Dissociation of Hypertension and Renal Damage After Cessation of High-Salt Diet in Dahl Rats.

BACKGROUND: Every year, thousands of patients with hypertension reduce salt consumption in the efforts to control their blood pressure. However, hypertension has a self-sustaining character in a significant part of the population. We hypothesized that chronic hypertension leads to irreversible renal damage that remains after removing the trigger, causing an elevation of the initial blood pressure. METHODS: Dahl salt-sensitive rat model was used for chronic, continuous observation of blood pressure. Rats were fed a high salt diet to induce hypertension, and then the diet was switched back to normal sodium content. RESULTS: We found that developed hypertension was irreversible by salt cessation: after a short period of reduction, blood pressure grew even higher than in the high-salt phase. Notably, the self-sustaining phase of hypertension was sensitive to benzamil treatment due to sustaining epithelial sodium channel hyperactivity, as shown with patch-clamp analysis. Glomerular damage and proteinuria were also irreversible. In contrast, some mechanisms, contributing to the development of salt-sensitive hypertension, normalized after salt restriction. Thus, flow cytometry demonstrated that dietary salt reduction in hypertensive animals decreased the number of total CD45+, CD3+CD4+, and CD3+CD8+ cells in renal tissues. Also, we found tubular recovery and improvement of glomerular filtration rate in the postsalt period versus a high-salt diet. CONCLUSIONS: Based on earlier publications and current data, poor response to salt restriction is due to the differential contribution of the factors recognized in the developmental phase of hypertension. We suggest that proteinuria or electrolyte transport can be prioritized over therapeutic targets of inflammatory response.

[Therapeutic strategy for totally thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation].

Objective: To examine the therapeutic strategy and its impacting factors by analyzing the perioperative outcomes of total thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation with cardiopulmonary bypass. Methods: This study is a retrospective case series. Totally 63 patients who underwent repeat mitral valve surgery by the same surgeon from January 2021 to December 2023 in Department of Cardiovascular Surgery, the First Medical Center of People's Liberation Army General Hospital were retrospectively enrolled. There were 28 males and 35 females with an age of (58.3±15.9) years (range: 13 to 84 years). Surgery was performed using a totally thoracoscopic approach under moderate hypothermia-induced ventricular fibrillation. Mitral valvuloplasty was completed in 32 cases and mitral valve replacement in 31 cases. Preoperative baseline data and perioperative outcomes of the patients were collected and Logistic regression was used to analyze independent influencing factors of premature ventricular contractions in the early postoperative period. Results: The intraoperative cardiopulmonary bypass time was (191.5±50.9) minutes (range: 95 to 286 minutes), and the hypothermic ventricular fibrillation time was (99.0±39.8) minutes (range: 34 to 203 minutes). The anal temperature before the start of cardiopulmonary bypass was (36.3±0.5) ℃ (range: 35.2 to 38.0 ℃), the lowest intraoperative anal temperature was (27.3±1.3) ℃(range: 23.7 to 30.1 ℃), and the anal temperature at the time of the cessation of cardiopulmonary bypass was (36.3±0.4) ℃ (range: 35.2 to 37.0 ℃), and excessive rewarming was observed in 33 cases. Six cases applied the artificial heart assist device. Seventeen cases developed premature ventricular contractions in the early postoperative period. Two cases developed neurologic complications. Five cases developed respiratory complications. One case developed urological systemic complications. Six cases were mechanically ventilated for more than 3 days, and the duration of ICU stay in 16 cases was more than 3 days and the postoperative discharge time of (M(IQR)) 8.0 (3.5) days (range: 3 to 26 days). Two cases died or were discharged voluntarily. Logistic regression results showed that persistent preoperative atrial fibrillation (OR=11.424, 95%CI: 1.477 to 144.564, P=0.033) and excessive rewarming (OR=15.249, 95%CI: 1.357 to 279.571, P=0.038) were independent risk factors for the appearance of premature ventricular contractions in the early postoperative period. Conclusions: The technique of total thoracoscopic surgery under induced moderate hypothermic ventricular fibrillation with cardiopulmonary bypass could be applied to repeated mitral valve surgeries with less trauma and faster recovery. Persistent preoperative atrial fibrillation and excessive rewarming are independent risk factors for the occurrence of premature ventricular contractions in the early postoperative period.

[Progress in complex network theory-based studies on the associations between health-related behaviors and chronic non-communicable diseases].

In recent years, the research focus on health-related behavior and chronic non-communicable diseases has shifted from the analysis on independent effects of multiple causes on a single outcome to the evaluation the complex relationships between multiple causes and multiple effects. Complex network theory, an important branch of system science, considers the relationships among factors in a network and can reveal how health-related behaviors interact with chronic diseases through a series of complex network models and indicators. This paper summarizes the definition and development of complex network theory and its commonly used models, indicators, and case studies in the field of health-related behavior and chronic disease to promote the application of complex network theory in the field of health and provide reference and tools for future research of the relationship between health-related behavior and chronic disease.

[Mediating effects of body mass index and lipid levels on the association between alcohol consumption and hypertension in occupational population].

Objective: To investigate the association between alcohol consumption and hypertension and SBP, DBP and the mediating effects of body mass index (BMI) and lipid level in occupational population, and provide reference for the intervention and prevention of hypertension. Methods: Based on the data of Southwest Occupational Population Cohort from China Railway Chengdu Group Co., Ltd., the information about the demographic characteristics, behavior and lifestyle, blood pressure and lipids level of the participants were collected through questionnaire survey, physical examination and blood biochemical test. Logistic/linear regression was used to analyze the association between alcohol consumption and hypertension, SBP and DBP. The individual and joint mediating effects of BMI, HDL-C, LDL-C, TG, and TC were explored through causal mediating analysis. A network analysis was used to explore the correlation between alcohol consumption, BMI and lipid levels, and hypertension. Results: A total of 22 887 participants were included, in whom 1 825 had newly detected hypertension. Logistic regression analysis found that current/former drinkers had a 33% increase of risk for hypertension compared with never-drinkers (OR=1.33, 95%CI:1.19-1.48). Similarly, alcohol consumption could increase SBP (ß=1.05, 95%CI:0.69-1.40) and DBP (ß=1.10, 95%CI:0.83-1.38). Overall, BMI and lipid levels could mediate the associations between alcohol consumption and hypertension, SBP and DBP by 21.91%, 28.40% and 22.64%, respectively. BMI and TG were the main mediators, and they were also the two nodes with the highest edge weight and bridge strength centrality in the network of alcohol consumption, BMI, lipid levels and hypertension. Conclusions: Alcohol consumption was associated with increased risk for hypertension, and BMI and TG were important mediators and key nodes in the network. It is suggested that paying attention to the alcohol consumption, BMI and TG might help prevent hypertension in occupational population.

[Association between work environment noise perception and cardiovascular diseases, depressive symptoms, and their comorbidity in occupational population].

Objective: To explore the association between occupational noise perception and cardiovascular disease (CVD), depression symptoms, as well as their comorbidity in occupational population and provide evidence for the prevention and control of physical and mental illnesses. Methods: A cross-sectional survey design was adopted, based on baseline data in population in 28 prefectures in Sichuan Province and Guizhou Province, and 33 districts (counties) in Chongqing municipality from Southwest Occupational Population Cohort from China Railway Chengdu Group Co., Ltd. during October to December 2021. A questionnaire survey was conducted to collect information about noise perception, depressive symptoms, and the history of CVD. Latent profile analysis model was used to determine identify noise perception type, and multinomial logistic regression analysis was conducted to explore the relationship between different occupational noise perception types and CVD, depression symptoms and their comorbidity. Results: A total of 30 509 participants were included, the mean age was (36.6±10.5) years, and men accounted for 82.0%. The direct perception of occupational noise, psychological effects and hearing/sleep impact of occupational noise increased the risk for CVD, depressive symptoms, and their comorbidity. By using latent profile analysis, occupational noise perception was classified into four levels: low, medium, high, and very high. As the level of noise perception increased, the association with CVD, depressive symptoms, and their comorbidity increased. In fact, very high level occupational noise perception were found to increase the risk for CVD, depressive symptoms, and their comorbidity by 2.14 (95%CI: 1.73-2.65) times, 8.80 (95%CI: 7.91-9.78) times, and 17.02 (95%CI: 12.78-22.66) times respectively compared with low-level occupational noise perception. Conclusions: Different types of occupational noise perception are associated with CVD and depression symptom, especially in the form of CVD complicated with depression symptom. Furthermore, the intensity of occupational noise in the work environment should be reduced to lower the risk for physical and mental health.

Multiparameter spectral CT-based radiomics in predicting the expression of programmed death ligand 1 in non-small-cell lung cancer.

AIM: To explore the value of radiomics for predicting the expression of programmed death ligand 1 (PD-L1) in non-small-cell lung cancer (NSCLC) based on multiparameter spectral computed tomography (CT) images. MATERIALS AND METHODS: A total of 220 patients with NSCLC were enrolled retrospectively and divided into the training (n=176) and testing (n=44) cohorts. The radiomics features were extracted from the conventional CT images, mono-energy 40 keV images, iodine density (ID) maps, Z-effective maps, and electron density maps. The logistic regression (LR) and support vector machine (SVM) algorithms were employed to build models based on radiomics signatures. The prediction abilities were qualified by the area under the curve (AUC) obtained from the receiver operating characteristic (ROC) curve. Internal validation was performed on the independent testing dataset. RESULTS: The combined model for PD-L1 ≥1%, which consisted of the radiomics score (rad-score; p<0.0001), white blood cell (WBC; p=0.027) counts, and air bronchogram (p=0.003), reached the highest performance with the AUCs of 0.873 and 0.917 in the training and testing dataset, respectively, which was better than the radiomics model with the AUCs of 0.842 and 0.886. The combined model for PD-L1 ≥50%, which consisted of rad-score (p<0.0001) and WBC counts (p=0.027), achieved the highest performance in the training and testing dataset with AUCs of 0.932 and 0.903, respectively, which was better than the radiomics model with AUCs of 0.920 and 0.892, respectively. CONCLUSION: The radiomics model based on the multiparameter images of spectral CT can predict the expression level of PD-L1 in NSCLC. The combined model can obtain higher prediction efficiency and serves as a promising method for immunotherapy selection.

[Reappraisals of biological behaviors of PDGFRA mutant gastrointestinal stromal tumor].

Objective: To investigate the biological behavior spectrum of platelet-derived growth factor alpha receptor (PDGFRA)-mutant gastrointestinal stromal tumor (GIST), and to compare the clinical values of the Zhongshan method of benign and malignant evaluation with the modified National Institutes of Health (NIH) risk stratification. Methods: A total of 119 cases of GIST with PDGFRA mutation who underwent surgical resection at Zhongshan Hospital, Fudan University from 2009 to 2020 were collected. The clinicopathological data, follow-up records, and subsequent treatment were reviewed and analyzed statistically. Results: There were 79 males and 40 females. The patients ranged in age from 25 to 80 years, with a median age of 60 years. Among them, 115 patients were followed up for 1-154 months, and 13 patients progressed to disease. The 5-year disease-free survival (DFS) and overall survival (OS) were 90.1% and 94.1%, respectively. According to the modified NIH risk stratification, 8 cases, 32 cases, 38 cases, and 35 cases were very-low risk, low risk, intermediate risk, and high risk, and 5-year DFS were 100.0%, 95.6%, 94.3%, and 80.5%, respectively. There was no significant difference in prognosis among the non-high risk groups, only the difference between high risk and non-high risk groups was significant (P=0.029). However, the 5-year OS was 100.0%, 100.0%, 95.0% and 89.0%, and there was no difference (P=0.221). According to the benign and malignant evaluation Zhongshan method, 43 cases were non-malignant (37.4%), 56 cases were low-grade malignant (48.7%), 9 cases were moderately malignant (7.8%), and 7 cases were highly malignant (6.1%). The 5-year DFS were 100.0%, 91.7%, 77.8%, 38.1%, and the difference was significant (P<0.001). The 5-year OS were 100.0%, 97.5%, 77.8%, 66.7%, the difference was significant (P<0.001). Conclusions: GIST with PDGFRA gene mutation shows a broad range of biological behavior, ranging from benign to highly malignant. According to the Zhongshan method, non-malignant and low-grade malignant tumors are common, the prognosis after surgery is good, while the fewer medium-high malignant tumors showed poor prognosis after surgical resection. The overall biological behavior of this type of GIST is relatively inert, which is due to the low proportion of medium-high malignant GIST. The modified NIH risk stratification may not be effective in risk stratification for PDGFRA mutant GIST.

Pathogenic/likely pathogenic mutations identified in Vietnamese children diagnosed with autism spectrum disorder using high-resolution SNP genotyping platform.

Among the most prevalent neurodevelopmental disorders, Autism Spectrum Disorder (ASD) is highly diverse showing a broad phenotypic spectrum. ASD also couples with a broad range of mutations, both de novo and inherited. In this study, we used a proprietary SNP genotyping chip to analyze the genomic DNA of 250 Vietnamese children diagnosed with ASD. Our Single Nucleotide Polymorphism (SNP) genotyping chip directly targets more than 800 thousand SNPs in the genome. Our primary focus was to identify pathogenic/likely pathogenic mutations that are potentially linked to more severe symptoms of autism. We identified and validated 23 pathogenic/likely pathogenic mutations in this initial study. The data shows that these mutations were detected in several cases spanning multiple biological pathways. Among the confirmed SNPs, mutations were identified in genes previously known to be strongly associated with ASD such as SLCO1B1, ACADSB, TCF4, HCP5, MOCOS, SRD5A2, MCCC2, DCC, and PRKN while several other mutations are known to associate with autistic traits or other neurodevelopmental disorders. Some mutations were found in multiple patients and some patients carried multiple pathogenic/likely pathogenic mutations. These findings contribute to the identification of potential targets for therapeutic solutions in what is considered a genetically heterogeneous neurodevelopmental disorder.

[Femtosecond laser assisted cataract surgery in a complicated cataract patient with reverse implantable collamer len: a case report].

The patient is a 33-year-old female who, 11 years ago, underwent bilateral posterior chamber phakic intraocular lens (pIOL) implantation due to myopia. She presented with a 2-year history of declining vision in her right eye and sought medical attention. She received femtosecond laser-assisted cataract surgery combined with pIOL extraction. Anterior segment optical coherence tomography and ultrasound biomicroscopy both showed an inverted pIOL in the right eye. Good visual results were achieved, and there were no complications during the six-month follow-up.

Effect of HIV infection on plasma exposure to first-line TB drugs and target attainment in children.

BACKGROUND: Whether HIV infection adversely affects exposure to first-line TB drugs in children is debatable. It is also not known whether HIV infection increases the risk of plasma underexposure or overexposure to TB drugs. This study sought to address these questions.DESIGN/METHODS: Children on TB treatment were enrolled. After 4 weeks on therapy, blood samples were collected at pre-dose, 1, 2, 4, 8, and 12 h post-dose for pharmacokinetic analysis. Plasma drug exposure below and above the lower and upper bounds of the 95% confidence intervals of the reference mean for children were considered underexposure and overexposure, respectively. The effect of HIV infection on drugs exposure and risk of underexposure were examined using multivariate analysis.RESULTS: Of 86 participants (median age: 4.9 years), 45 had HIV coinfection. HIV coinfection was associated with lower pyrazinamide (PZA) and ethambutol exposures in adjusted analysis. Patients with TB-HIV coinfection were three times more likely to have PZA underexposure than those with TB only. Underexposure of rifampin was common irrespective of HIV coinfection status.CONCLUSIONS: HIV coinfection was associated with a higher risk for PZA underexposure in children. This effect should be accounted for in models and simulations to determine optimal PZA dose for children.

[Efficacy analysis of laparoscopic sleeve gastrectomy in morbidly obese patients aged 10-21 years].

Objective: To investigate the efficacy of laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients aged 10 to 21 years. Methods: We conducted a retrospective analysis of clinical data from 89 out of 200 patients who underwent LSG at the Gastrointestinal Surgery/Weight Loss Center of the First Affiliated Hospital of Jinan University between January 2015 and December 2020. The primary outcome measures were the completion rate of LSG, the incidence of perioperative complications, and weight-related indicators 3, 6, 12, and ≥24 months postoperatively. Additionally, we compared glucose metabolism, lipid metabolism, vitamin levels, liver function, and other relevant biochemical variables before and after surgery. Normally distributed continuous data are presented as x±s. Because the numbers of patients at each follow-up time point were not identical with the number of patients in the study cohort preoperatively, independent sample t-tests were used for intergroup comparisons. Non-normally distributed continuous data are presented as M(Q1, Q3), and Mann-Whitney U tests were used for intergroup comparisons. Results: Among the 89 patients, 35 were male (39.3%), the mean age was (18±2) years, and mean body mass index (BMI) 38.5±4.8 kg/m²; 37 of the patients having a BMI greater than 40 kg/m². Additionally, 63 patients (70.8%) had fatty livers, 34 (38.2%) hyperuricemia, 31(34.8%) sleep apnea syndrome, 20 (22.4%) gastroesophageal reflux, eight (8.9%) type 2 diabetes, and two (2.2%) hypertension. All 89 patients underwent LSG surgery successfully, with no conversions to open surgery. During the perioperative period, there were no cases of major bleeding, gastric leakage, or infections. Notable postoperative symptoms included nausea, vomiting, and pain, most of which improved by the second postoperative day. BMI values 3, 6, and 12 months postoperatively had decreased to 31.5±5.8 kg/m², 28.6±4.3 kg/m², and 26.3±4.4 kg/m², respectively. All of these BMI values differed significantly from preoperative values (all P<0.05). At 12 and ≥24 months postoperatively, the percentages of total weight loss were (31.3±9.3)% and (33.1±10.5)%, respectively, both differing significantly from 3 months postoperatively (20.5±5.1)% (all P<0.05). The percentages of excess weight loss at 12 and ≥24 months postoperatively were 91% (70%, 113%) and 95% (74%, 118%) , respectively, both differing significantly from the percentage of total weight loss 3 months postoperatively (56% [45%, 72%]) (both P<0.05). Alanine transaminase and aspartate transaminase serum concentrations decreased from preoperative values of 44.4 (25.5, 100.5) U/L and 29.0 (9.5, 48.0) U/L to 14.0 (10.8, 18.3) U/L and 13.0 (10.5, 17.3) U/L, respectively, ≥24 months postoperatively. Hemoglobin A1c decreased from 5.6 (5.3, 5.8)% preoperatively to ≥24 months postoperatively 5.3 (5.0, 5.4)%. High-density lipoprotein increased from 1.0 (0.9, 1.2) mmol/L preoperatively to 1.4 (1.1, 1.6) mmol/L ≥24 months postoperatively. Vitamin B12 decreased from 350.0 (256.8, 441.3) µg/L preoperative to 230.3(195.4, 263.9) µg/L ≥24 months postoperatively. All differed significantly from preoperative values (all P<0.05). Conclusion: LSG has favorable efficacy in morbidly obese patients aged 10 to 21 years. However, further confirmation is required through long-term, multicenter, randomized, controlled trials.

[Predictive value of aMAP risk score for early recurrence of small hepatocellular carcinoma after microwave ablation].

Objective: To explore the value of the aMAP risk score (age, male, albumin-bilirubin, and platelets) to predict early recurrence within one year after microwave ablation in patients with small hepatocellular carcinoma. Methods: This was a retrospective study that enrolled 142 patients diagnosed with hepatocellular carcinoma who were treated with microwave ablation in the Department of Hepatology Unit of Nanfang Hospital, Southern Medical University from July 2016 to July 2021. The cohort enrolled 121 male and 21 female patients, including 110 patients that were <60 years old. All the patients were followed-up after microwave ablation to evaluate residual tumor and recurrence of tumor by computed tomography or magnetic resonance imaging. The observation indices mainly included general data and imaging data of patients. Using the X-tile tools, patients were divided into two groups: a high aMAP score group and a low aMAP score group. Multivariate Cox regression analysis was conducted for comparison of independent risk factors. Results: Multivariate Cox regression showed that high aMAP score, maximum tumor diameter >20 mm, and high AFP were the independent risk factors of early recurrence (all P<0.05). Kaplan-Meier survival curves showed that the median recurrence-free survival was 25.5 months in the low aMAP score group and 6.1 months in the high aMAP score group (P=0.001). Conclusions: The aMAP score could predict the early recurrence within 1 year of small hepatocellular carcinoma after microwave ablation. Patients with high aMAP score should undergo rigorous postoperative follow-up evaluations..

[Effects of tibial second toe free flap bridged with blood flow and nerve in the treatment of severe flexion contracture of the proximal interphalangeal joint].

Objective: To investigate the effects of tibial second toe free flap bridged with blood flow and nerve in the treatment of severe flexion contracture of the proximal interphalangeal joint. Methods: A retrospective observational study was conducted. From March 2013 to October 2019, 9 patients with severe flexion contracture (type Ⅲ) of the proximal interphalangeal joint after trauma operation, conforming to the inclusion criteria, were hospitalized in Suzhou Ruihua Orthopaedic Hospital, including 5 males and 4 females, aged from 17 to 62 years. After the contracture tissue affecting the extension of the proximal interphalangeal joint was cut off, and the scar tissue was resected, the size of the volar wound near the proximal interphalangeal joint in extended position was 2.0 cm×1.0 cm-2.5 cm×1.5 cm, with the length of proper digital artery and nerve defect being 1.0-1.5 cm. A free flap of the same size as the wound was cut from the tibial side of the second toe and transplanted to repair the wound, and the defective proper digital artery and nerve was repaired by bridging with the tibial proper plantar digital artery and nerve of about 1.5 cm in length. The full-thickness skin graft was taken from the proximal tibial side of the lower leg to repair the wound at flap donor site. The wound at skin graft donor site was sutured directly. The survival of flap and skin graft was observed after operation. The patients were followed up, and at the last follow-up, the recovery of the affected finger and the second toe, including the donor and recipient areas were observed, the two-point discrimination distances of the flap repaired site and the pulp of the affected finger were observed and measured at the same time, the blood flow patency of bridged vessel of the affected finger was examined by Allen test, and the function of the proximal interphalangeal joint of the affected finger was evaluated according to Chinese Medical Association's standard for the range of motion of proximal interphalangeal joint. Results: The flaps and skin grafts survived smoothly after operation. The follow-up after operation lasted for 5 to 22 months, with a mean of 10 months. At the last follow-up, the flap repaired site had good shape, good color and texture, with the two-point discrimination distance being 9-12 mm, and the two-point discrimination distance of the pulp of the affected finger was 6-10 mm; the Allen test results of the affected fingers were all negative (i.e., the bridged vessels had good blood flow patency), with no recurrence of flexion contracture, and the function of the proximal interphalangeal joint was evaluated as excellent; the skin graft area of the second toe was not ruptured but was a little pigmented, and the flexion and extension activities of toe were good. Conclusions: The tibial second toe free flap bridged with blood flow and nerve has reliable therapeutic effect in the treatment of severe flexion contracture of the proximal interphalangeal joint, and the color and texture of the flap repaired area are good. Bridging to repair the severely contracted proper digital artery and nerve is beneficial to improve the blood supply of the finger body and rebuild the sensation.

[Developing traditional medical heritage for further achievements in medical history and literature research-Commemorating the establishment of China Institute for History of Medicine and Medical Literature in the China Academy of Traditional Chinese Medicine].

The Institute of Chinese Medical History and Literature in the China Academy of Traditional Chinese Medicine was officially established on May 28, 1982. Its predecessor was the Medical History Research Office in the Chinese Medicine Institute of the Central Institute of Health, the Editorial Office of the China Academy of Traditional Chinese Medicine, and the Theory and Literature Research Office of the Institute of Acupuncture and Moxibustion. Before that, the Research Office of Chinese Medical History and Literature in the China Academy of Traditional Chinese Medicine was established in 1971. It made remarkable achievements in scientific research, personnel training and discipline construction in terms of medical history and literature. It was upgraded to the Institute with the approval of the Ministry of Health in 1980. After its establishment, the institute has benefited from great achievements.

The value of right ventricular ultrasound assessment and cardiac biomarkers in the prognosis of sepsis.

OBJECTIVE: The aim of this study was to explore the risk factors affecting the prognosis of patients with sepsis using a prospective design. PATIENTS AND METHODS: From January 2022 to March 2023, a prospective study was conducted in the Intensive Care Unit (ICU) of Cangzhou Central Hospital, including 58 patients who met the diagnostic criteria for sepsis. Patients were divided into a survival group (39 cases) and a death group (19 cases) based on outcome. Within 24 hours, the following indicators were collected: gender, age, underlying diseases, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, cardiac troponin I (cTnI), B-type natriuretic peptide (BNP), lactate, procalcitonin, ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), systolic velocity (S'), and global longitudinal strain/strain rate (GLS/GLSr) and global circumferential strain/strain rate (GCS/GCSr) by speckle tracking. Logistic regression analysis was used to evaluate the risk factors for mortality in septic patients, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of various risk factors for sepsis-related death. RESULTS: There was no significant difference in gender, age, underlying diseases, BNP, procalcitonin, EF, TAPSE, S', GLSr, GCS, or GCSr between the two groups (p>0.05). There were statistically significant differences in APACHE II score, SOFA score, cTnI, lactate, and GLS between the two groups (p<0.05). Logistic regression analysis showed that SOFA score (OR=2.32, 95% CI: 1.067-5.289, p<0.05), cTnI (OR=1.19, 95% CI: 1.001-1.312, p<0.05), and GLS (OR=1.58, 95% CI: 1.012-2.721, p<0.05) were risk factors for sepsis-related death (p<0.05). The areas under the ROC curves for SOFA score, cTnI, and GLS were 0.769, 0.757, and 0.846, respectively. CONCLUSIONS: SOFA score, cTnI, and GLS are independent risk factors for mortality in patients with sepsis. Among these factors, GLS has the highest predictive value for patient prognosis. Therefore, when predicting the prognosis of patients with sepsis, the assessment of right ventricular ultrasound can be used in clinical practice.

[Advances in endoscopic sleeve gastroplasty for the treatment of obesity and metabolic disease].

Obesity poses a serious threat to human health, and although bariatric surgery has been proven effective treatment for morbidly obese patients, its surgical risks and high medical costs limit its clinical application and popularity. Endoscopic sleeve gastroplasty (ESG), as a relatively new endoscopic surgery technique for weight loss, has satisfactory weight loss effects compared to laparoscopic sleeve gastrectomy and lifestyle interventions, while preserving the normal structure of the stomach. Its weight loss effects and safety have been validated in multicenter studies abroad. Although, ESG has not yet been widely performed in China, with the gradual maturity of this technique, its prospects are worth attention in the field of weight loss. In the future, large-scale, long-term, multi-center studies are urgently needed in China to clarify the long-term effects, remission of comorbidities, and occurrence of complications of ESG surgery in obese and metabolic disease patients.

Quantitative image features of gadoxetic acid-enhanced MRI for predicting glypican-3 expression of small hepatocellular carcinoma ≤3 cm.

AIM: To explore the value of quantitative image features of gadoxetic acid-enhanced magnetic resonance imaging (MRI) for predicting Gglypican-3 (GPC3) expression of single hepatocellular carcinoma (HCC) ≤3 cm. MATERIALS AND METHODS: One hundred and forty-nine patients with histopathologically confirmed HCC were included retrospectively. Quantitative image features and clinicopathological parameters were analysed. The significant predictors for GPC3 expression were identified using multivariate logistic regression analyses. Nomograms were constructed from the prediction model and the progression-free survival (PFS) rate was evaluated by the Kaplan-Meier method. RESULTS: The tumour-to-liver signal intensity (SI) ratio on the hepatobiliary phase (HBP; odds ratio [OR] = 0.004; p=0.001), serum alpha-fetoprotein (AFP) > 20 ng/ml (OR=6.175; p<0.001), and non-smooth tumour margin (OR=4.866; p=0.002) were independent significant factors for GPC3 expression. When the three factors were combined, the diagnostic specificity was 97.7% (42/43). The nomogram based on the predictive model performed satisfactorily (C-index: 0.852). Kaplan-Meier curves showed that patients with GPC3-positive HCCs have lower PFS rates than patients with GPC3-negative HCCs (Log-rank test, p=0.006). CONCLUSION: The tumour-to-liver SI ratio on the HBP combined with serum AFP >20 ng/ml and non-smooth tumour margin are potential predictive factors for GPC3 expression of small HCC ≤3cm. GPC3 expression is correlated with a poor prognosis in HCC patients.