Analysis of three-dimensional visualization imaging of severe portal vein stenosis after liver transplantation and clinical efficacy of portal vein stent implantation / 器官移植

Objective To analyze three-dimensional imaging characteristics and advantages for severe portal vein stenosis after liver transplantation, and to evaluate clinical efficacy of portal vein stent implantation. Methods Clinical data of 10 patients who received portal vein stent implantation for severe portal vein stenosis after liver transplantation were retrospectively analyzed. Imaging characteristics of severe portal vein stenosis, and advantages of three-dimensional reconstruction imaging and interventional treatment efficacy for severe portal vein stenosis were analyzed. Results Among 10 patients, 3 cases were diagnosed with centripetal stenosis, tortuosity angulation-induced stenosis in 2 cases, compression-induced stenosis in 2 cases, long-segment stenosis and/or vascular occlusion in 3 cases. Three-dimensional reconstruction images possessed advantages in accurate identification of stenosis, identification of stenosis types and measurement of stenosis length. All patients were successfully implanted with portal vein stents. After stent implantation, the diameter of the minimum diameter of portal vein was increased [(6.2±0.9) mm vs. (2.6±1.7) mm, P<0.05], the flow velocity at anastomotic site was decreased [(57±19) cm/s vs. (128±27) cm/s, P<0.05], and the flow velocity at the portal vein adjacent to the liver was increased [(41±6) cm/s vs. (18±6) cm/s, P<0.05]. One patient suffered from intrahepatic hematoma caused by interventional puncture, which was mitigated after conservative observation and treatment. The remaining patients did not experience relevant complications. Conclusions Three-dimensional visualization technique may visually display the location, characteristics and severity of stenosis, which is beneficial for clinicians to make treatment decisions and assist interventional procedures. Timely implantation of portal vein stent may effectively reverse pathological process and improve portal vein blood flow.

Research progress in liver transplantation in patients with situs inversus totalis / 器官移植

Situs inversus totalis (SIT) is a rare congenital condition, with an extremely low incidence. There is no difference between SIT individuals without onset of diseases and healthy counterparts. However, when SIT individuals suffer from diseases, the diagnosis and treatment are highly challenging due to insufficient understanding of SIT populations, especially for those complicated with end-stage liver disease and requiring liver transplantation. It is a huge challenge for surgeons whether SIT individuals serve as donors or recipients of liver transplantation. In this article, recent case reports related to liver transplantation in SIT patients were summarized, and the development, key procedures, clinical prognosis and postoperative complications of liver transplantation in SIT patients were reviewed.

Microbubbles carrying resiquimod enhance HIFU ablation and co-stimulate tumor immune response / 中华超声影像学杂志

Objective:To prepare the resiquimod-loaded lipid microbubbles R848-MBs, evaluate their enhanced ultrasound imaging and high intensity focused ultrasound (HIFU) ablation effects, and explore their ability to improve tumor immune microenvironment synergize with HIFU.Methods:R848-MBs were prepared by the thin film hydration-mechanical shock method; The basic characteristics and safety of R848-MBs were detected, the HIFU controlled-release characteristics were verified in vitro and the drug metabolism and biological distribution were investigated in vivo. The ability of enhancing ultrasound imaging was observed in vitro and in vivo. To investigate the enhanced HIFU ablation effect of R848-MBs, six EMT6 tumor-bearing mice were randomly divided into HIFU group and R848-MBs+ HIFU group, three mice in each group, the changes in contrast average sound intensity before and after ablation in mouse tumor areas and the change of ultrasound image gray value in tumor area were evaluated, the tumor were resected to observe the coagulative necresis by TTC staining and HE staining. Forty-five tumor-bearing mice were randomly divided into control group, Free R848 group, HIFU group, Blank-MBs+ HIFU group and R848-MBs+ HIFU group, nine mice in each group. On the third day after treatment, 3 mice in each group were randomly selected and killed, to evaluate the ability of R848-MBs to improve tumor immune microenvironment synergize with HIFU. The expression level of CRT on the surface of tumor cells were detected by immunofluorescence staining, the proportion of mature DC in lymph nodes, spleen, and CD8 + T cells in spleen were detected by flow cytometry. The treatment effectiveness of each group( n=6) were evaluated by measuring tumor volume, observing and drawing survival curves. Results:The R848-MBs lipid microbubbles with good safety were successfully prepared, with a concentration of 2.58×10 9/ml, as spherical bubbles under optical microscope and laser confocal microscopy, in a particle size of (1.72±0.11)μm, at a surface potential of (-10.16±0.73)mV. The cumulative drug release was up to 83.44% after HIFU (90 W, 3 s) in vitro. The concentration of R848 in plasma decreased rapidly, and the drug concentration in tumor tissue of the R848-MBs+ HIFU group was higher than that of the R848 group 24 hours after treatment ( P<0.01). The ultrasound imaging of R848-MBs was significantly enhanced in contrast mode in vitro and in vivo; R848-MBs can significantly enhance the HIFU ablation effect, the contrast average sound intensity change in the tumor area before and after ablation in the R848MBs+ HIFU group was greater than that in the R848 group ( P<0.05), and the immediate ultrasound grayscale value change in the HIFU+ R848-MBs group was 46.34±3.21, which was significantly greater than that in the HIFU group (10.67±1.53), with statistical significance ( P<0.000 1). Coagulation necrosis was observed in tumor HE staining and TTC staining. The results of treatment efficacy in vivo showed that R848-MBs+ HIFU group had the strongest therapeutic effect, and R848-MBs combined with HIFU treatment could significantly prolong the survival period of mice compared with intravenous injection of free R848 ( P<0.01). Immunofluorescence staining and flow cytometry results showed an increase in the expression level of CRT on the surface of tumor tissue in the R848-MBs combined with HIFU group, and the percentage of mature DC in tumor draining lymph nodes (58.53±1.04)% were significantly higher than those in the HIFU group (37.56±2.13)% ( P<0.001), and the percentage of mature DC in the spleen (70.65±1.91)% were significantly higher than those in the HIFU group (36.46±3.89)% ( P<0.001), the percentage of CD8 + T cells in the spleen (27.46±3.04)% was significantly higher than that in the HIFU group (18.69±0.29)% ( P<0.01). Conclusions:The HIFU controlled-release lipid microbubbles R848-MBs can not only enhance the efficiency of HIFU ablation, but also improve the tumor immune microenvironment.

Correlation analysis of serum TTR, RBP4 expressions and gestational metabolic syndrome / 中华内分泌外科杂志

Objective:To investigate the relationship between the expressions of serum trans thyroxine protein (TTR) , retinol binding protein 4 (RBP4) and metabolic syndrome of pregnancy (GMS) .Methods:A total of 103 patients with GMS from May. 2017 to Dec. 2019 were selected as the observation group, in addition, 100 healthy pregnant women with single pregnancy and no complications were selected as control group. Before pregnancy, the height and weight were detected. After the diagnosis of GMS, serum markers and blood pressure were detected. The levels of total cholesterol (TC) , triglyceride (TG) , low density lipoprotein cholesterol (LDL-C) , high density lipoprotein cholesterol (HDL-C) and fasting blood glucose (FBG) were detected by Hitachi 7600 automatic biochemical analyzer, and the expression levels of TTR and RBP4 in serum were detected by enzyme-linked immunosorbent assay (ELISA) . Receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic value of TTR and RBP4 in GMS. Multivariate Logistic regression model was used to analyze the influencing factors of GMS in pregnant women.Results:There was no significant difference in age or gestational weeks between the two groups ( P>0.05) . Compared with those in the control group, the levels of BMI, TC, TG, LDL-C, FBG, systolic blood pressure, diastolic blood pressure, serum TTR and RBP4 expression levels were higher in the observation group before pregnancy ( P<0.05) , while HDL-C was lower ( P<0.05) . The area under the curve (AUC) of TTR and RBP4 alone or combination in the diagnosis of GMS was 0.797, 0.816 and 0.898, respectively. The cut-off value of TTR was 284.91 mg/L, and the sensitivity and specificity were 63.10% and 89.00%, respectively. The cut-off value of RBP4 was 17.89 mg/L, and the sensitivity and specificity were 69.90% and 87.00%, respectively. The sensitivity and specificity of the combined diagnosis were 83.50% and 84.00% respectively. Multivariate Logistic regression analysis showed that high level of TTR and high level of RBP4 were independent risk factors of GMS in pregnant women ( P<0.05) . Conclusions:The expression levels of serum TTR and RBP4 in GMS patients are high, and they have certain diagnostic value for GMS. They are independent risk factors of GMS in pregnant women, which may provide new ideas for the early diagnosis and prevention of GMS.

Portal vein aneurysm after liver transplantation: report of two cases and literature review / 器官移植

Objective To summarize the diagnosis and treatment experience of portal vein aneurysm after liver transplantation. Methods Clinical data of two recipients with portal vein aneurysm after liver transplantation were retrospectively analyzed. Clinical features, diagnosis, treatment and prognosis were summarized based on literature review. Results Both two cases were diagnosed with intrahepatic portal vein aneurysm complicated with portal vein thrombosis and portal hypertension after liver transplantation. Case 1 was given with targeted conservative treatment and he refused to undergo liver retransplantation. Physical condition was worsened after discharge, and the patient eventually died from liver graft failure, kidney failure, lung infection, and septic shock. Case 2 received high-dose glucocorticoid pulse therapy, whereas liver function was not improved, and the patient was recovered successfully after secondary liver transplantation. Conclusions Long-term complication of portal vein aneurysm (especially intrahepatic type) after liver transplantation probably indicates poor prognosis. Correct understanding, intimate follow-up and active treatment should be conducted. Liver retransplantation may be a potential treatment regimen.

Efficacy and safety of sacubitril/valsartan after six months in patients with heart failure with reduced ejection fraction and asymptomatic hypotension / 老年心脏病学杂志（英文版）

BACKGROUND@#It is not clear whether sacubitril/valsartan is beneficial for patients with heart failure (HF) with reduced ejection fraction (HFrEF) and low systolic blood pressure (SBP). This study aimed to investigate the efficacy and tolerability of sacubitril/valsartan in HFrEF patients with SBP < 100 mmHg.@*METHODS & RESULTS@#An observational study was conducted on 117 patients, 40.2% of whom had SBP < 100 mmHg without symptomatic hypotension, and 59.8% of whom had SBP ≥ 100 mmHg in an optimized HF follow-up management system. At the 6-month follow-up, 52.4% of patients with SBP < 100 mmHg and 70.0% of those with SBP ≥ 100 mmHg successfully reached the target dosages of sacubitril/valsartan. A reduction in the concentration of N-terminal pro-B-type natriuretic peptide was similar between patients with SBP < 100 mmHg and SBP ≥ 100 mmHg (1627.5 pg/mL and 1340.1 pg/mL, respectively; P = 0.75). The effect of sacubitril/valsartan on left ventricular ejection fraction was observed in both SBP categories, with a 10.8% increase in patients with SBP < 100 mmHg (P < 0.001) and a 14.0% increase in patients with SBP ≥ 100 mmHg (P < 0.001). The effects of sacubitril/valsartan on SBP were statistically significant and inverse across both SBP categories (P = 0.001), with an increase of 7.5 mmHg in patients with SBP < 100 mmHg and a decrease of 11.5 mmHg in patients with SBP ≥ 100 mmHg. No statistically significant differences were observed between the two groups in terms of the occurrence of symptomatic hypotension, deteriorating renal function, hyperkalemia, angioedema, or stroke.@*CONCLUSIONS@#Within an optimized HF follow-up management system, sacubitril/valsartan exhibited excellent tolerability and prompted left ventricular reverse remodeling in patients with HFrEF who presented asymptomatic hypotension.

Omalizumab Treats Aspirin-Induced Asthma Complicated With Nasosinusitis and Otitis Media:Report of One Case / 中国医学科学院学报

Omalizumab,as a biological agent targeting IgE,is a recombinant humanized monoclonal antibody and the first targeted drug approved for treating moderate-to-severe bronchial asthma.By reviewing one case of aspirin-induced asthma complicated with nasosinusitis and otitis media,we discussed the value of omalizumab in the treatment of asthma and its complications,aiming to provide a reference for clinical practice.

Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession: a Meta-analysis / 华西口腔医学杂志

OBJECTIVES@#This study aimed to evaluate the efficacy and long-term stability of tunnel technique (TUN) and coronally advanced flap (CAF) combined with connective tissue graft (CTG) in treating gingival recession.@*METHODS@#Databases including PubMed, Web of Science, Embase, and CNKI were electronically searched to collect randomized controlled trial (RCT) of CAF+CTG compared to TUN+CTG in the treatment of Miller class Ⅰ or Ⅱ gingival recession on September 1, 2022.@*RESULTS@#There were 8 RCTs with 305 patients (454 recession sites) participating. The results of the Meta-analysis revealed that, in terms of mean root coverage (MRC) of main indicators, no significant difference was found between the CAF group and the TUN group in both short- and long-term results, which were [MD: 1.45%, 95%CI (-2.93%, 5.82%), P=0.52] and [MD: -0.70%, 95%CI (-6.41%, 5.00%), P=0.81]. However, the CAF group outperformed the TUN group in the long term [MD: 5.69%, 95%CI (0.87%, 10.50%), P=0.02], and the results of complete root coverage (CRC) analysis were similar to those of MRC. In the short term, the TUN group grew keratinized gingiva significantly faster than the CAF group [MD: -0.38 mm, 95%CI (-0.67 mm, -0.10 mm), P=0.008]. Long-term findings revealed no significant difference between the two groups [MD: -0.26 mm, 95%CI (-0.94 mm, 0.43 mm), P=0.46]. The TUN group's secondary index root coverage esthetic score (RES) was statistically significantly higher than the CAF group's [MD: 0.62, 95%CI (0.28, 0.96), P=0.000 3]. Given that there were few results included in the literature and the heterogeneity was too great, no significant difference was observed in the postoperative VAS pain index score [MD: 0.53, 95%CI (-1.96, 3.03), P=0.68].@*CONCLUSIONS@#This study discovered that both CAF+CTG and TUN+CTG can achieve good root coverage in treating gingival recession, with CAF outperforming TUN and both groups achie-ving good long-term stability. After the operation, the TUN group had a higher RES than the CAF group. Given the limitations of this study, more high-quality studies are needed in the future to demonstrate the efficacy of TUN in gingival retraction surgery.

Value of red blood cell distribution width in predicting early poor neurologic improvement after intravenous thrombolysis in patients with ischemic stroke / 中国临床药理学与治疗学

AIM: To explore the predictive value of red blood cell distribution width (RDW) in early poor neurologic improvement after intravenous thrombolysis in acute ischemic stroke (AIS). METHODS: A total of 102 patients with acute ischemic stroke who received intravenous thromblysis with alteplase within 4.5 hours of onset were analyzed retrospectively. RDW level was measured before thrombolysis. According to the percentage change in NIHSS at 24 hours, the patients were divided into two groups: good neurological improvement (≥ 30%) group (n=53) and poor neurological improvement (<30%) group (n=49). The univariate and multivariate Logistic regression analysis were used to investigate whether RDW level is an independent factor affecting patients' neurological improvement. The receiver operating characteristic (ROC) curve was used to analyze the cut-off value of RDW to predict poor early neurological improvement after thrombolysis. RESULTS: Compared with the good neurological improvement group, higher proportion of atrial fibrillation (24.5% vs. 9.4%, P= 0.042), diabetes mellitus (57.1% vs. 30.2%, P= 0.006), hemorrhagic transformation (10.2% vs. 0%, P=0.023) in the poor neurological improvement group. The level of RDW in poor neurological improvement group was significantly higher than that in good neurological improved group(14.09±0.77) vs. (13.31±0.63), P=0.000. Logistic regression analysis showed that elevated RDW (OR=4.614, 95%CI: 2.263-9.408, P=0.000) and history of diabetes mellitus (OR=2.606, 95%CI: 1.034-6.573, P=0.042) were independently associated with early poor neurological improvement. The ROC curve analysis showed that the optimal cut-off value of RDW to predict poor early neurological improvement after thrombolysis was 13.56% (AUC=0.782, 95%CI: 0.690-0.874; sensitivity 76%; specificity 74%). CONCLUSION: Elevated RDW is of a certain value in predicting the poor early neurological improvement of AIS patients after thrombolysis.

Research advances in immune checkpoint inhibitor-related cholangitis / 临床肝胆病杂志

Immune checkpoint inhibitors (ICIs) have ushered in a new era of tumor treatment; however, immunotherapy-related adverse events are critical issues that restrict the clinical application of ICIs and have attracted wide attention. The liver is one of the target organs that is easily affected. With the progress in research, scholars have found that besides hepatocytes, intrahepatic and extrahepatic bile ducts can also be attacked by the immune system, leading to the disease known as immune-related cholangitis. This article reviews the research advances in ICI-related cholangitis by summarizing related articles, in order to preliminarily reveal its clinical, pathological, and imaging features and provide clues for early identification, standard treatment, and subsequent research.

Dupilumab for Treatment of Food-Dependent, Exercise-Induced Anaphylaxis: Report of One Case / 中国医学科学杂志(英文版)

Food-dependent, exercise-induced anaphylaxis (FDEIA) is a potentially life-threatening disorder that often occurs with exercise, and patients typically have eaten a specific food within hours before disease onset. This disease is exceedingly rare, with a prevalence of 0.02%. No well-recognized prevention or treatment strategy has been available for FDEIA except avoiding triggers strictly. Here we report an 11-year-old boy with a history of recurrent anaphylaxis of unknown etiology more than 10 times within two years. As the anaphylactic symptoms had not been controlled after traditional treatments, the patient was given subcutaneous injection of dupilumab seven times within 33 weeks. During dupilumab treatments, the patient was exposed to culprit mushrooms plus exercises at least twice a month but without notable anaphylaxis. Thus, Dupilumab may improve the allergic reactions in FDEIA patients.

Advances in Diagnostic Criteria and Severity Assessment of Atopic Dermatitis / 中国医学科学院学报

Atopic dermatitis(AD),a chronic and relapsing skin disease,is characterized by dry skin and pruritus,severely affecting the quality of patients' life.Accurately grasping the diagnostic criteria and severity assessment is essential and helps to avoid misdiagnosis and missed diagnosis.Moreover,it facilities the development and adjustment of the therapeutic schedule according to the therapeutic reaction and disease control conditions.This article reviews the research advances in the diagnostic criteria and severity assessment of AD.

Application of SpyGlass endoscopic direct visualization system in complicated biliary complications after orthotopic liver transplantation / 器官移植

Objective To evaluate the application efficacy of SpyGlass endoscopic direct visualization system in management of complex biliary complications after orthotopic liver transplantation. Methods Clinical data of 369 adult patients with biliary complications after orthotopic liver transplantation who received endoscopic retrograde cholangiopancreatography (ERCP) for the first time were retrospectively analyzed. Preoperative conditions, intraoperative manifestations, treatment outcomes and complications of patients treated with SpyGlass system were analyzed. Results Fifty-six patients were treated with SpyGlass system. The main preoperative symptoms included abdominal discomfort in 38 cases, fever in 8 cases, jaundice in 6 cases and skin itching in 4 cases. Ultrasound examination in 18 patients indicated common bile duct stenosis and significant intrahepatic bile duct dilatation. Preoperative magnetic resonance cholangiopancreatography (MRCP) of 56 patients revealed that 36 cases were diagnosed with common bile duct stenosis complicated with stones, 16 cases of common bile duct stenosis alone and 4 cases of suspected tumors. All patients had definite indications for SpyGlass system treatment. Among 56 patients treated with SpyGlass system, 34 cases were diagnosed with anastomotic stricture complicated with stones, 12 cases of anastomotic stricture alone, 1 case of biliary stone and 4 cases of tumors. Among 48 cases who were successfully treated, the levels of alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, alkaline phosphatase and total bilirubin at postoperative 48 h were all significantly lower than preoperative levels (all P<0.05). No severe complications occurred in 56 patients treated with SpyGlass system. Conclusions Use of SpyGlass system may significantly increase success rate and guarantee surgical safety in the treatment of complex biliary complications after liver transplantation, which is worthy of promotion and application.

Fibroblasts overpressing WNT2b cause impairment of intestinal mucosal barrier / 南方医科大学学报

OBJECTIVE@#To investigate the mechanism by which fibroblasts with high WNT2b expression causes intestinal mucosa barrier disruption and promote the progression of inflammatory bowel disease (IBD).@*METHODS@#Caco-2 cells were treated with 20% fibroblast conditioned medium or co-cultured with fibroblasts highly expressing WNT2b, with the cells without treatment with the conditioned medium and cells co-cultured with wild-type fibroblasts as the control groups. The changes in barrier permeability of Caco-2 cells were assessed by measuring transmembrane resistance and Lucifer Yellow permeability. In Caco-2 cells co-cultured with WNT2b-overexpressing or control intestinal fibroblasts, nuclear entry of β-catenin was detected with immunofluorescence assay, and the expressions of tight junction proteins ZO-1 and E-cadherin were detected with Western blotting. In a C57 mouse model of dextran sulfate sodium (DSS)-induced IBD-like enteritis, the therapeutic effect of intraperitoneal injection of salinomycin (5 mg/kg, an inhibitor of WNT/β-catenin signaling pathway) was evaluated by observing the changes in intestinal inflammation and detecting the expressions of tight junction proteins.@*RESULTS@#In the coculture system, WNT2b overexpression in the fibroblasts significantly promoted nuclear entry of β-catenin (P < 0.01) and decreased the expressions of tight junction proteins in Caco-2 cells; knockdown of FZD4 expression in Caco-2 cells obviously reversed this effect. In DSS-treated mice, salinomycin treatment significantly reduced intestinal inflammation and increased the expressions of tight junction proteins in the intestinal mucosa.@*CONCLUSION@#Intestinal fibroblasts overexpressing WNT2b causes impairment of intestinal mucosal barrier function and can be a potential target for treatment of IBD.

Research advances in immunotherapy for hepatocellular carcinoma / 临床肝胆病杂志

Hepatocellular carcinoma (HCC) has an insidious onset, and most patients are in the advanced stage when attending the hospital and thus lose the opportunity for radical surgical resection, which results in the poor prognosis of patients. With the development of clinical treatment, the treatment of advanced HCC has gradually transitioned from the relatively single and limited treatment options in the past to the new model of comprehensive treatment. In recent years, immunotherapy, represented by immune checkpoint inhibitors (ICIs), has become widely used in clinical practice. At present, a number of clinical studies have been conducted for immunotherapy combined with local and targeted antitumor therapy, and in particular, ICIs combined with targeted therapy have become a research hotspot in the field of HCC treatment. This article reviews the research advances in immunotherapy for the treatment of HCC.

Mechanism of intestinal injury induced by WNT2B high-expressed fibroblasts in Crohn's disease / 中华儿科杂志

Objective: To explore the mechanism of intestinal tissue damage induced by macrophages activated by WNT2B high-expressed fibroblasts. Methods: This study involved biological information analysis, pathological tissue research and cell experimental research. The biological information of the colon tissue from the children with inflammatory bowel disease in previous study was analyzed again with single-cell sequencing. The pathological tissues were collected by colonoscopy from 10 children with Crohn's disease treated in the Department of Gastroenterology of Guangzhou Women and Children's Medical Center from July 2022 to September 2022. According to the findings of colonoscopy, tissues with obvious inflammation or ulceration were classified as the inflammatory group, while tissues with slight inflammation and no ulceration were classified as the non-inflammatory group. HE staining was performed to observe the pathological changes of the colon tissues. Macrophage infiltration and CXCL12 expression were detected by immunofluorescence. In terms of cell experiments, fibroblasts transfected with WNT2B plasmid or empty plasmid were co-cultured with salinomycin treated or non-treated macrophages, respectively; the expression of proteins through Wnt classical pathway were detected by western blotting. Macrophages treated with SKL2001 were used as the experimental group, and those with phosphate buffer as the control group. The expression and secretion of CXCL12 in macrophages were detected by quantitative Real-time PCR and enzyme-linked immunosorbent assay (ELISA). T-test or rank sum test were used for the comparison between groups. Results: Single-cell sequencing analysis suggested that macrophages were the main cells in inflammatory bowel disease colon tissue, and there was interaction between WNT2B high-expressed fibroblasts and macrophages. HE staining of the 10 patients ((9.3±3.8) years old, 7 males and 3 females) showed that the pathological score of colon tissue in the inflammatory group was higher than that in the non-inflammatory group (4 (3, 4) vs. 2 (1, 2) points, Z=3.05, P=0.002). Tissue immunofluorescence indicated that the number of infiltrating macrophages in the inflammatory group was significantly higher than that in the non-inflammatory group under high power field of view (72.8±10.4 vs.8.4±3.5, t=25.10, P<0.001), as well as the number of cells expressing CXCL12 (14.0±3.5 vs. 4.7±1.9, t=14.68, P<0.001). In cell experiments, western blotting suggested an elevated level of glycogen synthase kinase-3β phosphorylation in macrophages co-cultured with fibroblast transfected with WNT2B plasmid, and salinmycin could reverse this change. Real-time PCR suggested that the transcription level of CXCL12 in the experimental group was higher than that in the control group (6.42±0.04 vs. 1.00±0.03, t=183.00, P<0.001), as well as the expression and secretion of CXCL12 by ELISA ((465±34) vs. (77±9) ng/L, t=13.21, P=0.006). Conclusion: WNT2B high-expressed fibroblasts can secrete WNT2B protein and activate the Wnt classical signaling pathway thus enhancing the expression and secretion of CXCL12 in macrophages, inducing the development of intestinal inflammation of Crohn's disease.

Feasibility analysis and nail planning ofS2 iliac crest screw placement in children / 中国骨伤

OBJECTIVE@#To evaluate the feasibility of S2 alar iliac screw insertion in Chinese children using computerized three-dimension reconstruction and simulated screw placement technique, and to optimize the measurement of screw parameters.@*METHODS@#A total of 83 pelvic CT data of children who underwent pelvic CT scan December 2018 to December 2020 were retrospectively analyzed, excluding fractures, deformities, and tumors. There were 44 boys and 39 girls, with an average age of (10.66±3.52) years, and were divided into 4 groups based on age (group A:5 to 7 years old;group B:8 to 10 years old;group C:11-13 years old;group D:14 to 16 years old). The original CT data obtained were imported into Mimics software, and the bony structure of the pelvis was reconstructed, and the maximum and minimum cranial angles of the screws were simulated in the three-dimensional view with the placement of 6.5 mm diameter S2 alar iliac screws. Subsequently, the coronal angle, sagittal angle, transverse angle, total length of the screw, length of the screw in the sacrum, width of the iliac, and distance of the entry point from the skin were measured in 3-Matic software at the maximum and minimum head tilt angles, respectively. The differences among the screw parameters of S2 alar iliac screws in children of different ages and the differences between gender and side were compared and analyzed.@*RESULTS@#In all 83 children, 6.5 mm diameter S2 iliac screws could be placed. There was no significant difference between the side of each screw placement parameter. The 5 to 7 years old children had a significantly smaller screw coronal angle than other age groups, but in the screw sagittal angle, the difference was more mixed. The 5 to 7 years old children could obtain a larger angle at the maximum head tilt angle of the screw, but at the minimum cranial angle, the larger angle was obtained in the age group of 11 to 13 years old. There were no significant differences among the age groups. The coronal angle and sagittal angle under maximum cephalic angle and minimum cranial angle of 5 to 7 years old male were (40.91±2.91)° and (51.85±3.75)° respectively, which were significantly greater than in female. The coronal angle under minimum cranial angle was significantly greater in girls aged 8-10 years old than in boys. For the remaining screw placement angle parameters, there were no significant differences between gender. The differences in the minimum iliac width, the screw length, and the length of the sacral screws showed an increasing trend with age in all age groups. The distance from the screw entry point to the skin in boys were significantly smaller than that of girls. The minimum width of the iliac in boys at 14 to 16 years of age were significantly wider than that in girls at the same stage. In contrast, in girls aged 5 to 7 years and 11 to 13 years, the screw length was significantly longer than that of boys at the same stage.@*CONCLUSION@#The pelvis of children aged 5 to 16 years can safely accommodate the placement of 6.5 mm diameter S2 alar iliac screws, but the bony structures of the pelvis are developing and growing in children, precise assessment is needed to plan a reasonable screw trajectory and select the appropriate screw length.

Comparative study of two biliary drainage strategies in perioperative period of cholangiojejunostomy / 国际外科学杂志

Objective:To evaluate the clinical efficacy of PTCD and ERCP combined with T tube in the perioperative period of biliary anastomosis in patients with moderate to severe obstructive jaundice.Methods:The data of 93 patients with moderate obstructive jaundice who met the inclusion criteria and planned to undergo cholangiojejunostomy (including reconstruction after pancreaticoduodenectomy) in Shuguang Hospital Affiliated to Shanghai University of traditional Chinese medicine from March 2015 to December 2021 were collected. According to the perioperative drainage strategy, 54 cases were divided into PTCD group and 39 cases were divided into ERCP combined with intraoperative T-tube drainage group. Retrospective cohort method was used to analyze the bile duct diameter, postoperative hospital stay, operation cost, time of jaundice reduction, degree of jaundice reduction, average postoperative bile loss, postoperative bile leakage, abdominal infection of the two groups. The measurement data were expressed as mean ± standard deviation( ± s), and t test was used for comparison between groups. The data of skewed distribution were represented by M( Q1, Q3), and nonparametric rank sum test was used. Chi-square test was used for counting data. Results:The preoperative yellowing reduction time, operation cost, mean bile loss 7 days after operation, time to remove biliary drainage tube, and postoperative hospital stay in PTCD group were (5.9±3.1) d, (59 846.3±9 129.7) yuan, 210.0(170.0, 325.0) mL/d, (18.4±5.6) d, and(10.7±4.4) d, respectively, while those in ERCP group were (9.5±4.4) d, (77 833.1±12 164.5) yuan, 285.0(225.0, 370.0) mL/d, (41.4±17.2) d and(15.3±5.6) d, respectively. The difference between the two groups was statistically significant ( P<0.05). There was no significant difference between the two groups in general condition before drainage, cholangitis and hemorrhage after drainage, degree of jaundice reduction, bile leakage after surgery, abdominal infection, etc. Conclusions:When performing biliary enterostomy in patients with moderate or above obstructive jaundice, PTCD and ERCP combined with intraoperative T-tube drainage are effective means to improve the safety of perioperative period. PTCD has some advantages in reducing jaundice efficiency, operation cost and rapid postoperative rehabilitation.

Causes, diagnosis and treatment strategies for dental pulp calcification / 中华口腔医学杂志

Dental pulp calcification can lead to root canal stenosis or obliteration. It is usually difficult to negotiate the root canal if the affected tooth needs to be treated and intraoperative complications are easily brought about during the root canal treatment. The etiologies of dental pulp calcification are complicated and careful considerations should be given to the diagnosis and treatment. Only by weighing the advantages and disadvantages can appropriate treatment plan be chosen. Based on the literature and authors' clinical experiences, the present article summarizes the causes, pathogenesis, diagnosis and treatment strategies of dental pulp calcification, in order to provide some references in diagnosis and treatment for the dental clinicians.

Predictive value of machine learning for in-hospital mortality for trauma-induced acute respiratory distress syndrome patients: an analysis using the data from MIMICⅢ / 中华危重病急救医学

Objective:To investigate the value of machine learning methods for predicting in-hospital mortality in trauma patients with acute respiratory distress syndrome (ARDS).Methods:A retrospective non-intervention case-control study was performed. Trauma patients with ARDS met the Berlin definition were extracted from the the Medical Information Mart for Intensive CareⅢ (MIMICⅢ) database. The basic information [including gender, age, body mass index (BMI), pH, oxygenation index, laboratory indexes, length of stay in the intensive care unit (ICU), the proportion of mechanical ventilation (MV) or continuous renal replacement therapy (CRRT), acute physiology scoreⅢ(APSⅢ), sequential organ failure score (SOFA) and simplified acute physiology scoreⅡ(SAPSⅡ)], complications (including hypertension, diabetes, infection, acute hemorrhagic anemia, sepsis, shock, acidosis and pneumonia) and prognosis data of patients were collected. Multivariate Logistic regression analysis was used to screen meaningful variables ( P < 0.05). Logistic regression model, XGBoost model and artificial neural network model were constructed, and the receiver operator characteristic curve (ROC) was performed to evaluate the predictive value of the three models for in-hospital mortality in trauma patients with ARDS. Results:A total of 760 trauma patients with ARDS were enrolled, including 346 mild cases, 301 moderate cases and 113 severe cases; 618 cases survived and 142 cases died in hospital; 736 cases received MV and 65 cases received CRRT. Multivariate Logistic regression analysis screened out significant variables, including age [odds ratio ( OR) = 1.035, 95% confidence interval (95% CI) was 1.020-1.050, P < 0.001], BMI ( OR = 0.949, 95% CI was 0.917-0.983, P = 0.003), blood urea nitrogen (BUN; OR = 1.019, 95% CI was 1.004-1.033, P = 0.010), lactic acid (Lac; OR = 1.213, 95% CI was 1.124-1.309, P < 0.001), red cell volume distribution width (RDW; OR = 1.249, 95% CI was 1.102-1.416, P < 0.001), hematocrit (HCT, OR = 1.057, 95% CI was 1.019-1.097, P = 0.003), hypertension ( OR = 0.614, 95% CI was 0.389-0.968, P = 0.036), infection ( OR = 0.463, 95% CI was 0.289-0.741, P = 0.001), acute renal failure ( OR = 2.021, 95% CI was 1.267-3.224, P = 0.003) and sepsis ( OR = 2.105, 95% CI was 1.265-3.502, P = 0.004). All the above variables were used to construct the model. Logistic regression model, XGBoost model and artificial neural network model predicted in-hospital mortality with area under the curve (AUC) of 0.737 (95% CI was 0.659-0.815), 0.745 (95% CI was 0.672-0.819) and 0.757 (95% CI was 0.680-0.884), respectively. There was no significant difference between any two models (all P > 0.05). Conclusion:Logistic regression model, XGBoost model and artificial neural network model including age, BMI, BUN, Lac, RDW, HCT, hypertension, infection, acute renal failure and sepsis have good predictive value for in-hospital mortality of trauma patients with ARDS.