[Establishment and efficiency test of a clinical prediction model of bronchopulmonary dysplasia associated pulmonary hypertension in very premature infants]

Objective: To develop a risk prediction model for identifying bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH) in very premature infants. Methods: This was a retrospective cohort study. The clinical data of 626 very premature infants whose gestational age <32 weeks and who suffered from BPD were collected from October 1st, 2015 to December 31st, 2021 of the Seventh Medical Center of the People's Liberation Army General Hospital as a modeling set. The clinical data of 229 very premature infants with BPD of Hunan Children's Hospital from January 1 st, 2020 to December 31st, 2021 were collected as a validation set for external verification. The very premature infants with BPD were divided into PH group and non PH group based on the echocardiogram after 36 weeks' corrected age in the modeling set and validation set, respectively. Univariate analysis was used to compare the basic clinical characteristics between groups, and collinearity exclusion was carried out between variables. The risk factors of BPD associated PH were further screened out by multivariate Logistic regression, and the risk assessment model was established based on these variables. The receiver operating characteristic (ROC) area under curve (AUC) and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the model's discrimination and calibration power, respectively. And the calibration curve was used to evaluate the accuracy of the model and draw the nomogram. The bootstrap repeated sampling method was used for internal verification. Finally, decision curve analysis (DCA) to evaluate the clinical practicability of the model was used. Results: A total of 626 very premature infants with BPD were included for modeling set, including 85 very premature infants in the PH group and 541 very premature infants in the non PH group. A total of 229 very premature infants with BPD were included for validation set, including 24 very premature infants in the PH group and 205 very premature infants in the non PH group. Univariate analysis of the modeling set found that 22 variables, such as artificial conception, fetal distress, gestational age, birth weight, small for gestational age, 1 minute Apgar score ≤7, antenatal corticosteroids, placental abruption, oligohydramnios, multiple pulmonary surfactant, neonatal respiratory distress syndrome (NRDS)>stage Ⅱ, early pulmonary hypertension, moderate-severe BPD, and hemodynamically significant patent ductus arteriosus (hsPDA) all had statistically significant influence between the PH group and the non PH group (all P<0.05). Antenatal corticosteroids, fetal distress, NRDS >stage Ⅱ, hsPDA, pneumonia and days of invasive mechanical ventilation were identified as predictive variables and finally included to establish the Logistic regression model. The AUC of this model was 0.86 (95%CI 0.82-0.90), the cut-off value was 0.17, the sensitivity was 0.77, and the specificity was 0.84. Hosmer-Lemeshow goodness-of-fit test showed that P>0.05. The AUC for external validation was 0.88, and the Hosmer-Lemeshow goodness-of-fit test suggested P>0.05. Conclusions: A high sensitivity and specificity risk prediction model of PBD associated PH in very premature infants was established. This predictive model is useful for early clinical identification of infants at high risk of BPD associated PH.

A bibliometric analysis and visualization of retinopathy of prematurity from 2001 to 2021

OBJECTIVE

Retinopathy of prematurity (ROP) is an eye disease with the potential to cause blindness, primarily affecting premature infants with low birth weight. This study analyzed the etiology, primary location, and research advances in ROP.

MATERIALS AND METHODS

We used bibliometric techniques and searched the Web of Science Core Collection for "retinopathy of prematurity." We found 4,018 original articles and reviews with 69,819 references. We analyzed the data using HistCite (12.03.17), VOSviewer (1.6.16), CiteSpace (6.1. R5), and the Bibliometrix Package (4.1.0).

RESULTS

The amount of literature in this area has increased between 2001-2021. An analysis of references and journal co-citations highlights this field's most influential articles and related topics. Hellström, from the University of Gothenburg (Sweden), is the most prolific researcher; Harvard University is the most prolific research institution, and the USA is the most productive country. "Threshold ROP" and "cryotherapy" are the keywords with the highest burst strength. The future research hotspots are artificial intelligence, zone II, ROP development, ranibizumab, and type 1 retinopathy.

CONCLUSIONS

This article offers a comprehensive review of the present status of ROP research, along with insights into emerging concepts and potential international collaborations in this field.

Alzheimer's Disease and Aging Association: Identification and Validation of Related Genes

BACKGROUND

Aging is considered a key risk factor for Alzheimer's disease (AD). This study aimed to identify and validate potential aging-related genes associated with AD using bioinformatics analysis.

METHODS

Datasets GSE36980 and GSE5281 were selected to screen differentially expressed genes (DEGs), and the immune cell correlation analysis and GSEA analysis of DEGs were performed. The intersection with senescence genes was taken as differentially expressed senescence-related genes (DESRGs), and the GSE44770 dataset was used for further validation. The potential biological functions and signaling pathways were determined by GO and KEGG, and the hub genes were identified by 12 algorithms in Cytohubba. The expression of 10 hub genes in different brain regions was determined and single-cell sequencing analysis was performed, and diagnostic genes were further screened by gene expression and receiver operating characteristic (ROC) curve. Finally, a miRNA-gene network of diagnostic genes was constructed and targeted drug prediction was performed.

RESULTS

A total of 2137 DEGs were screened from the GSE36980 and GSE5281 datasets, and 278 SRGs were identified from the CellAge database. The overlapping DEGs and SRGs constituted 29 DESRGs, including 14 senescence suppressor genes and 15 senescence inducible genes. The top 10 hub genes, including MDH1, CKB, PSMD14, SMARCA4, PEBP1, DDB2, ITPKB, ATF7IP, YAP1, and EWSR1 were screened. Furthermore, four diagnostic genes were identified: PMSD14, PEBP1, ITPKB, and ATF7IP. The ROC analysis showed that the respective area under the curves (AUCs) of PMSD14, PEBP1, ITPKB, and ATF7IP were 0.732, 0.701, 0.747, and 0.703 in the GSE36980 dataset and 0.870, 0.817, 0.902, and 0.834 in the GSE5281 dataset. In the GSE44770 dataset, PMSD14 (AUC, 0.838) and ITPKB (AUC, 0.952) had very high diagnostic values in the early stage of AD. Finally, based on these diagnostic genes, we found that the drug Abemaciclib is a targeted drug for the treatment of age-related AD. Flutamide can aggravate aging-related AD.

CONCLUSION

The results of this study suggest that cellular SRGs might play an important role in AD. PMSD14, PEBP1, ITPKB, and ATF7IP have the potential as specific biomarkers for the early diagnosis of AD.

TNFSF14 mediates the impact of docosahexaenoic acid on atopic dermatitis: a Mendelian randomization study

OBJECTIVE

While current research suggests potential value for docosahexaenoic acid (DHA) in the prevention and management of atopic dermatitis (AD), the causal relationship between DHA and AD remains unclear, and the underlying mechanisms are not well understood.

MATERIALS AND METHODS

To investigate the potential causal relationship between DHA and AD, as well as to explore potential mediating mechanisms, we employed the Mendelian randomization (MR) methods. To study these potential relationships, we conducted MR analysis using publicly available Genome-Wide Association Studies (GWAS) data. Effect estimates were computed using the random-effects inverse-variance weighted method.

RESULTS

Our study demonstrates a negative correlation between DHA levels and AD risk (OR: 0.915, 95% CI: 0.858-0.975, p=0.007). Furthermore, in MR analysis using tumor necrosis factor ligand superfamily member 14 (TNFSF14) levels as an outcome, DHA levels also show a negative association with TNFSF14 levels (OR: 0.933, 95% CI: 0.879-0.990, p=0.022). Subsequently, we performed further analysis to explore the relationship between TNFSF14 and AD risk, revealing a positive correlation (OR: 1.069, 95% CI: 1.005-1.137, p=0.033). This suggests a potential mediating role of TNFSF14 in the impact of DHA on AD risk.

CONCLUSIONS

In summary, our study employs MR analysis to offer genetic evidence indicating a potential role of DHA in reducing the risk of AD, as well as opening avenues for further in-depth investigation into potential mechanisms. These findings emphasize the importance of ongoing research in this field.

[Focusing on timing selection and whole-course management of liver transplantation treatment for patients with acute-on-chronic liver failure]

Acute-on-chronic liver failure (ACLF) is a clinical syndrome of acute decompensation accompanied by organ failure that occurs on the basis of chronic liver disease and has a high short-term mortality rate. Currently, there are still differences in relation to the definition of ACLF; thus, baseline characteristics and dynamic changes are important bases for clinical decision-making in patients with liver transplantation and others. The basic strategies for treating ACLF currently include internal medicine treatment, artificial liver support systems, and liver transplantation. Multidisciplinary active collaborative management throughout the whole course is of great significance for further improving the survival rate in patients with ACLF.

Correlation of pericoronary adipose tissue CT attenuation values of plaques and periplaques with plaque characteristics

AIM

To investigate the relationship between different plaque characteristics and pericoronary adipose tissue (PCAT) computed tomography (CT) attenuation values for plaques and periplaques.

MATERIALS AND METHODS

The data from 188 eligible patients with stable coronary heart disease (280 lesions) who underwent coronary CT angiography between March 2021 and November 2021 were collected retrospectively. All PCAT CT attenuation values of plaques and periplaques (the area within 5 and 10 mm proximal and distal to the plaque) were calculated, and multiple linear regression was used to assess their correlation with different plaque characteristics.

RESULTS

PCAT CT attenuation of plaques and periplaques was higher in non-calcified plaques (-73.38 ± 10.41 HU, -76.77 ± 10.86 HU, 79.33 ± 11.13 HU, -75.67 ± 11.24 HU, -78.63 ± 12.09 HU) and mixed plaques (-76.83 ± 8.11 HU, -79 [-85, -68.5] HU, -78.55 ± 11 HU, -78.76 ± 9.9 HU, -78.79 ± 11.06 HU) than in calcified plaques (-86.96 ± 10 HU, -84 [-92, -76] HU, -84.14 ± 11.08 HU, -84.91 ± 11.41 HU, -84.59 ± 11.69 HU; all p<0.05) and higher in distal segment plaques than in proximal segment plaques (all p<0.05). Plaque PCAT CT attenuation was lower in plaques with minimal stenosis than in plaques with mild or moderate stenosis (p<0.05). The significant determinants of PCAT CT attenuation values of plaques and periplaques were non-calcified plaques, mixed plaques, and plaques located in the distal segment (all p<0.05).

CONCLUSIONS

PCAT CT attenuation values in both plaques and periplaques were related to plaque type and location.

[Risk factors of gastrointestinal polypectomy concurrent with bleeding in patients with liver cirrhosis]

Objective: To investigate and analyze the occurrence and the related risk factors of gastrointestinal polypectomy accompanied by bleeding in patients with liver cirrhosis. Methods: 127 cases of gastrointestinal polyps with cirrhosis who had endoscopy at the Endoscopic Center of Tianjin Third Central Hospital between November 2017 and November 2020 were collected. At the same time, 127 cases of gastrointestinal polyps with non-cirrhosis that were treated by endoscopy were collected for comparison. The occurrence of hemorrhagic complications between the two groups was compared. The effects of age, sex, liver function, peripheral blood leukocytes, hemoglobin, platelets, blood glucose, the international normalized ratio (INR), polyp resection method, polyp location, size, number, endoscopic morphology, pathology, the presence or absence of diabetes, portal vein thrombosis, and esophageal varices on polypectomy bleeding in the cirrhosis group were analyzed. The measurement data between groups were compared using the t-test and rank sum test. The χ (2) test or Fisher's exact probability method, and multivariate logistic regression analysis were used for the comparison of categorical data between groups. Results: The number of polypectomy bleeding cases in the cirrhotic group was 21, with a bleeding rate of 16.5%. The number of bleeding cases in the non-cirrhotic group was 3, with a bleeding rate of 2.4%. The bleeding rate was higher in the cirrhosis group when polypectomy was performed (χ (2) = 14.909, P < 0.001). A univariate analysis of the risk factors for gastrointestinal polypectomy associated with bleeding in patients with liver cirrhosis showed that liver function grading, platelets, INR, hemoglobin, degree of esophageal and gastric varices, and the location, shape, size, and pathology of the polyps had a statistically significant impact on bleeding (P < 0.05). Multivariate logistic regression analysis showed that liver function grade, degree of varicose veins, and polyp location were independent risk factors for bleeding. Patients with Child-Pugh B or C grade liver function were more likely to bleed than those with Child-Pugh A grade (OR = 4.102, 95% CI 1.133 ~ 14.856), gastric polyps were more likely to bleed than colorectal polyps (OR = 27.763, 95% CI 5.567 ~ 138.460), and severe esophagogastric varices were more likely to bleed than no varices or mild to moderate varices (OR = 7.183, 95% CI 1.384 ~ 37.275). Conclusion: Cirrhotic population has higher risk of bleeding during endoscopic gastrointestinal polypectomy than the non-cirrhotic population. Cirrhotic patients with Child-Pugh grades B or C liver function, polyps located in the stomach, severe esophagogastric varices, and other high-risk factors should be listed as a relative contraindication for endoscopic polypectomy.

Discrimination between microcystic meningioma and atypical meningioma using whole-lesion apparent diffusion coefficient histogram analysis

AIM

To explore the value of whole-lesion apparent diffusion coefficient (ADC) histogram analysis in discriminating microcystic meningioma (MCM) from atypical meningioma (AM).

MATERIALS AND METHODS

Clinical and preoperative MRI data of 20 patients with MCM and 26 patients with AM were analysed retrospectively. Whole-lesion apparent diffusion coefficient (ADC) histogram analysis was performed on each patient's lesion to obtain histogram parameters, including mean, variance, skewness, kurtosis, the 1st (ADCp1), 10th (ADCp10), 50th (ADCp50), 90th (ADCp90), and 99th (ADCp99) percentiles of ADC. The differences between the ADC histogram parameters of the two tumours were compared, and the receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of statistically significant parameters in distinguishing the two tumours.

RESULTS

The mean, ADCp1, ADCp10, ADCp50, and ADCp90 of MCM were greater than those of AM, and significant differences were observed in these parameters between MCM and AM (all p<0.05). ROC analysis showed that the mean had the highest area under the curve value (AUC) in distinguishing the two tumours (AUC = 0.852), when using 120.46 × 10^-6 mm²/s as the optimal threshold, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for discriminating the two groups were 84.6%, 75%, 80.4%, 81.5%, and 78.9%, respectively.

CONCLUSION

Histogram analysis based on whole-lesion ADC maps was useful for discriminating between MCM from AM preoperatively, with the mean being the most promising potential parameter.

Pre-clinical data supporting immunotherapy for HIV using CMV-HIV-specific CAR T cells with CMV vaccine

T cells engineered to express HIV-specific chimeric antigen receptors (CARs) represent a promising strategy to clear HIV-infected cells, but to date have not achieved clinical benefits. A likely hurdle is the limited T cell activation and persistence when HIV antigenemia is low, particularly during antiretroviral therapy (ART). To overcome this issue, we propose to use a cytomegalovirus (CMV) vaccine to stimulate CMV-specific T cells that express CARs directed against the HIV-1 envelope protein gp120. In this study, we use a GMP-compliant platform to engineer CMV-specific T cells to express a second-generation CAR derived from the N6 broadly neutralizing antibody, one of the broadest anti-gp120 neutralizing antibodies. These CMV-HIV CAR T cells exhibit dual effector functions upon in vitro stimulation through their endogenous CMV-specific T cell receptors or the introduced CARs. Using a humanized HIV mouse model, we show that CMV vaccination during ART accelerates CMV-HIV CAR T cell expansion in the peripheral blood and that higher numbers of CMV-HIV CAR T cells were associated with a better control of HIV viral load and fewer HIV antigen p24⁺ cells in the bone marrow upon ART interruption. Collectively, these data support the clinical development of CMV-HIV CAR T cells in combination with a CMV vaccine in HIV-infected individuals.

Efficacy of mirror therapy and virtual reality therapy in alleviating phantom limb pain: a meta-analysis and systematic review

INTRODUCTION

Amputations result from trauma, war, conflict, vascular diseases and cancer. Phantom limb pain (PLP) is a potentially debilitating form of chronic pain affecting around 100 million amputees across the world. Mirror therapy and virtual reality (VR) are two commonly used treatments, and we evaluated their respective success rates.

METHODS

A meta-analysis and systematic review was undertaken to investigate mirror therapy and VR in their ability to reduce pain levels. A mean difference (MD) model to compare group pain levels pretreatment and post-treatment via aggregating these results from numerous similar studies was employed. Meta-analysis was conducted using RevMan (V.5.4) and expressed in MD for visual analogue scale (VAS) score.

RESULTS

A total of 15 studies met our search criteria; they consisted of eight mirror therapy with 214 participants and seven VR including 86 participants, totalling 300 participants. Mean age ranged from 36 to 63 years, 77% male, of which 61% were lower body amputees. Both led to a VAS reduction (mirror therapy mean reduction VAS score was 2.54, 95% CI 1.42 to 3.66; p<0.001; VR 2.24, 95% CI 1.28 to 3.20; p<0.001). There was no statistically significant difference in pain alleviation between mirror therapy and VR (p=0.69).

CONCLUSIONS

Mirror therapy and VR are both equally efficacious in alleviating PLP, but neither is more effective than the other. However, due to small sample size and limited number of studies, factors such as gender, cause of amputation, site of limb loss or length of time from amputation, which may influence treatment success, could not be explored.

[Changes of serum uric acid levels in patients with chronic hepatitis C after using direct antiviral agents therapy]

Objective: To observe the changes of serum uric acid levels and clinical characteristic in patients with chronic hepatitis C combined with hyperuricemia after direct antiviral agents (DAA) therapy. Methods: A prospective cohort study was used to investigate the risk of hyperuricemia in patients with chronic hepatitis C who received DAA treatment to obtain sustained virological response. The changes and factors influencing serum uric acid levels after 12 weeks of DAA treatment were observed. Comparisons between groups were performed using χ (2) test or Fisher's exact test, analysis of variance, Student's t test, or the non-parametric Mann-Whitney U test. Serum uric acid (SUA) changes, liver and kidney function indexes before and after treatment were compared by repeated measurement and paired t-test. Uric acid reduction was defined as a decrease in SUA from baseline at 12 weeks after treatment. Rates of change in eGFR, aspartate aminotransferase/platelet ratio, alanine aminotransferase and controlled attenuation parameter were defined from baseline (baseline to 12 weeks after treatment). Binary logistic regression analysis was used to compare the risk factors and factors influencing high and low uric acid level. Results: 161 cases with chronic hepatitis C who received DAA treatment were included, of which 19.3% patients were hyperuricemic. eGFR < 60 ml/(min·1.73 m(2)) and body mass index were independent risk factors for hyperuricemia in patients with chronic hepatitis C (eGFR: OR = 0.123, P = 0.002; body mass index: OR = 1.220, P = 0.002). SUA levels was changed significantly before treatment, at the end of treatment and at 12 weeks after treatment (327.96 vs. 320.76 vs. 314.92, F = 3.272, P = 0.042). At 12 weeks after treatment, SUA, liver stiffness, alanine aminotransferase and control attenuation parameters were all significantly lower than baseline (P < 0.05). The rate of increase in eGFR from baseline and the rate of decrease in controlled attenuation parameter during treatment were the factors influencing SUA reduction (eGFR: OR = 5124, P = 0.000; controlled attenuation index: OR = 0.010, P = 0.039). Conclusion: In chronic hepatitis C, reduced eGFR and body mass index are the risk factors for the development of hyperuricemia and a significant reduction in serum uric acid levels after DAA treatment can eradicate the virus.

Large-scale manufacturing and characterization of CMV-CD19CAR T cells

BACKGROUND

Adoptive transfer of CD19-specific chimeric antigen receptor (CD19CAR) T cells can induce dramatic disease regression in patients with B cell malignancies. CD19CAR T cell therapy may be limited by insufficient engraftment and persistence, resulting in tumor relapse. We previously demonstrated a proof of principle that cytomegalovirus (CMV)-specific T cells can be isolated and enriched prior to CD19CAR transduction to produce CMV-CD19CAR T cells, and that these CMV-CD19CAR T cells can be expanded in vivo through CMV vaccination, resulting in better tumor control in a murine model. Here we developed a clinical platform for generating CMV-CD19CAR T cells.

METHODS

Peripheral blood mononuclear cells (PBMCs) collected from CMV-seropositive healthy donors were stimulated with a good manufacturing practices-grade PepTivator overlapping CMVpp65 peptide pool and enriched for CMV-responsive interferon γ (IFNγ)+T cells using IFNγ Catchmatrix, within the CliniMACS Prodigy Cytokine Capture System (Miltenyi Biotec). Resulting CMV-specific T cells were transduced with a lentiviral vector encoding a second generation CD19R:CD28:ζ/EGFRt CAR and expanded with interleukin 2 (IL-2) and IL-15 for 15 days before characterization.

RESULTS

CMV-specific T cells were enriched from 0.8%±0.5 of input PBMC to 76.3%±11.6 in nine full-scale qualification runs (absolute yield of 4.2±3.3×10⁶ IFNγ+T cells from an input of 1×10⁹ PBMCs). Average CD19CAR transduction efficiency of CMV-specific T cells was 27.0%±14.2 in the final products, which underwent rapid expansion, resulting in a total cell dose of 6.2±0.9 × 10⁶ CD19CAR-tranduced T cells with CMV specificity (ie, functionally bispecific). CMV-CD19CAR T cells were polyclonal, expressed memory markers but had low expression of exhaustion markers, responded to both CD19 and CMVpp65 stimulation with rapid proliferation and exhibited antigen-specific effector functions against both CD19-expressing tumors and CMVpp65 antigen. The final products passed release criteria for clinical use.

CONCLUSIONS

We demonstrated the feasibility of our large-scale platform for generating CMV-CD19CAR T cells for clinical application. We plan to initiate a clinical trial at City of Hope using CMV-CD19CAR T cells for patients with intermediate/high-grade B cell non-Hodgkin's lymphoma immediately after autologous hematopoietic cell transplantation followed by vaccination with a novel CMV vaccine based on Modified Vaccinia Ankara (Triplex) 28 days and 56 days post-T cell infusion.

[Risk factors and nutritional status analysis in patients with liver cirrhosis and concomitant chronic periodontitis]

Objective: To study and explore the prevalence, characteristics, preliminary risk factors, as well as their relationship with nutritional scores in liver cirrhotic patient with chronic periodontitis. Methods: 163 patients with liver cirrhosis who were hospitalized in the Hepatology Division, Department of Internal Medicine at Tianjin Third Central Hospital from June to September 2018 were enrolled as the case group, while the control group consisted 140 healthy individuals enrolled during the same period. Periodontal examination, biochemical examination and oral hygiene habits were investigated. The prevalence of periodontitis in the two groups was compared, and the risk factors of severe periodontitis were conducted by multivariate regression analysis. Results: The prevalence of chronic periodontitis was significantly higher in patients with liver cirrhosis than healthy control population, and the differences were statistically significant (P < 0.05). The prevalence of severe periodontitis and full edentulous jaws was significantly higher in patients with liver cirrhosis than healthy control group, and the differences were statistically significant (P < 0.05 and P < 0.001). Compared with the healthy control group, the depth of periodontal pocket and the degree of attachment loss were significantly increased in the liver cirrhosis group (P < 0.001). Multivariate regression analysis showed that liver cirrhosis was the independent risk factors for both groups of patients with severe periodontitis (χ (2) = 11.046, P < 0.001). Univariate and multivariate regression analysis showed that toothbrushing frequency, nutritional risk score, prealbumin level and Child-Pugh grade were independent risk factors for occurrence of severe periodontitis in liver cirrhotic patient (χ (2) = 5.252, P = 0.022; χ (2) = 24.162, P < 0.001; χ (2) = 4.159, P = 0.041; χ (2) = 9.249, P = 0.002). Conclusion: The prevalence of periodontitis is significantly higher in patients with liver cirrhosis than healthy individuals, and liver cirrhosis is an independent risk factor for the occurrence of severe periodontitis. Toothbrushing frequency, nutritional risk score, prealbumin level and Child-Pugh grade are risk factors for severe periodontitis in patients with liver cirrhosis.

[Impact of cardiovascular metabolic diseases on COVID-19: review of recent progress]

The high comorbidity between cardiovascular and metabolic diseases (CVMD) and coronavirus disease 2019 (COVID-19) and the consequent high mortality and the potential risk of cardiovascular damage have brought great challenges to the clinical diagnosis and treatment of the condition. The latest studies found that advanced age, immune function defects, inflammatory factor storms and oxidative stress damage all potentially contribute to the high comorbidity of the two. Direct virus invasion, myocardial oxygen supply and demand imbalance and vascular endothelial and coagulation dysfunction may be important mechanisms for cardiovascular injury in COVID-19 patients. In addition, the expression level of ACE2 (the cell membrane receptor of SARS-CoV-2) in various organs and the peripheral blood not only mediates the direct invasion and damage of the organs, but also participates in regulation of the balance of systematic inflammation and oxidative stress, thus affecting the susceptibility and outcomes of the patients. Herein we review the recent research progress in the comorbidity between COVID-19 and CVMD and explore the mechanisms of cardiovascular damage caused by SARS-CoV-2, thus to provide a theoretical basis for the clinical diagnosis and treatment of COVID-19 with underlying CVMD.

[Assessment and intervention strategies for sarcopenia in patients with liver cirrhosis]

Sarcopenia is a common complication in patients with liver cirrhosis, which has an adverse effect on the clinical outcome and prognosis. Attention must be paid to early detection and active diagnosis and treatment. Clinically, the diagnosis process of finding suspicious cases can be traced through screening-assessment-diagnosis-severity evaluation. On the ground of treating liver cirrhosis and its complications, reasonable nutritional intervention and exercise are currently important measures for the treatment of liver cirrhosis with sarcopenia, and the role of hormone supplementation and drug therapy for skeletal muscle metabolism needs to be further investigated.

IGF-1 concentrations after weaning in young sows fed different pre-mating diets are positively associated with piglet mean birth weight at subsequent farrowing

Pre-mating diets can influence piglet birth weight and within-litter birth weight variation and thereby piglet survival and development. The major objective of this study was to evaluate the litter characteristics of young sows whose pre-mating diets received different supplementation. The supplements included a top-dressing of 200 g, consisting of either wheat (CON) or wheat plus microfibrillated cellulose, _L-carnitine or _L-arginine at one of two supplementation levels (low and high) in late lactation and during the weaning-to-oestrus interval (WEI). The second objective was to investigate the role of body condition loss and IGF-1 concentration during the WEI for subsequent litter characteristics. In total, sows after their first (N =41) and second (N =15) lactation were used. One week before weaning, the sows were allocated to the seven treatments based on the number of piglets and BW loss from farrowing until 1 week before weaning. Pre-mating diets did not affect litter characteristics at subsequent farrowing. However, at subsequent farrowing, sows after their first lactation had a lower total number of piglets born per litter (18.3 v. 20.3), higher mean piglet birth weight (1365 v. 1253 g), lower CV of birth weight (20.0 v. 26.1%) and lower percentage of piglets <1000 g (11.5 v. 24.4%) than sows after their second lactation. Litter weight at second parturition was positively related to IGF-1 during the WEI after first lactation (P <0.04). Within parity, piglet mean birth weight was positively related to IGF-1 at oestrus (P <0.02). Surprisingly, within parity, a higher relative loin muscle depth loss during previous lactation was related to lower CV and SD of birth weight (P <0.05, for both). In conclusion, pre-mating diets did not affect litter characteristics at subsequent birth. However, a higher IGF-1 concentration during the WEI was positively associated with subsequent litter weight and piglet mean birth weight. Further studies should elucidate the role of IGF-1 during the WEI for subsequent litter characteristics and dietary interventions to stimulate IGF-1.

LncRNA H19 promotes the development of hepatitis B related hepatocellular carcinoma through regulating microRNA-22 via EMT pathway

OBJECTIVE

To explore the relationship between long non-coding RNA (lncRNA) H19 expression and prognosis of hepatitis B-related hepatocellular carcinoma (HBV-related HCC), and its underlying mechanism.

PATIENTS AND METHODS

Expression level of lncRNA H19 in 36 HBV-related HCC tissues and para-cancerous tissues was detected by quantitative Real-time polymerase chain reaction (qRT-PCR). The relationship between lncRNA H19 expression and prognosis of HBV-related HCC was analyzed by Kaplan-Meier method. Serum DNA levels of HBV were detected by fluorescence quantitative polymerase chain reaction (FQ-PCR). For in vitro experiments, lncRNA H19 expression in HCC cell line, HBV-related HCC cell line and normal liver cell line was detected by qRT-PCR. After plasmids construction, the effects of lncRNA H19 on cell viability, migration, and invasion were detected by cell counting kit-8 (CCK-8), colony formation and transwell assay, respectively. Finally, protein levels of epithelial-mesenchymal transition (EMT) pathway-related genes were detected by Western blot.

RESULTS

LncRNA H19 was highly expressed in HBV-related HCC tissues. The expression of lncRNA H19 was positively correlated with lymph node metastasis and distant metastasis, whereas negatively correlated with the overall survival of HBV-related HCC patients. Results of in vitro experiments showed that lncRNA H19 knockdown significantly downregulated cell proliferation and invasion. However, lncRNA H19 knockdown significantly upregulated apoptosis of HBV-related HCC cells. Western blot results demonstrated that lncRNA H19 remarkably decreased the protein expressions of EMT pathway-related genes, including N-cadherin, Vimentin, β-catenin and MMP-9. In addition, rescue experiments demonstrated that lncRNA H19 remarkably promoted malignant development of HBV-related HCC via regulating microRNA-22.

CONCLUSIONS

LncRNA H19 promotes malignant development of HBV-related HCC through regulating microRNA-22 via EMT pathway.

[Establishment of clinical features and prognostic scoring model in early-stage hepatitis B-related acute-on-chronic liver failure]

Objective: To explore the clinical characteristics and establish a corresponding prognostic scoring model in patients with early-stage clinical features of hepatitis B-induced acute-on-chronic liver failure (HBV-ACLF). Methods: Clinical characteristics of 725 cases with hepatitis B-related acute-on-chronic hepatic dysfunction (HBV-ACHD) were retrospectively analyzed using Chinese group on the study of severe hepatitis B (COSSH). The independent risk factors associated with 90-day prognosis to establish a prognostic scoring model was analyzed by multivariate Cox regression, and was validated by 500 internal and 390 external HBV-ACHD patients. Results: Among 725 cases with HBV-ACHD, 76.8% were male, 96.8% had cirrhosis base,66.5% had complications of ascites, 4.1% had coagulation failure in respect to organ failure, and 9.2% had 90-day mortality rate. Multivariate Cox regression analysis showed that TBil, WBC and ALP were the best predictors of 90-day mortality rate in HBV-ACHD patients. The established scoring model was COSS-HACHADs = 0.75 × ln(WBC) + 0.57 × ln(TBil)-0.94 × ln(ALP) +10. The area under the receiver operating characteristic curve (AUROC) of subjects was significantly higher than MELD, MELD-Na, CTP and CLIF-C ADs(P < 0.05). An analysis of 500 and 390 cases of internal random selection group and external group had similar verified results. Conclusion: HBV-ACHD patients are a group of people with decompensated cirrhosis combined with small number of organ failure, and the 90-day mortality rate is 9.2%. COSSH-ACHDs have a higher predictive effect on HBV-ACHD patients' 90-day prognosis, and thus provide evidence-based medicine for early clinical diagnosis and treatment.

Influence of post-core material and cement peculiarities on stress of post-cores under ultrasonic vibration: a three-dimensional finite element analysis

AIM

To analyse the effect of post-core, and cement materials and thickness of the cement lute on the stress in post-core systems under ultrasonic vibration at different frequencies and amplitudes using three-dimensional finite element analysis.

METHODOLOGY

Eight three-dimensional finite element models of a maxillary central incisor with post-cores were established. Two post-core materials (Au and Ni-Cr alloys), two cements (glass ionomer (GI) and zinc phosphate (ZP)) and two cement layer thicknesses (50 and 150 μm) were considered. Vibration loads were applied near the neck on the buccal side of the core at frequencies of 10-40 kHz and amplitudes of 10-50 μm. The maximum shear stress of the cement layer and maximum principal stress of the roots and their distributions were investigated.

RESULTS

The stresses on cements and roots increased with an increase in the frequency and amplitude of the vibration load and elastic modulus of the cements, and decreased with increasing thickness of the cement layer and elastic modulus of the post-core. Maximum cement stress was observed on the contralateral upper part of the loading side, whereas the maximum root stress was found on the ferrule where the load was applied.

CONCLUSIONS

In this simulated model, the frequency and amplitude of ultrasound needed to remove a post-core were positively related to the elastic modulus of the post-core and thickness of the cement layer and negatively related to the elastic modulus of the cements.

[Diagnosis and therapeutic strategies for hepatopulmonary syndrome]

Hepatopulmonary syndrome (HPS) is a common pulmonary complication in patients with liver disease and / or portal hypertension, and is characterized by abnormal arterial oxygenation caused by intrapulmonary vascular dilatation. The pathogenesis of HPS is complex, with a low clinical early diagnosis rate and poor prognosis. HPS currently lacks effective therapeutic drugs; therefore, liver transplantation is the only fundamental treatment. This article summarizes the pathogenesis, clinical manifestations, diagnosis and treatment of HPS in order to further improve the level of clinical screening and diagnosis and treatment of HPS.

[Risk factors of cirrhosis combined with sarcopenia and their impact on clinical outcomes]

Objective: To study the occurrence of sarcopenia in patients with liver cirrhosis, and to explore their risk factors and impact on clinical outcomes. Methods: 199 hospitalized cases with liver cirrhosis were collected for nutritional risk screening, anthropometric measurement and blood biochemical examination. The body composition analysis was measured based on the skeletal muscle content of the four limbs to calculate the appendicular skeletal muscle mass index (ASMI). Patients were divided into sarcopenia and non-sarcopenia group and the relevant indexes of both groups were compared to screen for factors affecting the occurrence of sarcopenia. During the follow-up of 48 months, the survival and complications of the both groups were compared. Statistical analysis was performed using t-test, χ(2) test and logistic regression analysis in terms of different data. Results: The incidence of sarcopenia in cirrhosis was 36.7%, with the highest prevalence in patients with recurrent hepatic encephalopathy (62.5%), followed by patients with abdominal ascites / pleural effusion (37.6%). The incidence of sarcopenia was significantly higher in those with nutritional risk than in those without nutritional risk (P < 0.05). However, even among those without nutritional risk, 14.8% had combined sarcopenia. The body mass index (BMI), upper arm muscle circumference (AMC), and body cell mass (BCM) of the sarcopenia group were lower than those of the non-sarcopenia group (P < 0.05), and the edema index (ECW/TBW) was higher than the latter (P < 0.05). Multivariate analysis showed that age, gender, BMI, and complications of hepatic encephalopathy were the main influencing factors of cirrhosis combined with sarcopenia (P < 0.05). During the follow-up period, the sarcopenia group had a higher mortality rate than non-sarcopenia goup (P < 0.05), and the incidence of recurrent abdominal ascites/pleural effusion, hepatic encephalopathy, and infection was also significantly elevated (P < 0.05). Conclusion: Sarcopenia is one of the manifestations of malnutrition in patients with liver cirrhosis, which increases the risk of mortality and other complications, and has adverse impact on the clinical outcome. Additionally, older age, male sex, low BMI and recurrent hepatic encephalopathy has higher risk for developing sarcopenia.

[Research advances of sarcopenia in chronic liver disease]

Sarcopenia is the main constituent of malnutrition and is a frequent complication of chronic liver diseases, which affects up to 70% of patients with advanced liver diseases. It has been associated with adverse clinical outcomes and prognosis, including poor quality of life, development of other complications and reduction in survival rate of non-transplant patients and transplant recipients. Chronic liver disease causes alteration in glucose metabolism, lipid oxidation, ketogenesis and protein catabolism, leading to the loss of adipose and muscle tissue. In addition, inadequate nutrients intake and limited or lack of physical activity perpetuate the reduction of muscle mass. Recently, the roles and mechanisms of muscle growth-related hormones, hyperammonemia-mediated signaling pathways and gut microbiota have been recognized. In view of its impact in chronic liver disease, sarcopenia can be considered as a powerful prognostic factor and a useful additional tool in the global assessment of patients with advanced liver disease. Rational nutritional intervention, appropriate physical exercise, effective ammonia lowering strategies, hormone supplements and targeted molecular therapy (use of myostatin blockers), and liver transplantation, may improve sarcopenia, but still needs more studies for validation.

[Advances in new type of biomolecular markers for liver fibrosis]

Liver fibrosis is a common pathological process of chronic liver disease, and the number of deaths from liver cirrhosis, liver failure and liver cancer is increasing year-by-year worldwide. Presently, the detection methods to evaluate hepatic fibrosis mainly include hepatic histological examination, imaging and serum markers, but all these have many limitations in clinical aspects. Recently, there have been more and more studies related to the development of non-coding RNA, exosomes and liver fibrosis that are considered as a new type of biomolecular markers with potential clinical application. Herein, we did a preliminary assessment in conjunction with relevant advances to provide a reference for the early diagnosis and treatment of liver fibrosis.

Comparing the efficacy of targeted next-generation sequencing in the identification of somatic mutations in circulating tumor DNA from different stages of lung cancer

This study aims to assess the potential clinical application of targeted next generation sequencing (NGS)-based deep sequencing for the detection of clinically relevant mutations in circulating tumor DNA (ctDNA) obtained from non-small cell lung cancer (NSCLC) patients. Targeted deep sequencing was performed to identify High Confidence Somatic Variants (HCSVs) in matched tumor tissue DNA (tDNA) and ctDNA in 50 NSCLC patients. Our results demonstrated that NSCLC patients with Stage IV (61.5%) exhibited a higher concordance rate at the mutation level between plasma ctDNA and tDNA samples than those with Stage I-III (14.5%). Moreover, it is noteworthy that the allele frequency of these detected HCSVs in ctDNA increased with the advance in tumor stage. Besides, using tDNA as a reference, the sensitivity of plasma ctDNA analyzed by deep NGS for actionable EGFR was much higher in patients with Stage IV (66.6%) than those with Stage I-III (7.7%). In conclusion, it appears that ctDNA NGS-based deep sequencing is a feasible approach to identify mutations in patients with Stage IV NSCLC. However, additional methods with higher sensitivity and specificity are needed to improve the successful application of this platform in the earlier stages of NSCLC.

[Nutritional status and energy metabolism characteristics in patients with nonalcoholic fatty liver disease]

Objective: To study the nutritional status and energy metabolic characteristics of patients with nonalcoholic fatty liver disease (NAFLD), and to provide evidence for clinical evaluation and intervention. Methods: A total of 359 NAFLD patients diagnosed on ultrasound from June 2015 to March 2017 were selected as study subjects and divided into mild, moderate to severe fatty liver disease group and 50 healthy subjects as control group. The changes of ICW, ECW, body fat, skeletal muscle, protein and visceral fat area (VFA) of patients and controls were analyzed by using body composition analyzer. The energy metabolism index was measured by the oxidation rate of resting energy expenditure(REE), respiratory quotient (RQ), and the oxidation rates of the three nutrients (CHO %, FAT %, and PRO %). According to different types of data, non-parametric tests like Kruskal-Wallis or χ(2) were used for this analysis. Results: Compared with the mild fatty liver group and the control group, the moderate and severe fatty liver group the BMI, waist circumference, waist-hip ratio were significantly elevated (P-value < 0.001), and their serum alanine aminotransferase, triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein, FBS levels were significantly increased (P value < 0.05). The Body composition analysis showed that there was no significant difference in skeletal muscle content between the three groups (P = 0.067). The ICW, ECW, protein, body fat content of moderate and severe fatty liver group were significantly higher than those of mild fatty liver group and control group (P < 0.01), but there was no significant difference between the mild fatty liver group and the control group. There was significant difference in the VFA between the three groups, while VFA in the moderate and severe fatty liver group was significantly increased. Metabolic results showed that the RQ of patients with moderate-severe fatty liver and mild fatty liver were 0.72 ± 0.08 and 0.78 ± 0.06, respectively, which were lower than those of the control group (0.80 ± 0.02), P = 0.004. Resting energy expenditure (REE) was not significantly different between moderate and severe fatty liver group and mild fatty liver group (P = 0.207), but both were significantly higher than those of the control group (P < 0.001). The percentages of CHO, FAT and PRO in moderate and severe fatty liver group were 19.49% ± 9.71%, 66.23% ± 12.54% and 14.22% ± 6.11% respectively. Compared with the control group, CHO % decreased, and FAT % increased. Conclusion: NAFLD patients have different extent of nutritional imbalance and energy metabolism disorders, the use of Body Composition analyzer and metabolic cart can comprehensively assess and monitor NAFLD patient's nutrition and energy metabolism status, to provide a basis for clinical intervention.

[Effect of aerobic exercise and resistance exercise in improving non-alcoholic fatty liver disease: a randomized controlled trial]

Objective: To investigate the effect of dietary control combined with different exercise modes on plasma vaspin, irisin, and metabolic parameters in patients with non-alcoholic fatty liver disease (NAFLD) through a randomized open parallel-controlled study. Methods: The patients aged 30-65 years who visited Tianjin Third Central Hospital from January 2013 to December 2014 and were diagnosed with NAFLD by liver ultrasound and fat content determination were screening, and 474 patients were enrolled in this randomized controlled trial and divided into aerobic exercise group, resistance exercise group, and control group. All patients received dietary intervention. The three groups were compared in terms of biochemical parameters, fat content, NFS score, energy metabolic parameters, body composition index, and levels of vaspin and irisin at baseline and after 6 months of intervention. SPSS 19.0 was used for statistical analysis. The t-test, the Mann-Whitney U test, the chi-square test, and an analysis of variance were used for comparison between groups. The multiple imputation method was used for missing data, and the results were included in the intention-to-treat analysis. Results: There were no significant differences in age, sex, anthropometrical parameters, and biochemical parameters between the three groups at baseline. Compared with dietary control alone, aerobic exercise and resistance exercise helped to achieve significant reductions in waist circumference, diastolic pressure, percentage of body fat, volatile fatty acid, fasting blood glucose, homeostasis model assessment of insulin resistance, triglyceride, low-density lipoprotein cholesterol, free fatty acid, uric acid, alanine aminotransferase, and liver fat content after 6 months of intervention (P < 0.05). The aerobic exercise group had a significant increase in non-protein respiratory quotient and significant reductions in body mass index and aspartate aminotransferase after intervention, as well as a significant increase in resting energy expenditure and significant reductions in abdominal fat ratio and total cholesterol after 6 months of resistance exercise (P < 0.05). The aerobic exercise group and the resistance exercise group had a significant reduction in vaspin and a significant increase in irisin after intervention (P < 0.05), and the resistance exercise group had significantly greater changes in these two adipokines than the aerobic exercise group (P < 0.05). Conclusion: Exercise therapy is an effective method for the treatment of metabolism-associated diseases, and a combination of resistance and aerobic exercises is more reasonable and effective in clinical practice. As a relatively safe exercise mode, resistance exercise can also effectively improve the metabolic state of NAFLD patients.

[Clinical effect and safety of pegylated interferon-α-2b injection (Y shape, 40 kD) in treatment of HBeAg-positive chronic hepatitis B patients]

Objective: To investigate the clinical effect and safety of long-acting pegylated interferon-α-2b (Peg-IFN-α-2b) (Y shape, 40 kD) injection (180 μg/week) in the treatment of HBeAg-positive chronic hepatitis B (CHB) patients, with standard-dose Peg-IFN-α-2a as positive control. Methods: This study was a multicenter, randomized, open-label, and positive-controlled phase III clinical trial. Eligible HBeAg-positive CHB patients were screened out and randomized to Peg-IFN-α-2b (Y shape, 40 kD) trial group and Peg-IFN-α-2a control group at a ratio of 2:1. The course of treatment was 48 weeks and the patients were followed up for 24 weeks after drug withdrawal. Plasma samples were collected at screening, baseline, and 12, 24, 36, 48, 60, and 72 weeks for centralized detection. COBAS® Ampliprep/COBAS® TaqMan® HBV Test was used to measure HBV DNA level by quantitative real-time PCR. Electrochemiluminescence immunoassay with Elecsys kit was used to measure HBV markers (HBsAg, anti-HBs, HBeAg, anti-HBe). Adverse events were recorded in detail. The primary outcome measure was HBeAg seroconversion rate after the 24-week follow-up, and non-inferiority was also tested. The difference in HBeAg seroconversion rate after treatment between the trial group and the control group and two-sided confidence interval (CI) were calculated, and non-inferiority was demonstrated if the lower limit of 95% CI was > -10%. The t-test, chi-square test, or rank sum test was used according to the types and features of data. Results: A total of 855 HBeAg-positive CHB patients were enrolled and 820 of them received treatment (538 in the trial group and 282 in the control group). The data of the full analysis set showed that HBeAg seroconversion rate at week 72 was 27.32% in the trial group and 22.70% in the control group with a rate difference of 4.63% (95% CI -1.54% to 10.80%, P = 0.1493). The data of the per-protocol set showed that HBeAg seroconversion rate at week 72 was 30.75% in the trial group and 27.14% in the control group with a rate difference of 3.61% (95% CI -3.87% to 11.09%, P = 0.3436). 95% CI met the non-inferiority criteria, and the trial group was non-inferior to the control group. The two groups had similar incidence rates of adverse events, serious adverse events, and common adverse events. Conclusion: In Peg-IFN-α regimen for HBeAg-positive CHB patients, the new drug Peg-IFN-α-2b (Y shape, 40 kD) has comparable effect and safety to the control drug Peg-IFN-α-2a.

[Clinical analysis of endoscopic endonasal approach for removal of sellar tumors]

Objective:To investigate the safety and efficacy of endoscopic endonasal approach for removal of sellar tumors. Method: The clinical data of 18 patients with sellar tumors undergoing endoscopic endonasal surgery were analyzed retrospectively. This series consisted of ten pituitary adenomas, five craniopharyngiomas, three meningiomas. The headache, visual improvement, endocrine, extent of resection and surgical complications were evaluated. Result:Total removal was achieved in 14 patients (77.8%), almost total removal was achieved in one patient of pituitary adenoma with two craniopharyngiomas (16.7%), and one patient with the subtotal removal of craniopharyngioma (5.6%) received gamma knife therapy. Overall, 18 patients with headache got improved obviously; 15 patients presented with visual and view impairment, All of them, vision and view were improved or even recovered to normal following surgery; There were 2 new cases of postoperative diabetes insipidu; 5(27.8%) patients had hyposmia after operation; 1 patient (5.6%) with adenoma suffered cerebrospinal fluid rhinorrhea, the second operation was successful. The follow-up lasted 12-84 months, no tumor recurrence was identified by MRI examination, and no patient died. Conclusion:The endoscopic endonasal approach is feasible and safe for the treatment of tumors in the sellar region. With advantages of clear vision, better exposure, without brain retraction, and preservation of vascular and neurological function. Skilled endoscopic technique and reliable skull base reconstruction are important to ensure success of surgery.

[Olfactory functional magnetic resonance imaging in patients with mild cognitive impairment]

Objective: To analyze the activation of brain regions associated with olfactory in patients with mild cognitive impairment (MCI) by olfactory functional magnetic resonance imaging (fMRI). Methods: Twenty six patients with MCI were compared with twenty six controls in the dementia center of Tianjin HuanHu hospital in terms of olfactory function T&T testing, the differences between the activation of the whole brain and region of interest associated with olfactory (bilateral primary olfactory cortex(POC), bilateral hippocampus, bilateral orbital frontal gyrus) by olfactory stimulator using event correlation design for olfactory fMRI scanning. To analyze the correlation between the number of activator in POC and the threshold of olfactory discriminate as well as the severity of cognitive impairment.SPSS 19.0 software was used for the statistical analysis. Results: T&T olfactory testing revealed that MCI patients had higher scores than controls (3.57±1.29 (x±s) vs 1.02±0.35, t=4.372, P<0.05). The activation range of whole brain in MCI patients was less than controls (pleasant odor (po) 147.36±21.45 vs 323.11±39.76, unpleasant odor (upo) 201.86±24.93 vs 447.73±57.22, t(po)=4.241, t(upo)=5.365, both P<0.05). The activation range of whole brain in inhaling unpleasant odor was more than pleasant odor in controls (447.73±57.22 vs 323.11±39.76, t=3.936, P<0.05). The number of activator in ROI(awo) in MCI patients was less than controls (pleasant odor (po) 51.0[8.0, 109.0](M[P(25), P(75)]) vs 135.0[21.0, 321.5], unpleasant odor (upo) 65.0[6.0, 158.0]vs 205.0[36.5, 491.0], Z(po)=-2.199, Z(upo)=-2.216, both P<0.05). The number of activator in POC in MCI patients was less than controls (pleasant odor (po) 19.0[4.0, 35.5]vs 46.0[9.0, 118.5], unpleasant odor (upo) 26.0[2.0, 51.0]vs 79.0[17.5, 189.0], Z(po)=-1.898, Z(upo)=-2.167, both P<0.05). The number of activator in POC was negatively correlated with olfactory discriminate threshold in MCI patients (r(po)=-0.415, r(upo)=-0.409, both P<0.05). The number of activator in POC was positively correlated with MoCA in MCI patients (r(po)=0.289, r(upo)=0.296, both P<0.05). Conclusion: Olfactory fMRI can objectively assess the olfactory function in MCI, it is a imaging indicator with neuropsychological tests for detection in MCI, the number of activator in POC can reflect the severity of MCI.

[Efficacy and safety of pegylated interferon α-2b injection (Y shape, 40 kD) in treatment of patients with genotype 1/6 chronic hepatitis C]

Objective: To investigate the efficacy and safety of the new investigational drug pegylated interferon α-2b (Peg-IFN-α-2b) (Y shape, 40 kD) injection (180 µg/week) combined with ribavirin in the treatment of patients with genotype 1/6 chronic hepatitis C (CHC), with standard-dose Peg-IFN-α-2a combined with ribavirin as a positive control. Methods: A multicenter, randomized, open-label, and positive-controlled phase III clinical trial was performed. Eligible patients with genotype 1/6 CHC were screened out and randomly divided into Peg-IFN-α-2b(Y shape, 40kD) group and Peg-IFN-α-2a group at a ratio of 2:1. The patients in both groups were given oral ribavirin for 48 weeks in addition and then followed up for 24 weeks after drug withdrawal. Abbott Real Time HCV Genotype II was used to determine HCV genotype, and Cobas TaqMan quantitative real-time PCR was used to measure HCV RNA level at 0, 4, 12, 24, 48, and 72 weeks. Adverse events were recorded in detail. The primary efficacy endpoint was sustained virological response (SVR), and a non-inferiority test was also performed. Results: A total of 561 patients with genotype 1/6 CHC were enrolled, among whom 529 received treatment; 90.9% of these patients had genotype 1 CHC. The data of the full analysis set showed that SVR rate was 69.80% (95% CI 65.00%-74.60%) in the trial group and 74.16% (95% CI 67.73%-80.59%) in the control group (P = 0.297 0). The data of the per protocol set (PPS) showed that SVR rate was 80.63% (95% CI 76.04%-85.23%) in the trial group and 81.33% (95% CI 75.10%-87.57%) in the control group (P = 0.849 8), and the 95% CI of rate difference conformed to the non-inferiority standard. The analysis of the PPS population showed that of all subjects, 47.9% achieved rapid virologic response, with a positive predictive value of 93.8%. The incidence rate of adverse events was 96.30% in the trial group and 94.94% in the control group, and the incidence rate of serious adverse events was 5.13% in the trail group and 5.06% in the control group. Conclusion: In the regimen of Peg-IFN-α combined with ribavirin for the treatment of genotype 1/6 CHC, the new investigational drug Peg-IFN-α-2b(Y shape, 40 kD) has comparable clinical effect and safety to the control drug Peg-IFN-α-2a.

Long Non-Coding RNA: An Emerging Paradigm of Pancreatic Cancer

Pancreatic cancer remains a worldwide issue and burden that is hard to resolve given its low resection rate and chemo-resistance. Early diagnosis and early treatment are critical for conquering pancreatic cancer. Therefore, new biomarkers for diagnosis and prognosis are urgently needed. Previously, researchers mainly focused on protein-coding genetic and epigenetic changes in many types of cancers, and regarded the noncoding part as waste. Recently, however, long non-coding RNA (lncRNA) has emerged as a major participant in carcinogenesis, as it regulates cell proliferation, migration, invasion, metastasis, chemo-resistance, etc. The underlying mechanisms are summarized as signaling, decoy, guide and scaffold, yet the specific regulation networks remain to be uncovered. Several studies have revealed that some lncRNAs are dysregulated in pancreatic cancer, participating in biological functions. In this review, we will briefly outline the functional lncRNAs in pancreatic cancer, decipher possible mechanisms of lncRNAs, and further explore their significance in pancreatic cancer.

Hypospadias in male infants - a review

The external genitalia problems are cumbersome problems for both doctors and parents, as these abnormalities have a consequent impact on future generations. However, the affected young infants are unaware of the consequences due to immature emotional state. Further, the feeling of being different and inferior in affected young patients could give rise to negative emotions including depression, insecurity, anxiety, powerlessness, etc. These all factors collectively could cause a mental imbalance in the affected children. The present review article is focused on the latest updates in the area.

[Research advances in diagnosis and treatment of liver failure in 2016]

Liver failure has various clinical types, a complex pathogenesis, and rapid disease progression, as well as a high mortality rate. Liver failure caused by hepatitis B virus infection is the most common type in China with severe conditions, various complications, and a mortality rate as high as 40%-90%. Invasive fungal disease secondary to acute-on-chronic liver failure can affect patients' prognosis and increase mortality rate. This article introduces the research advances in hepatitis B-related liver failure, artificial liver, and invasive fungal disease secondary to acute-on-chronic liver failure in 2016.

[Imaging diagnosis of 95 cases of moderate and severe acute carbon monoxide poisoning]

Objective: To explore the difference of radiological imaging features of delayed encephalopathy after carbon monoxide poisoning (DECMP) and acute carbon monoxide poisoning (ACMP) , and the correlation between the imaging findings and clinical prognosis of the disease. Methods: The correlation between imaging findings and clinical manifestations and prognosis of 95 patients with moderate and severe acute carbon monoxide poisoning were retrospectively analyzed. In the above 95 cases, there were 62 cases of ACMP and 33 cases of DEACMP. All patients underwent conventional CT, MRI and magnetic resonance diffusion tensor imaging (DTI) . Circular regions of interest (ROI) measurement was used for analysis of average diffusion coefficient (ADC) value and fractional anisotropy (FA) value of the MRI and DTI imaging manifestations in different brain regions. Results: The main clinical manifestation of moderate acute carbon monoxide poisoning was consciousness disorder and fatigue; Severe poisoning patients showed deep coma as the main clinical manifestations; The most prominent clinical manifestations of DEACMP were mental disorders and neurological impairment in the extrapyramidal system. A total of 95 cases with moderate or severe CO poisoning showed unilateral or bilateral cerebral cortex, bilateral basal ganglia (white ball) , cerebral white matter around bilateral ventricles or bilateral centrum semiovale, around bilateral ventricles cerebral white matter around bilateral ventricles and bilateral centrum semiovale, cerebral cortex and subcortical involvement. CT showed normal or low density shadow.MRI showed that the lesion T(1)WI presented slightly low or equal signal, T(2)WI and FLAIR sequences showed equal, a slightly higher or high signal; DWI sequence showed slightly higher or high signal. ADC value and FA value in different brain white matter regions of DEACMP group was significantly lower than those of ACMP group (P<0.05) , especially for those around semi oval center and lateral ventricles of the brain white matter (P<0.01) ; The ADC values increased significantly, FA value decreased significantly in the nerve nucleus (P<0.05) , especially for ADC values in globus pallidus (P<0.01) . Conclusion: DTI can evaluate the brain tissue damage in patients with DEACMP more early and more accurately.