showed that the lower SQ , the worse renal function;the study of Knutson' research team in British showed that the shorter sleep time, the lower eGFR. In addition, studies showed that sleep index also has influence on Hb, ALB, Scr, UPCR and other indicators.Conclusion: Sleep status can affect the renal function of CKD patients in different degrees. Shorter sleep time and poor sleep quality will damage renal function and accelerate the progress of CKD.

World Federation of Acupuncture-Moxibustion Societies(WFAS)Technical Benchmark of Acupuncture and Moxibustion;Electroacupuncture

World Federation of Acupuncture-Moxibustion Societies(WFAS)Technical Benchmark of Acupuncture and Moxibustion:Electroacupuncture,developed under the leadership of Shanghai University of Traditional Chinese Medicine,was approved by WFAS.This technical benchmark was issued on October 9,2023,and implemented on December 31,2023.The main contents include the scope,normative references,terms and definitions,acupuncture and moxibustion procedures and rules,and safety.This article focuses on the above contents.An outlook on the application,popularization,and update plan of this technical benchmark is proposed.