Two new chemical constituents from the aerial parts of Tripterygium wilfordii.

Tripterygium wilfordii has been historically employed as a conventional botanical insecticide and a plant of medicinal significance. A new dihydroagarofuran sesquiterpene (1) and a new acyclic compound (2), along with seven known compounds (3-9), have been isolated from the aerial parts of Tripterygium wilfordii. The identification of the structures of novel compounds were accomplished through comprehensive spectroscopic analyses, encompassing HRESIMS, NMR, UV, IR, and a comparative analysis with spectroscopic data from compounds previously characterised. In in-vitro bioassay, compound 8 exhibited significant inhibitory activity for NO release in LPS-induced RAW 264.7 cells, with an IC50 value of 15.7 µM.

Phenolic and flavonoid compounds from the fruit shell of Camellia oleifera.

A new phenolic compound oleiphenol (1), and a new dihydrochalcone oleifechalcone (2) along with seven known compounds (3-9) were isolated from the fruit shell of Camellia oleifera Abel. The planar structures of compounds 1 and 2 were determined on the basis of extensive spectroscopic analyses (IR, UV, NMR, and HR-ESI-MS) and comparison with literature data. The absolute configurations of the new structures were determined by ECD calculations and chemical methods. In addition, compounds 1-9 underwent a series of pharmacological activity tests, including cytotoxic, anti-inflammatory, anti-RSV and antioxidant activities.

Exploring the biological behavior and underlying mechanism of KITLG in triple-negative breast cancer.

The tyrosine-kinase receptor that is specified by the KIT locus is demarcated by KITLG. This multifaceted factor is instrumental during in-utero germ and neural cell maturation and hematopoiesis, ostensibly reflecting its role in facilitating cell migration. Concurrently, KITLG is prone to a mutation in germ cell tumors, entailing a presumed connection to tumorigenesis. Despite this, the intricacies of its function in breast cancer and the relevant mechanisms remain elusive. Multiple independent databases depict a consistently low expression of KITLG within tissues affected by triple-negative breast cancers (TNBC), a trend strongly coupled with reduced survival rates. Interestingly, non-triple-negative breast cancers exhibit a markedly high expression of KITLG compared to the norm. An initial analysis of the GEO database speculates that KITLG may serve as an oncogene suppressor in TNBC, hinting at varied roles for KITLG isoforms within this disease context. In conclusion, our preliminary analysis offers valuable insights into the role and expression pattern of KITLG in TNBC. We provide evidence supporting its consideration as a promising new prognostic marker, thereby potentially enriching therapeutic strategies for TNBC. Indeed, given the limited advances in molecularly targeted therapy for TNBC, a significant need exists for a more precise therapeutic approach and a comprehensive understanding of its inherent mechanisms of action.

Correction of Lying Ear and Aesthetic Modification of Helix and Ear Lobule with Hyaluronic Acid Filler Injection: Experience in Chinese Patients.

BACKGROUND: Large and long ears are regarded as symbols of wealth and health in eastern Asian culture, patients with lying ears wish their ears to be more exposed and prominent. Surgeries correcting lying ears have been documented. OBJECTIVES: We report correction of lying ears and aesthetic modification of helix and ear lobule with HA injections. METHODS: We performed HA injections at auriculocephalic sulcus (AS) to increase cranioauricular angle (CA) and correct lying ears. The injections at helix and lobule were case-specific. The CA was measured and photographs were taken at baseline and 1-, 3-, 6-, and 10-month follow-ups. Efficacy was assessed using a 5-point global aesthetic improvement scale (GAIS). Adverse events (AEs) were recorded. RESULTS: Forty-six patients (92 ears) received HA injections and completed follow-ups. Instant correction outcomes were observed. Sixteen (34.8%) patients received one touch-up injection, whose clinical efficacy persisted for 1 to 1.5 years. The GAIS for over 90% of cases with touch-up treatment was "very much improved" or "much improved" at all follow-ups. The GAIS for over 70% of cases without touch-up treatment was "very much improved" or "much improved" at 1, 3, and 6-month follow-ups. CA increased significantly compared with the baseline. Patients also reported "more V-shaped face shape" and "lifted jawline" effects. No serious AEs occurred. CONCLUSIONS: As an alternative technique to surgeries, HA filler injections at AS effectively corrected lying ears. This technique produced immediate, long-lasting, and aesthetically pleasing results. The side effects and downtime were minimal.

Artesunate attenuates serum amyloid A-induced M1 macrophage differentiation through the promotion of PHGDH.

Clinical studies indicated that Serum Amyloid A (SAA) might be a promising biomarker for forecasting the activity, severity, and adverse prognosis of systemic lupus erythematosus (SLE). Simultaneously, a positive correlation has been observed between macrophages, Th17 cells, and SLE disease activity, with both these immune cells being affected by SAA. Presently, the relationship between SAA and the aforementioned immune cell types in SLE remains to be elucidated. To discern the immune cell type most closely associated with SAA, we undertook a single-cell RNA sequencing data analysis via the GEO database. Subsequent results revealed a strong association between macrophages and SAA, a relationship further validated through flow cytometry of spleen macrophages in the MRL/lpr model. We discovered that SAA stimulate M1 macrophage differentiation along with the upregulation of pro-inflammatory cytokines such as IL-6 and IL-1ß. Our findings suggest that SAA may promote M1 macrophage differentiation via the downregulation of phosphoglycerate dehydrogenase (PHGDH). Artesunate (ART), primarily utilized for malaria treatment, was shown to inhibit M1 macrophage differentiation and pro-inflammatory cytokine levels via upregulating the PHGDH expression, thereby attenuating the disease activity in SLE.

Spleen-dedicated stiffness measurement performed well to rule out high-risk varices in HBV-related hepatocellular carcinoma: Screening for high-risk varices in HCC.

BACKGROUND: Esophagogastroduodenoscopy (EGD) is required to screen for high-risk varices (HRV) in patients with hepatocellular carcinoma (HCC), especially since overall survival rates have dramatically improved with new systemic therapies. AIM: To assess the Baveno VI and Baveno VII algorithms' ability to rule out HRV in hepatitis B virus (HBV)-related HCC METHODS: We prospectively enrolled consecutive patients with HBV related, compensated cirrhosis and newly diagnosed HCC who underwent liver stiffness measurement, spleen stiffness measurement (SSM) using a 100-Hz shear wave frequency, and EGD. RESULTS: From September 2021 to August 2023, we enrolled 219 patients with HCC, with 107 (48.9%) Barcelona Clinic Liver Cancer (BCLC) A, 28 (12.8%) BCLC B and 84 (38.3%) BCLC C, respectively. HRV prevalence was 28.8% (63/219). Baveno VI criteria safely (HRV missing rate, 3.2%) avoided 27.4% unnecessary EGDs, while the Baveno VII algorithm avoided 49.3% with HRV missing rate at 7.9% (5/63). The SSM ≤40 kPa avoided 47.5% of EGDs safely (HRV missing rate, 4.8%), significantly better than the Baveno VI criteria (p < 0.001) and comparable to the Baveno VII algorithm (p = 0.390). The SSM ≤40 kPa safely avoided EGDs in patient subgroups within Milan criteria, with portal vein tumour thrombosis or BCLC B/C or candidates for systemic therapy. CONCLUSIONS: We validated that the SSM ≤40 kPa using a 100-Hz probe could safely eliminate more unnecessary EGDs than the Baveno VI criteria in patients with HBV-related HCC. However, the efficacy of the Baveno VII algorithm in patients with HCC requires further investigation.

Respiratory syncytial virus co-opts hypoxia-inducible factor-1α-mediated glycolysis to favor the production of infectious virus.

IMPORTANCE: Respiratory syncytial virus (RSV) is the leading etiological agent of lower respiratory tract illness. However, efficacious vaccines or antiviral drugs for treating RSV infections are currently not available. Indeed, RSV depends on host cells to provide energy needed to produce progeny virions. Glycolysis is a series of oxidative reactions used to metabolize glucose and provide energy to host cells. Therefore, glycolysis may be helpful for RSV infection. In this study, we show that RSV increases glycolysis by inducing the stabilization, transcription, translation, and activation of hypoxia-inducible factor (HIF)-1α in infected cells, which is important for the production of progeny RSV virions. This study contributes to understanding the molecular mechanism by which HIF-1α-mediated glycolysis controls RSV infection and reveals an effective target for the development of highly efficient anti-RSV drugs.

Dense Convolutional Neural Network for Identification of Raman Spectra.

The rapid development of cloud computing and deep learning makes the intelligent modes of applications widespread in various fields. The identification of Raman spectra can be realized in the cloud, due to its powerful computing, abundant spectral databases and advanced algorithms. Thus, it can reduce the dependence on the performance of the terminal instruments. However, the complexity of the detection environment can cause great interferences, which might significantly decrease the identification accuracies of algorithms. In this paper, a deep learning algorithm based on the Dense network has been proposed to satisfy the realization of this vision. The proposed Dense convolutional neural network has a very deep structure of over 40 layers and plenty of parameters to adjust the weight of different wavebands. In the kernel Dense blocks part of the network, it has a feed-forward fashion of connection for each layer to every other layer. It can alleviate the gradient vanishing or explosion problems, strengthen feature propagations, encourage feature reuses and enhance training efficiency. The network's special architecture mitigates noise interferences and ensures precise identification. The Dense network shows more accuracy and robustness compared to other CNN-based algorithms. We set up a database of 1600 Raman spectra consisting of 32 different types of liquid chemicals. They are detected using different postures as examples of interfered Raman spectra. In the 50 repeated training and testing sets, the Dense network can achieve a weighted accuracy of 99.99%. We have also tested the RRUFF database and the Dense network has a good performance. The proposed approach advances cloud-enabled Raman spectra identification, offering improved accuracy and adaptability for diverse identification tasks.

Keyframe-aided resolution enhancement network for dynamic super-resolution structured illumination microscopy.

Deep learning has been used to reconstruct super-resolution structured illumination microscopy (SR-SIM) images with wide-field or fewer raw images, effectively reducing photobleaching and phototoxicity. However, the dependability of new structures or sample observation is still questioned using these methods. Here, we propose a dynamic SIM imaging strategy: the full raw images are recorded at the beginning to reconstruct the SR image as a keyframe, then only wide-field images are recorded. A deep-learning-based reconstruction algorithm, named KFA-RET, is developed to reconstruct the rest of the SR images for the whole dynamic process. With the structure at the keyframe as a reference and the temporal continuity of biological structures, KFA-RET greatly enhances the quality of reconstructed SR images while reducing photobleaching and phototoxicity. Moreover, KFA-RET has a strong transfer capability for observing new structures that were not included during network training.

Venetoclax with CAG regimen for early T-cell precursor acute lymphoblastic leukemia: a case report and literature review.

This article describes a potential treatment for early T-cell precursor acute lymphoblastic leukemia (ETP-ALL), a relatively rare and highly aggressive hematologic malignancy. A 59-year-old woman admitted to our hospital with enlarged cervical lymph nodes, weight loss, abnormal count, and morphology of peripheral blood cells was diagnosed with ETP-ALL according to morphology, immunology, cytogenetics, and molecular biology. The patient initially received two cycles of the VICP regimen, including vincristine, idarubicin, cyclophosphamide, and prednisone, and had a response with positive minimal residual disease (MRD). The patient was then given venetoclax plus the CAG regimen, including aclarubicin, cytosine arabinoside, and granulocyte colony-stimulating factor. After one cycle, the patient achieved complete remission with negative MRD and was eligible for allogeneic hematopoietic stem cell transplantation.

Dry eye syndrome model established in rabbits via mitomycin C injection in the lacrimal gland.

PURPOSE: To develop a new dry eye syndrome (DES) animal model by injecting mitomycin C (MMC) into the lacrimal glands (LGs) of rabbits evaluated by clinical examinations. MATERIALS AND METHODS: A volume of 0.1 mL of MMC solution was injected in the LG and the infraorbital lobe of the accessory LG of rabbits for DES induction. Twenty male rabbits were separated into three groups, the control group, and different concentration of MMC, (MMC 0.25: 0.25 mg/mL or MMC 0.50: 0.5 mg/mL) were tested. Both MMC-treated groups received MMC twice injection on day 0 and day 7. Assessment of DES included changes in tear production (Schirmer's test), fluorescein staining pattern, conjunctival impression cytology, and corneal histological examination. RESULTS: After MMC injection, no obvious changes in the rabbit's eyes were noted by slit-lamp examination. Both the MMC 0.25 and the MMC 0.5 groups revealed decreased tear secretion after injection, and the MMC 0.25 group showed a continuous decrease in tear secretion up to 14 days. Fluorescent staining showed punctate keratopathy in both MMC-treated groups. In addition, both MMC-treated groups demonstrated decreased numbers of conjunctival goblet cells after injection. CONCLUSION: This model induced decreased tear production, punctate keratopathy, and decreased numbers of goblet cells, which are consistent with the current understanding of DES. Therefore, injecting MMC (0.25 mg/mL) into the LGs is an easy and reliable method to establish a rabbit DES model which can apply in new drug screening.

Gout and risk of dementia, Alzheimer's disease or vascular dementia: a meta-epidemiology study.

Objectives: The association between gout and dementia, Alzheimer's disease (AD), or vascular dementia (VD) is not fully understood. The aim of this meta-analysis was to evaluate the risk of all-cause dementia, AD, and VD in gout patients with or without medication. Methods: Data sources were PubMed, Embase, the Cochrane Library, and reference lists of included studies. This meta-analysis included cohort studies assessing whether the risk of all-cause dementia, AD, and VD was associated with gout. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to access the overall certainty of evidence. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model, and publication bias was assessed with funnel plots and Egger's test. Results: A total of six cohort studies involving 2,349,605 individuals were included in this meta-analysis, which were published between 2015 and 2022. The pooling analysis shows that the risk of all-cause dementia was decreased in gout patients [RR = 0.67, 95% CI (0.51, 0.89), I2 = 99%, P = 0.005, very low quality], especially in gout patients with medication [RR = 0.50, 95% CI (0.31, 0.79), I2 = 93%, P = 0.003, low quality]. The risk of AD [RR = 0.70, 95% CI (0.63, 0.79), I2 = 57.2%, P = 0.000, very low quality] and VD [RR = 0.68, 95% CI (0.49, 0.95), I2 = 91.2%, P = 0.025, very low quality] was also decreased in gout patients. Despite the large heterogeneity, the sensitivity analysis indicated that the results were robust, and there was little evidence of publication bias. Conclusion: The risk of all-cause dementia, AD, and VD is decreased in gout patients, but the quality of evidence is generally low. More studies are still needed to validate and explore the mechanisms of this association. Systematic review registration: https://www.crd.york.ac.uk/prospero/#recordDetails, identifier: CRD42022353312.

Heterostructure of NiFe@NiCr-LDH for Active and Durable Oxygen Evolution Reactions in Alkaline Media.

Developing cost-effective, efficient, and durable catalysts for oxygen evolution reactions (OER) is the key for promoting large-scale H2 production through electrochemical water splitting. Herein, we report a facile method for fabricating an NiFe@NiCr-LDH catalyst toward alkaline OER. The electronic microscopy technique revealed that it has a well-defined heterostructure at the interface between the NiFe and NiCr phases. In 1.0 M KOH, the as-prepared NiFe@NiCr-LDH catalyst shows excellent catalytic performance, evidenced by an overpotential of 266 mV at the current density of 10 mA cm-2 and a small Tafel slope of 63 mV dec-1; both are comparable with the RuO2 benchmark catalyst. It also exhibits robust durability in long-term operation, manifested by a 10% current decay in 20 h, which is superior to that of the RuO2 catalyst. Such excellent performance is attributed to the interfacial electron transfer that occurs at the interfaces of the heterostructure, and the Fe(III) species facilitate the formation of Ni(III) species as active sites in NiFe@NiCr-LDH. This study offers a feasible strategy for preparing a transition metal-based LDH catalyst for OER toward H2 production and other electrochemical energy technologies.

Three-dimensional cerebral vasculature topological parameter extraction of transgenic zebrafish embryos with a filling-enhancement deep learning network.

Quantitative analysis of zebrafish cerebral vasculature is essential for the study of vascular development and disease. We developed a method to accurately extract the cerebral vasculature topological parameters of transgenic zebrafish embryos. The intermittent and hollow vascular structures of transgenic zebrafish embryos, obtained from 3D light-sheet imaging, were transformed into continuous solid structures with a filling-enhancement deep learning network. The enhancement enables the extraction of 8 vascular topological parameters accurately. Quantitation of the zebrafish cerebral vasculature vessels with the topological parameters show a developmental pattern transition from 2.5 to 5.5 dpf.

Functional Peptide-Loaded Gelatin Nanoparticles as Eyedrops for Cornea Neovascularization Treatment.

Background: Corneal neovascularization (NV) is a process of abnormal vessel growth into the transparent cornea from the limbus and can disturb the light passing through the cornea, resulting in vision loss or even blindness. The use of nanomedicine as an effective therapeutic formulation in ophthalmology has led to higher drug bioavailability and a slow drug release rate. In this research, we designed and explored the feasibility of a new nanomedicine, gp91 ds-tat (gp91) peptide-encapsulated gelatin nanoparticles (GNP-gp91), for inhibiting corneal angiogenesis. Methods: GNP-gp91 were prepared by a two-step desolvation method. The characterization and cytocompatibility of GNP-gp91 were analyzed. The inhibition effect of GNP-gp91 on HUVEC cell migration and tube formation was observed by an inverted microscope. The drug retention test in mouse cornea was observed by in vivo imaging system, fluorescence microscope, and DAPI/TAMRA staining. Finally, the therapeutic efficacy and evaluation of neovascularization-related factors were conducted through the in vivo corneal NV mice model via topical delivery. Results: The prepared GNP-gp91 had a nano-scale diameter (550.6 nm) with positive charge (21.7 mV) slow-release behavior (25%, 240hr). In vitro test revealed that GNP-gp91 enhanced the inhibition of cell migration and tube formation capacity via higher internalization of HUVEC. Topical administration (eyedrops) of the GNP-gp91 significantly prolongs the retention time (46%, 20 min) in the mouse cornea. In chemically burned corneal neovascularization models, corneal vessel area with a significant reduction in GNP-gp91 group (7.89%) was revealed when compared with PBS (33.99%) and gp91 (19.67%) treated groups via every two days dosing. Moreover, GNP-gp91 significantly reduced the concentration of Nox2, VEGF and MMP9 in NV's cornea. Conclusion: The nanomedicine, GNP-gp91, was successfully synthesized for ophthalmological application. These data suggest that GNP-gp91 contained eyedrops that not only have a longer retention time on the cornea but also can treat mice corneal NV effectively delivered in a low dosing frequency, GNP-gp91 eyedrops provides an alternative strategy for clinical ocular disease treatment in the culture.

Popular science and education of cosmetic surgery in China: Quality and reliability evaluation of Douyin short videos.

BACKGROUND: Douyin APP is the short video APP with the largest number of users in China. OBJECTIVE: This study aimed to evaluate the quality and reliability of short videos about cosmetic surgery on Douyin. METHODS: In August 2022, we retrieved and screened 300 short videos related to cosmetic surgery from Douyin, extracted basic video information, encoded the content and identified the video source. The quality and reliability of short video information were evaluated using the DISCERN instrument. RESULTS: A total of 168 short videos of cosmetic surgery were included in the survey, and the video sources included personal accounts and institutional accounts. Overall, the total proportion of institutional accounts (47/168, 27.98%) is significantly less than that of personal accounts (121/168, 72.02%); nonhealth professionals received the most praises, comments and even collections and reposts, while for-profit academic organizations or institutions received the least. The DISCERN scores of 168 short videos of cosmetic surgery were 3.74-4.58 (average 4.22). Content reliability (p = .04) and overall short video quality (p = .02) are significantly different, but short videos published from different sources have no significant difference in treatment selection (p = .052). CONCLUSION: The overall information quality and reliability of short videos about cosmetic surgery on Douyin are satisfactory in China. PATIENT OR PUBLIC CONTRIBUTION: The participants were involved in developing research questions, study design, management and conduct, interpretation of evidence and dissemination.

Effects of fermented dairy products on inflammatory biomarkers: A meta-analysis.

AIM: Fermented dairy products (FDPs) are made from raw milk under the action of specific microorganisms by lactic acid bacteria fermentation or co-fermentation of lactic acid bacteria, bifidobacteria, and yeast. The aim of this study was to explore the effects of FDPs on inflammatory biomarkers. DATA SYNTHESIS: A comprehensive search was conducted on four electronic databases, including PubMed, Web of Science, Embase, and the Cochrane Library. Finally, fourteen trials (15 arms) were included in this meta-analysis: yogurt (n = 9), fermented milk (n = 4), and kefir (n = 2). Additionally, the random effects model or fixed-effects model was used to pool the study results. Firstly, the analysis indicated that FDPs' supplementation decreased the levels of C-reactive protein (CRP) (SMD = -0.21; 95% CI: -0.40, -0.02; P = 0.033) and increased interferon-gamma (IFN-γ) levels (SMD = 0.12; 95% CI: 0.01, 0.23; P = 0.033). Furthermore, we obtained some statistically significant results in the following subgroups: CRP decreased in participants with metabolic diseases. IFN-γ increased in the intervention that lasted ≥12 weeks, Asian, yogurt, and healthy population. Finally, there was no significant effect on tumor necrosis factor-alpha, interleukin (IL)-6, IL-10, and IL-2. CONCLUSIONS: FDPs reduced CRP and increased IFN-γ, but they had no effect on other inflammatory markers. The results showed that the consumption of FDPs was slightly associated with reduced inflammation, but because of the limited literature, these results should be interpreted with caution.

CO2 fractional laser combined with triamcinolone acetonide injection for the hypertrophic scars: which is first?

The aim of this study is to investigate and analyze the effect of different application sequences of CO2 fractional laser and triamcinolone acetonide injection on the application effect of hypertrophic scar in one operation. Patients with hypertrophic scars who received CO2 lattice laser combined with triamcinolone acetonide injection from January 2021 to December 2022 were retrospectively analyzed. According to the different initial operations, they were divided into CO2 FL-TA group and TA-CO2 FL group. The Vancouver Scar Scale score and scar thickness of the two groups before and after treatment were analyzed. The complications occurred in the two groups during the treatment period. The clinical efficacy of the two groups before and after the treatment was calculated. Before treatment, there was no difference in scar thickness and VSS score between the two groups (P > 0.05). After treatment, the above indexes in CO2 FL-TA group were significantly better than those in TA-CO2 FL group (P < 0.05); the incidence of adverse reactions in CO2 FL-TA group was 9.38%, which was significantly lower than that in TA-CO2 FL group (18.75%) (P < 0.05); the total effective rate of CO2 FL-TA group was 90.63%, which was significantly higher than that in TA-CO2 FL group (65.63%) (P < 0.05). In the process of combined CO2 fractional laser and triamcinolone acetonide injection in the treatment of hypertrophic scars, CO2 fractional laser treatment first, and then triamcinolone acetonide injection can reduce the number of treatments, reduce the incidence of adverse reactions, and achieve more satisfactory treatment effect.

Analysis of risk factors for quality management to blepharoplasty based on DEMATEL-ISM.

OBJECTIVE: Blepharoplasty is a typical complex structural system, which involves many factors and the interaction among them. Therefore, it is the basis of controlling the occurrence of medical complications in blepharoplasty to clarify the hierarchical relationship of various risk factors and find out the key risk factors. METHODS: On the basis of identifying the risk factors for quality management of blepharoplasty by means of literature research, questionnaire survey and expert interview, the risk factor model of blepharoplasty quality management were analyzed and constructed. The relationship between the risk factors and the degree of influence on the risk factors was studied using Decision-Making Trialand Evaluation Laboratory and Interpretative Structural Modeling Method, and the hierarchical structure model of the risk factors for blepharoplasty quality management was obtained. RESULTS: Six levels of risk factors in quality management of blepharoplasty were identified and classified, and the causal attributes among risk factors were determined. Six key risk factors in quality management of double eyelid surgery were determined according to centrality, and finally the above risk factors were divided into three categories: direct cause, excessive cause, and essential cause. CONCLUSIONS: This study realizes the comprehensive risk factor analysis of the complex system of quality management of blepharoplasty, which can provide reference for plastic surgeons to make safety decisions of blepharoplasty.

Design for a Multicentre Prospective Cohort for the Assessment of Platelet Function in Patients with Hepatitis-B-Virus-Related Acute-on-Chronic Liver Failure.

Background: Acute-on-chronic liver failure (ACLF) has high short-term mortality and lacks sufficient medical therapy. Available algorithms are unable to precisely predict short-term outcomes or safely stratify patients with ACLF as emergent liver transplantation candidates. Therefore, a personalized prognostic tool is urgently needed. Purpose: Platelet function and its clinical significance in ACLF patients with chronic hepatitis B virus (HBV) infection have not been investigated. This study aimed to assess changes in platelet function using thromboelastography (TEG) and platelet mapping (TEG-PM) in HBV-related ACLF patients. Methods: Chronic liver disease patients with acute decompensation or acute hepatic injury were recruited. The derivation cohort enrolled HBV-related patients at Nanfang Hospital. HBV-related and non-HBV-related patients were both enrolled in internal and external validation cohorts at seven university hospitals. TEG and TEG-PM were performed at baseline in the derivation cohort and baseline, day 7, and day 14 in the validation cohorts. The primary outcome was all-cause 28-day mortality. Status check and new-onset complications were recorded during the 3-month follow-up, but status check will extend to 5 years. Conclusion and Future Plans: In this study, 586 participants were enrolled, including 100 in derivation cohort, 133 in internal validation cohort, and 353 in external validation cohort. Biomaterials, including plasma, serum, urine, and some explanted liver tissues, were collected from these patients. A 3-month follow-up with survival status was completed. The baseline characteristics indicated that 51% of the patients had adenosine diphosphate (ADP)-hyporesponsive circulating platelets. The prognostic potential of platelet function will be explored in the derivation cohort (HBV-related ACLF patients) and further substantiated in the validation cohorts (HBV-related and non-HBV-related ACLF patients). Biosamples are currently used to explore the underlying mechanisms related to ADP-hyporesponsive platelets. The ongoing proteomic and metabolic analyses will provide new insights into the pathogenesis of extrahepatic organ failures in ACLF patients.