Comparison of long-term outcomes of splenectomy with periesophagogastric devascularization and transjugular intrahepatic portosystemic shunt in treating cirrhotic portal hypertension patients with recurrent variceal bleeding.

PURPOSE: Transjugular intrahepatic portosystemic shunt (TIPS) and splenectomy with periesophagogastric devascularization (SPD) are widely used to treat cirrhotic portal hypertension (PH) and prevent variceal rebleeding. However, direct comparisons between these two approaches are rare. This study was designed to compare the long-term outcomes of TIPS and SPD in patients with cirrhotic PH and variceal rebleeding. METHODS: The study included cirrhotic PH patients with a history of gastroesophageal variceal bleeding between 18 and 80 years of age who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to January 2022. Patients were enrolled into two groups according to TIPS or SPD was performed. Baseline characteristics were matched using propensity score matching (PSM). RESULTS: A total of 230 patients underwent TIPS, while 184 underwent SPD. PSM was carried out to balance available covariates, resulting in a total of 83 patients in the TIPS group and 83 patients in the SPD group. Patients in SPD group had better liver function during 60 months follow-up. Five-year overall survival rates in SPD group and TIPS group were 72 and 27%, respectively, at 2 years were 88 and 86%, respectively. The 2- and 5-year freedom from variceal rebleeding rates were 95 and 80% in SPD group and 80 and 54% in TIPS group. CONCLUSIONS: SPD is clearly superior to TIPS in terms of OS and freedom from variceal rebleeding in patients with cirrhotic PH. In addition, SPD improved liver function in patients with cirrhotic PH.

The longitudinal relation between violence exposure in daily life, hostile automatic thoughts, and cyber-aggression.

Cyber-aggression is a serious social problem worldwide. Its risks have been frequently explored, and violence exposure in daily life has been regarded as an important risk factor of cyber-aggression. However, the longitudinal association between violence exposure in daily life and cyber-aggression has not yet been examined, and the mechanisms underlying the link between violence exposure and cyber-aggression remain largely unclear. Based on the General Aggression Model and Script Theory, we explored the circular relation between violence exposure in daily life, hostile automatic thoughts, and cyber-aggression. The current study adopted a longitudinal design to address these issues among 941 college students. The results indicated violence exposure in daily life predicted hostile automatic thoughts and cyber-aggression 6 months later; hostile automatic thoughts predicted violence exposure and cyber-aggression 6 months later; and cyber-aggression predicted hostile automatic thoughts and violence exposure 6 months later. Moreover, each of them plays a mediating role in the association between the other two variables. These results support and expand the General Aggression Model and Script Theory that violence exposure, aggressive cognition, and aggression facilitate each other. This also provides theoretical guidance on reducing cyber-aggression in daily life.

ZIF-67-Derived NiCo-Layered Double Hydroxide@Carbon Nanotube Architectures with Hollow Nanocage Structures as Enhanced Electrocatalysts for Ethanol Oxidation Reaction.

The rational design of efficient Earth-abundant electrocatalysts for the ethanol oxidation reaction (EOR) is the key to developing direct ethanol fuel cells (DEFCs). Among these, the smart structure is highly demanded for highly efficient and stable non-precious electrocatalysts based on transition metals (such as Ni, Co, and Fe). In this work, high-performance NiCo-layered double hydroxide@carbon nanotube (NiCo-LDH@CNT) architectures with hollow nanocage structures as electrocatalysts for EOR were prepared via sacrificial ZIF-67 templates on CNTs. Comprehensive structural characterizations revealed that the as-synthesized NiCo-LDH@CNTs architecture displayed 3D hollow nanocages of NiCo-LDH and abundant interfacial structure between NiCo-LDH and CNTs, which could not only completely expose active sites by increasing the surface area but also facilitate the electron transfer during the electrocatalytic process, thus, improving EOR activity. Benefiting from the 3D hollow nanocages and interfacial structure fabricated by the sacrificial ZIF-67-templated method, the NiCo-LDH@CNTs-2.5% architecture exhibited enhanced electrocatalytic activity for ethanol oxidation compared to single-component NiCo-LDH, where the peak current density was 11.5 mA·cm-2, and the jf/jb value representing the resistance to catalyst poisoning was 1.72 in an alkaline environment. These results provide a new perspective on the fabrication of non-precious metal electrocatalysts for EOR in DEFCs.

Application of associating liver partition and portal vein ligation for staged hepatectomy for initially unresectable hepatocellular carcinoma.

OBJECTIVE: To evaluate the safety and efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of initially unresectable hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) and to preliminarily explore the mechanism of rapid growth of the future liver remnant (FLR). METHODS: Twenty-four patients with HBV-associated HCC who underwent ALPPS in our hospital from August 2014 to January 2021 were retrospectively studied. Propensity score matching was used to compare oncologic outcomes of patients treated with ALPPS and transarterial chemoembolization (TACE). The expression of YAP and JNK in liver tissue after two stages of ALPPS were detected. RESULTS: The median standard liver volume (SLV) was 1471.4 ml. Before second stage of ALPPS, the median FLR increased by 74.4%, and the median FLR/SLV increased from 26.1 to 41.6%. Twenty-two patients (91.7%) received staged hepatectomy after a median interval of 15 (9-24) d. The total incidence of postoperative complications in ALPPS group was 54.5%, and of Clavien-Dindo ≥ IIIb postoperative complications (requiring surgical, endoscopic or radiological intervention under general anesthesia) was 9.1%. There was no significant difference in total complications between ALPPS group and TACE group, but there were lower rate of above grade III complications in the TACE group than that in the ALPPS group. The incidence of complications was lower in laparoscopic-ALPPS than that in open surgery. In ALPPS group, the 1-year, 2-year and 5-year overall survival rate were respectively 71.4%, 33.3% and 4.8%. Interval time was an independent risk factor associated with overall survival rate. There was no significant difference in overall survival rate between ALPPS group and TACE group. For advanced HCC (BCLC stage B and C), ALPPS group was not superior to TACE group in overall survival rate. The expression of YAP and p-JNK in the residual liver tissue after second stage procedure was higher than that after first stage procedure, and the co-expression of YAP and p-JNK was observed in the residual liver tissue. CONCLUSION: ALPPS is a safe and effective treatment for initially unresectable HBV-associated HCC. Laparoscopic technique might improve the effect of ALPPS. YAP and JNK pathway might take a role in rapid FLR increase in ALPPS procedure.

Long-term results of ERCP- or PTCS-directed photodynamic therapy for unresectable hilar cholangiocarcinoma.

BACKGROUND: Photodynamic therapy (PDT) can be performed as palliative therapy for cholangiocarcinoma, while there is currently insufficient evidence for the efficacy. The aim of this study was to explore the clinical efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP)- or percutaneous transhepatic cholangioscopy (PTCS)-directed PDT combined with stent placement for unresectable hilar cholangiocarcinoma. METHODS: A retrospective analysis was conducted on 62 patients with unresectable hilar cholangiocarcinoma. Thirty patients received PDT using hematoporphyrin combined with biliary stent placement (PDT+stent group), including 22 receiving ERCP-directed PDT and 8 receiving PTCS-directed PDT. Survival time, quality of life, and postoperative adverse events were compared to 32 patients receiving biliary stent placement alone (Stent-only group). RESULTS: After 42 months of follow-up, median survival time was significantly longer in the PDT+stent group than the Stent-only group (14.2 vs. 9.8 months, P = 0.003). In the PDT+stent group, the median survival time was longer in the 6 patients with recurrence after surgical resection than the 24 patients without prior surgical resection (20.0 vs. 13.0 months, P = 0.017). The QOL total scores was significantly higher in the PDT+stent group than the Stent-only group at postoperative 6, 9, and 12 months (P<0.05). There was no significant difference in the incidence of postoperative adverse events between the two groups (24 [38.7%] vs. 20 [29.0%], P = 0.239). CONCLUSION: ERCP- or PTCS-directed PDT + stent placement can prolong the survival of patients with unresectable hilar cholangiocarcinoma, especially those with recurrence and improve quality of life without increasing adverse events.

Alpha lipoic acid antagonizes cytotoxicity of cobalt nanoparticles by inhibiting ferroptosis-like cell death.

As a main element in the hard metal industry, cobalt is one of the major components of human metal implants. Cobalt-containing implants, especially joint prostheses used for artificial joint replacement, can be corroded due to the complex physiological environment in vivo, producing a large number of nanoscale cobalt particles (Cobalt Nanoparticles, CoNPs). These CoNPs can be first accumulated around the implant to cause adverse local reactions and then enter into the blood vessels followed by reaching the liver, heart, brain, kidney, and other organs through systematic circulation, which leads to multi-system toxicity symptoms. To ensure the long-term existence of cobalt-containing implants in the body, it is urgently required to find out a safe and effective detoxification drug. Herein, we have demonstrated that CoNPs could induce the ferroptosis-like cell death through the enhancement of intracellular reactive oxygen species (ROS) level, cytoplasmic Fe2+ level, lipid peroxidation, and consumption of reduced glutathione (GSH) as well as inhibition of glutathione peroxidase 4 (GPX4) activity. Importantly, α-lipoic acid (ALA), a natural antioxidant with the capability to scavenge free radicals and chelate toxic metals, was found to efficiently alleviate the adverse effects of CoNPs. The present study illustrates a new mechanism of CoNPs mediated by ferroptosis-like cytotoxicity and discloses an effective method for the detoxification of CoNPs by employing the natural antioxidant of ALA, providing a basis for further in vivo detoxification study.

Frequency Shift Raman-Based Sensing of Serum MicroRNAs for Early Diagnosis and Discrimination of Primary Liver Cancers.

Frequency shift surface-enhanced Raman scattering (SERS) achieves multiplex microRNA sensing for early serological diagnosis of, and discrimination between, primary liver cancers in a patient cohort for whom only biopsy is effective clinically. Raman reporters microprinted on plasmonic substrates shift their vibrational frequencies upon biomarker binding with a dynamic range allowing direct, multiplex assay of serum microRNAs and the current best protein biomarker, α-fetoprotein. Benchmarking against current gold-standard polymerase chain reaction and chemiluminescence methods validates the assay. The work further establishes the frequency shift approach, sensing shifts in an intense SERS band, as a viable alternative to conventional SERS sensing which involves the more difficult task of resolving a peak above noise at ultralow analyte concentrations.

8H-10H Stacking Periodicity Control in Twinned Hexagonal Perovskite Dielectrics.

Isovalent substitution of Zr4+ for smaller Ti4+ was performed in the 8-layer twinned hexagonal perovskite (referred to as 8H) tantalate Ba8Ti3Ta4O24, which stabilizes a 10-layer twinned hexagonal perovskite (referred to as 10H). The formation of the 10H phase occurs at low substitution concentration ( x = 0.1) in Ba8Zr xTi3- xTa4O24 at 1300 °C and reverts back to the 8H phase upon heating at elevated temperatures. Such a 10H-to-8H phase transformation is suppressed at higher Zr-substitution contents ( x > 0.1). The approach combining simulated annealing and Rietveld refinement with compositional constrain indicates that the 10H Ba8Zr0.4Ti2.6Ta4O24 ( x = 0.4) composition adopts a simply P63/ mmc disordered structure with Zr cations preferably located in corner-sharing octahedral (CSO) sites compared to face-sharing octahedral (FSO) sites. This 8H-10H phase competition, dependent on the substitution of Zr4+ for Ti4+ and firing temperature, is discussed in terms of the FSO B-B repulsion controlled by the cationic size, as well as the stacking periodicity which affects the thermodynamic stability. Both 8H- and 10H-phase pellets of Ba8Zr xTi3- xTa4O24 exhibit comparable and poorer microwave dielectric properties than the parent 8H Ba8Ti3Ta4O24, which is characterized by cationic disorder and FSO B-B repulsion. The 8H and 10H Ba8Zr xTi3- xTa4O24 ceramics display electrical insulator behavior but with electrically heterogeneous microstructure on the bulk grains. This study demonstrates the opportunity to control the stacking periodicity for the twinned hexagonal perovskites via tuning the B-cationic size and the firing temperature.

Common and distinct brain networks underlying verbal and visual creativity.

Creativity is imperative to the progression of human civilization, prosperity, and well-being. Past creative researches tends to emphasize the default mode network (DMN) or the frontoparietal network (FPN) somewhat exclusively. However, little is known about how these networks interact to contribute to creativity and whether common or distinct brain networks are responsible for visual and verbal creativity. Here, we use functional connectivity analysis of resting-state functional magnetic resonance imaging data to investigate visual and verbal creativity-related regions and networks in 282 healthy subjects. We found that functional connectivity within the bilateral superior parietal cortex of the FPN was negatively associated with visual and verbal creativity. The strength of connectivity between the DMN and FPN was positively related to both creative domains. Visual creativity was negatively correlated with functional connectivity within the precuneus of the pDMN and right middle frontal gyrus of the FPN, and verbal creativity was negatively correlated with functional connectivity within the medial prefrontal cortex of the aDMN. Critically, the FPN mediated the relationship between the aDMN and verbal creativity, and it also mediated the relationship between the pDMN and visual creativity. Taken together, decreased within-network connectivity of the FPN and DMN may allow for flexible between-network coupling in the highly creative brain. These findings provide indirect evidence for the cooperative role of the default and executive control networks in creativity, extending past research by revealing common and distinct brain systems underlying verbal and visual creative cognition. Hum Brain Mapp 38:2094-2111, 2017. © 2017 Wiley Periodicals, Inc.

Brain structure links everyday creativity to creative achievement.

Although creativity is commonly considered to be a cornerstone of human progress and vital to all realms of our lives, its neural basis remains elusive, partly due to the different tasks and measurement methods applied in research. In particular, the neural correlates of everyday creativity that can be experienced by everyone, to some extent, are still unexplored. The present study was designed to investigate the brain structure underlying individual differences in everyday creativity, as measured by the Creative Behavioral Inventory (CBI) (N=163). The results revealed that more creative activities were significantly and positively associated with larger gray matter volume (GMV) in the regional premotor cortex (PMC), which is a motor planning area involved in the creation and selection of novel actions and inhibition. In addition, the gray volume of the PMC had a significant positive relationship with creative achievement and Art scores, which supports the notion that training and practice may induce changes in brain structures. These results indicate that everyday creativity is linked to the PMC and that PMC volume can predict creative achievement, supporting the view that motor planning may play a crucial role in creative behavior.

[Iterated Tikhonov Regularization for Spectral Recovery from Tristimulus].

Reflective spectra in a multispectral image can objectively and originally represent color information due to their high dimensionality, illuminant independent and device independent. Aiming to the problem of loss of spectral information when the spectral data reconstructed from three-dimensional colorimetric data in the trichromatic camera-based spectral image acquisition system and its subsequent problem of loss of color information, this work proposes an iterated Tikhonov regularization to reconstruct the reflectance spectra. First of all, according to relationship between the colorimetric value and the reflective spectra in the colorimetric theory, this work constructs a spectral reconstruction equation which can reconstruct high dimensional spectral data from three dimensional colorimetric data acquired by the trichromatic camera. Then, the iterated Tikhonov regularization, inspired by the idea of the pseudo inverse Moore-Penrose, is used to cope with the linear ill-posed inverse problem during solving the equation of reconstructing reflectance spectra. Meanwhile, the work also uses the L-curve method to obtain an optimal regularized parameter of the iterated Tikhonov regularization by training a set of samples. Through these methods, the ill condition of the spectral reconstruction equation can be effectively controlled and improved, and subsequently loss of spectral information of the reconstructed spectral data can be reduced. The verification experiment is performed under another set of training samples. The experimental results show that the proposed method reconstructs the reflective spectra with less spectral information loss in the trichromatic camera-based spectral image acquisition system, which reflects in obvious decreases of spectral errors and colorimetric errors compared with the previous method.

Applied anatomical study of the modified anconeus flap approach.

PURPOSE: Conventional surgical therapy for an intercondylar humerus fracture might result in multiple potential complications. Our study was conducted to evaluate the modified anconeus flap approach by adequately exposing the distal humeral articular surface, avoiding osteotomy of the olecranon and transection of the main part of the triceps brachial tendon from the olecranon. METHODS: Preparations of 20 upper limb specimens from adult cadavers were used in this study. We investigated the anatomical features of the distal tendon of the triceps brachii. Then, we designed a modified anconeus flap approach in cadaver specimens combined with the medial paratricipital approach, and we compared the extent of exposure of the distal humeral articular surface between the triceps-reflecting anconeus pedicle approach and this modified approach. RESULTS: The downward neurovascular bundles supplying the anconeus were located far from the intramuscular tendon of the triceps brachii. In addition, the medial head of the triceps was continuous with the anconeus near the lateral epicondyle of the humerus. These anatomical properties could assist in reducing adverse events in surgery. The percentage of the exposed humerus distal articular surface was 42.7% by applying the modified anconeus flap approach combined with the medial paratricipital approach. The modified anconeus flap approach can overcome the shortcomings of osteotomy or triceps transverse and fulfill reduction and internal fixation of most distal humerus intercondylar fractures. CONCLUSIONS: The present study has demonstrated a new approach for adequately exposing the distal humeral articular surface during surgery for an intercondylar humerus fracture. With this modified approach, osteotomy of the olecranon and the separation or transection of the main part of the triceps brachial tendon from the olecranon are not necessarily required. Therefore, we suggest that this novel approach could be applied as the primary surgical approach in intercondylar humerus fracture surgeries if the surgeons are familiar with the regional features of distal tendon of the triceps brachii and anconeus.

Longitudinal relations between bullying victimization and aggression: The multiple mediation effects of anger rumination and hostile automatic thoughts.

Bullying victimization is widely accepted to be associated with aggression. However, the mechanisms underlying this relationship remain unknown. To examine the long-term impact of bullying victimization on aggression, the present study tested the potential mediating effects of both anger rumination and hostile automatic thoughts. A total of 809 undergraduates from four universities across China (74.80% female; Mage = 19.63 years, SD = 0.82 years) completed the survey on three occasions, with a 6-month delay between Time 1 and Time 2 and a 1-year interval between Time 2 and Time 3. A cross-lagged model of anger rumination and hostile automatic thoughts was developed to test whether they predicted one another, and two structural models were constructed to test their mediating roles in bullying victimization and aggression. Findings indicated that anger rumination and hostile automatic thoughts are mutually predictable; the correlation between bullying victimization and aggression is mediated independently by anger rumination and hostile automatic thoughts, and the chain mediation of bullying victimization predicting aggression first through anger rumination and then through hostile automatic thinking was established. In addition, an alternative mediation model is also significant, with hostile automatic thoughts as the primary mediator and anger rumination as the secondary mediator. These results highlight the significance of anger rumination and hostile automatic thoughts in the long-term effects of bullying victimization on aggression. Interventions designed to reduce undergraduate students' anger rumination and hostile automatic thoughts may help reduce their aggression.

Activated Carbon Based on Recycled Epoxy Boards and Their Adsorption toward Methyl Orange.

With the swift progress of the electronics industry, discarded circuit boards have become an important source of non-degradable waste. In this work, discarded epoxy resin was collected as a precursor to prepare activated carbon (AC) through stepwise carbonization/activation methods. The rough carbon materials with a certain graphite and amorphous structure reveal the multiple oxygen-containing groups on their surface. In the process of studying the adsorption of methyl orange by activated carbon, it is found that the adsorption is in accordance with the quasi-secondary kinetic model, and equilibrium adsorption amounts can reach 41.051 mg/g. The adsorption isotherm of AC is more in line with the Langmuir model, and the saturation adsorption amount at three different temperatures is 23.137 mg/g, 30.358 mg/g, and 37.202 mg/g, respectively. The enthalpy (ΔH) is 17.30 KJ/mol in the adsorption process, which indicates that is a physical process with heat-absorbing capabilities. This work is of great significance with regard to the recycling of waste to reduce pollution and in terms of gaining economic benefits.

Neural correlates of individual differences in moral identity and its positive moral function.

Moral identity is an important moral variable which has positive moral functions, such as contributing to prosocial behaviours, reducing antisocial behaviours, and resisting the risk factors of antisocial behaviours. However, little is known about the neural correlates of moral identity and the neural basis of the effect of moral identity on the risk factors of antisocial behaviours, including moral disengagement. In this study, we explored these issues in 142 college students by estimating the regional homogeneity (ReHo) through resting-state functional magnetic resonance imaging (fMRI). The whole-brain correlation analyses found that higher internalized moral identity was correlated with higher ReHo in the precuneus. Furthermore, the ReHo in the precuneus was negatively correlated with moral disengagement, suggesting positive moral functions of the neural mechanisms of moral identity. These findings deepen our understanding of individual differences in moral identity and provide inspiration for the education of moral identity and the intervention for moral disengagement from the perspective of the brain.

Hippo (YAP)-autophagy axis protects against hepatic ischemia-reperfusion injury through JNK signaling.

BACKGROUND: Hepatic ischemia-reperfusion injury (HIRI) remains a common complication during liver transplantation (LT) in patients. As a key downstream effector of the Hippo pathway, Yes-associated protein (YAP) has been reported to be involved in various physiological and pathological processes. However, it remains elusive whether and how YAP may control autophagy activation during ischemia-reperfusion. METHODS: Human liver tissues from patients who had undergone LT were obtained to evaluate the correlation between YAP and autophagy activation. Both an in vitro hepatocyte cell line and in vivo liver-specific YAP knockdown mice were used to establish the hepatic ischemia-reperfusion models to determine the role of YAP in the activation of autophagy and the mechanism of regulation. RESULTS: Autophagy was activated in the post-perfusion liver grafts during LT in patients, and the expression of YAP positively correlated with the autophagic level of hepatocytes. Liver-specific knockdown of YAP inhibited hepatocytes autophagy upon hypoxia-reoxygenation and HIRI ( P <0.05). YAP deficiency aggravated HIRI by promoting the apoptosis of hepatocytes both in the in vitro and in vivo models ( P <0.05). Attenuated HIRI by overexpression of YAP was diminished after the inhibition of autophagy with 3-methyladenine. In addition, inhibiting autophagy activation by YAP knockdown exacerbated mitochondrial damage through increasing reactive oxygen species ( P <0.05). Moreover, the regulation of autophagy by YAP during HIRI was mediated by AP1 (c-Jun) N-terminal kinase (JNK) signaling through binding to the transcriptional enhanced associate domain (TEAD). CONCLUSIONS: YAP protects against HIRI by inducing autophagy via JNK signaling that suppresses the apoptosis of hepatocytes. Targeting Hippo (YAP)-JNK-autophagy axis may provide a novel strategy for the prevention and treatment of HIRI.

Selective electrooxidation of 5-hydroxymethylfurfural at low working potentials promoted by 3D hierarchical Cu(OH)2@Ni3Co1-layered double hydroxide architecture with oxygen vacancies.

Selective electrooxidation of 5-hydroxymethylfurfural (HMF) to 2,5-furandicarboxylic acid (FDCA) is of great significance in the manufacture of fine chemicals, liquid fuels, pharmaceuticals, plastics, etc., but still suffers from the high potential input, resulting in high electricity consumption. Developing active, low-cost and stable electrocatalysts is crucial for this electrochemical reaction at low working potentials. Herein, a three-dimensional (3D) hierarchical Cu(OH)2@Ni3Co1-layered double hydroxide architecture with abundant oxygen vacancies (Vo) was synthesized by facile electrodeposition of Ni3Co1-LDH nanosheets on copper foam (CF) supported-Cu(OH)2 nanorods (CF/Cu(OH)2@Ni3Co1-LDH) for the selective electrooxidation of HMF to FDCA. The 3D hierarchical architecture of the Cu(OH)2 nanorod core loaded with Ni3Co1-LDH nanosheet shell facilitates the rapid transfer of charges and exposes more active sites. The synergistic effect of the core-shell nanoarray structure, atomic level dispersion of Ni and Co on LDH laminates, and rich Vo gives 98.12% conversion of HMF, 98.64% yield and 91.71% selectivity for FDCA at a low working potential of 1.0 V vs. RHE. In addition, CF/Cu(OH)2@Ni3Co1-LDH exhibits superior stability by maintaining 93.26% conversion of HMF, 93.65% yield and 91.57% selectivity of FDCA after eight successive cycles, showing the immense potential of utilizing electrochemical conversion for biomass.

JNK signaling mediates acute rejection via activating autophagy of CD8+ T cells after liver transplantation in rats.

Background: Acute rejection (AR) after liver transplantation (LT) remains an important factor affecting the prognosis of patients. CD8+ T cells are considered to be important regulatory T lymphocytes involved in AR after LT. Our previous study confirmed that autophagy mediated AR by promoting activation and proliferation of CD8+ T cells. However, the underlying mechanisms regulating autophagy in CD8+ T cells during AR remain unclear. Methods: Human liver biopsy specimens of AR after orthotopic LT were collected to assess the relationship between JNK and CD8+ T cells autophagy. The effect of JNK inhibition on CD8+ T cells autophagy and its role in AR were further examined in rats. Besides, the underlying mechanisms how JNK regulated the autophagy of CD8+ T cells were further explored. Results: The expression of JNK is positive correlated with the autophagy level of CD8+ T cells in AR patients. And similar findings were obtained in rats after LT. Further, JNK inhibitor remarkably inhibited the autophagy of CD8+ T cells in rat LT recipients. In addition, administration of JNK inhibitor significantly attenuated AR injury by promoting the apoptosis and downregulating the function of CD8+ T cells. Mechanistically, JNK may activate the autophagy of CD8+ T cells through upregulating BECN1 by inhibiting the formation of Bcl-2/BECN1 complex. Conclusion: JNK signaling promoted CD8+ T cells autophagy to mediate AR after LT, providing a theoretical basis for finding new drug targets for the prevention and treatment of AR after LT.

Diagnostic performance of PIVKA-II in identifying recurrent hepatocellular carcinoma following curative resection: a retrospective cohort study.

Protein induced by vitamin K absence or antagonist II (PIVKA-II) plays a critical role in the diagnosis of hepatocellular carcinoma (HCC), however, studies on its efficacy in diagnosing recurrent HCC were rarely found. A multicenter, retrospective, and observational study was conducted. During the overall follow-up of 5 years, HCC patients who had curative resection were monitored every 3 months in the first year post-surgery and every 6 months thereafter if no recurrence occurred. Tumor markers were collected at the diagnosis of recurrence for those with recurrence and at the last follow-up for those without recurrence. The median serum levels of PIVKA-II and AFP in the recurrence group were significantly higher than those in the non-recurrence group (PIVKA-II: 84.62 vs. 18.76 mAU/ml, p < 0.001; AFP: 4.90 vs. 3.00 ng/ml, p < 0.001) and there is a significant correlation between PIVKA-II and AFP (R = 0.901, p < 0.001). PIVKA-II showed better accuracy than AFP in the diagnosis of overall recurrent HCC (AUC: 0.883 vs. 0.672; p < 0.0001), but also in patients with negative PIVKA-II before curative resection (AUC: 0.878 vs. 0.680, p = 0.001). Clinician should pay more attention to serum PIVKA-II values when following patients after curative HCC resection to detect early recurrence.Clinical trial registration: ChiCTR2300070874.

Development of a risk assessment scale for use by nurses to assess the risk of deep vein thrombosis in gynaecology in China: A Delphi-based study.

AIM: Risk assessment models for deep vein thrombosis (DVT) used worldwide are based on multidisciplinary data from Western countries. We aimed to establish a DVT risk assessment model that is applicable to Chinese patients with gynaecological conditions. DESIGN: A risk assessment tool for DVT in gynaecology using the Delphi method. METHODS: A three-round Delphi study was conducted among experts who were asked to rate the importance of each risk factor in the Caprini scale. The consensus for each item was defined as a mean rating of >3 and a coefficient of variation (CV) of <0.5 in the first round, as CV <0.3 in the second round. RESULTS: Eleven experts participated in the Delphi method, with a response rate of 100%. Kendall's coefficients of concordance (W) were 0.264 and 0.322 in the first and second rounds, respectively (p < 0.001). The DVT risk assessment scale includes 8 dimensions and 34 items.