Objective To investigate the effect of nicotinamide adenine dinucleotide-dependent deacetylase 1 (Sirt1) on high glucose-induced exosome release from podocytes. Methods Immortalized mouse podocytes MPC5 were divided into six groups: normal glucose group (5.5 mmol/L glucose, group A), high mannitol group (5.5 mmol/L glucose+24.5 mmol/L mannitol, group B), high glucose group (30.0 mmol/L glucose, group C), high glucose+Sirt1-overexpressed lentivirus transfection group (Sirt1-overexpressed lentivirus transfection+30.0 mmol/L glucose, group D), high glucose+negative lentivirus transfection group (negative lentivirus transfection+30.0 mmol/L glucose, group E), and high glucose+exosome secretion inhibitor group (GW4869+30.0 mmol/L glucose, group F). Western blot was used to analyze the expression levels of Nephrin, Podocin, Sirt1, CD63, CD81, and Alix in each group. Real-time quantitative polymerase chain reaction was used to analyze the expression level of Sirt1 mRNA in D and E group. The morphology of podocyte exosomes was observed by a transmission electron microscope. The particle size and concentration of exosomes were determined by nanoparticle tracking analysis. Results The results of RT-qPCR showed that the relative expression of Sirt1 mRNA was significantly increased in group D compared with that in group E (t=14.580,P<0.01). The results of nanoparticle tracking analysis and Western blot showed that the relative expression of Sirt1, Nephrin, and Podocin proteins in podocytes among groups A to C was significantly different (F=49.84-106.40,P<0.01). Compared with group A, group C had significantly increased secretion of podocyte exosomes (t=14.550,P<0.01) and significantly reduced expression of Sirt1, Nephrin, and Podocin (t=7.446-15.110,P<0.01). Compared with group E, group D had significantly reduced release of podocyte exosomes (t=74.610,P<0.01) and significantly increased relative expression of Sirt1, Nephrin, and Podocin (t=4.657-32.860,P<0.05). Compared with group C, group F had significantly reduced release of podocyte exosomes (t=16.300,P<0.05) and significantly increased relative expression of Nephrin and Podocin (t=3.790,8.151,P<0.01), but showed no significant change in the expression level of Sirt1 (P>0.05). Conclusion Loss of Sirt1 in high glucose-treated podocytes promotes exosome secretion and podocyte injury.

Objective To investigate the effect of regulator of ribosome synthesis 1 (RRS1) on the proliferation and metastasis abilities of human breast cancer cells. Methods Western Blot was used to measure the protein expression level of RRS1 in human breast cancer cell lines (MDA-MB-231, MDA-MB-468, BT549, and MCF-7) and normal human breast epithelial cells. MDA-MB-468 cells were infected with sh-RRS1 lentivirus (sh-RRS1 group) and negative-control lentivirus (Con group), and MDA-MB-468 cells without infection were established as Blank group. Lentiviral infection efficiency was observed under a fluorescence microscope for the Con group and the sh-RRS1 group, and quantitative real-time PCR and Western blot were used to measure the mRNA and protein expression levels of RRS1 in cells; CCK-8 assay was used to observe the effect of RRS1 on the viability of MDA-MB-468 cells; scratch assay, Transwell assay, and invasion assay were used to observe the effect of RRS1 on the invasion and migration abilities of MDA-MB-468 cells. Results The expression level of RRS1 in the breast cancer cell lines was significantly higher than that in normal human breast epithelial cells (F=28.71,P<0.05). Compared with the Blank group and the Con group, the sh-RRS1 group had significant reductions in the mRNA and protein expression levels of RRS1 (F=118.10,335.40,P<0.05), cell proliferation activity (F=825.60-2839.00,P<0.05), and the invasion and migration abilities of cells (F=25.60-430.80,P<0.05). Conclusion The RRS1 gene might be involved in the proliferation and metastasis of breast cancer cells, which may be associated with the high expression of RRS1 in cells.

Objective To analyze the computed tomography (CT) and magnetic resonance imaging (MRI) findings of immunoglobulin G4 (IgG4)-related autoimmune pancreatitis (AIP), to improve the understanding of the imaging features of this disease, and to reduce imaging misdiagnosis. Methods A retrospective analysis was performed on the clinical data of 47 patients with IgG4-related AIP, among whom 33 underwent plain CT scan and contrast-enhanced CT scan, 24 underwent plain MRI scan, contrast-enhanced MRI scan, and magnetic resonance cholangiopancreatography (MRCP) examination, and 10 underwent combined CT and MRI examination to observe the morphology, changes in density/signal, contrast enhancement characteristics of the diseased pancreas, the peripancreatic and pancreatic duct changes, and the manifestations out of the pancreas. Results The CT and MRI scans showed that among the 47 patients, 27 had a “sausage-like”, diffusely enlarged pancreas and 20 had a focally enlarged pancreas. The plain CT scan showed a uniform and slightly low density; the contrast-enhanced CT scan of the lesion showed an inhomogeneous patchy enhancement in arterial phase, and a uniformly delayed progressive enhancement in portal vein phase and delayed phase. The MRI scan of the lesion showed inhomogeneous and slight hypointensity on T₁WI-FS and slight hyperintensity on T₂WI, the contrast-enhanced MRI scan showed an inhomogeneous mild enhancement in the early stage and a uniformly delayed progressive enhancement on delayed scan. The CT and MRI scans showed that 28 patients had capsule-like edges around the panc-reas, namely “capsule sign”, with a mild to moderate delayed enhancement on contrast-enhanced images. The MRCP showed that 10 patients had segmental stenosis of the main pancreatic duct and localized mild dilatation of the upstream pancreatic duct. The CT and MRI scans showed that 30 patients had changes in the bile duct system, with wall thickening, stenosis, and delayed enrichment of the pancreatic segment of common bile duct. The MRCP showed “beak-like” changes, and dilatation of upstream intrahepatic and extrahepatic bile ducts to varying degrees. Conclusion The CT and MRI findings of IgG4-related AIP have certain characteristics. The combination of imaging findings and relevant laboratory tests can help improve the diagnosis of this disease.

Objective To investigate the effect of human cytomegalovirus immediate-early protein 2 (HCMV-IE2) on fructose-induced hepatic steatosis in UL122 transgenic model mice. Methods The UL122 transgenic mice were established as experimental group, and age-matched wild-type mice were established as control group. The mice were fed with high-fructose (60%) diet for 8 weeks, and the changes in body weight and blood glucose were monitored. After the glucose tolerance test and the insulin tolerance test were performed, the mice were sacrificed, and the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured, as well as the levels of triglyceride (TG) and total cholesterol (TC) in the liver. Liver tissue was collected, and HE staining and oil red O staining were used to observe histopathological changes; flow cytometry was used to observe macrophage polarization in the liver; RT-qPCR and Western blot were used to measure the mRNA and protein expression levels of lipid synthesis-related genes in the liver. Results Compared with the control group, the experimental group had significant increases in body weight and fasting blood glucose level (F=12.78-100.05,P<0.05) and significantly impaired glucose tolerance and insulin resistance, with significant increases in the area under the GTT and ITT curves (t=3.25,4.70,P<0.05). There were significant increases in the serum levels of ALT and AST and the levels of TG and TC in the liver (t=4.52-13.12,P<0.05). The experimental group had a significant increase in the proportion of M1-type macrophages and a significant reduction in the proportion of M2-type macrophages in liver tissue (t=4.81-12.12,P<0.05), as well as significant increases in the mRNA and protein expression levels of the lipid synthesis genes SREBP1c, ACC1, FAS, and CD36 in the liver (t=3.54-9.96,P<0.05). Conclusion HCMV-IE2 affects the balance of liver lipid metabolism by inducing M1 polarization of macrophages in the liver, thereby promoting the progression of fructose-induced nonalcoholic fatty liver disease.

Objective To explore the value of computed tomography (CT) imaging features and texture analysis in the differential diagnosis of acinar cell carcinoma of the pancreas (ACCP). Methods The clinical data of patients who were patholo-gically diagnosed with ACCP, pancreatic ductal adenocarcinoma (PDAC), or solid pseudopapillary neoplasm (SPN) of the pancreas in our hospital from January 2017 to October 2018 were retrospectively analyzed. The clinical manifestations, tumor markers, CT imaging features, and texture parameters were compared and analyzed. Results The contrast-enhanced CT images of 5 patients with ACCP showed that most of the lesions were solid-cystic masses with a large size and more solid components. The CT images of 12 patients with PDAC showed that most of the lesions were solid masses with a small size. The CT images of 12 patients with SPN showed that most of the lesions were solid-cystic masses with a size greater than that of ACCP lesions and fewer solid components, showing the “floating cloud sign”. Eight texture parameters were valuable for the differential diagnosis between ACCP and PDAC (Z=2.015-2.530,P<0.05). Four texture parameters were valuable for the differential diagnosis between ACCP and SPN (Z=2.108-2.864,P<0.05). Conclusion The diagnosis of ACCP is relatively difficult. The CT imaging features and texture analysis contribute to the diagnosis of ACCP and its differentiation with PDAC and SPN.

Objective To investigate the relationship between intraoperative electroencephalographic (EEG) spindle loss and emergence delirium (ED) in elderly patients undergoing joint replacement surgery, and to further analyze the independent risk factors for ED. Methods A total of 69 elderly patients who underwent joint replacement surgery under general anesthesia in The Affiliated Hospital of Qingdao University from November 2020 to February 2021 were selected. Preoperative and intraoperative indicators, as well as length of stay in postanesthesia care unit and postoperative delirium incidence, were recorded. According to the presence or absence of EEG spindle waves, the patients were divided into spindle group and spindle loss group, and the relationship between intraoperative EEG spindle loss and ED was analyzed. The patients were then divided into ED group and non-ED group according to the presence or absence of ED after surgery. A univariate analysis was performed on various indicators of patients in the two groups. Factors with P<0.05 in univariate analysis and risk factors reported in previous studies were included in a multivariate logistic regression analysis model to identify independent risk factors for ED. Results The results of univariate analysis showed that the proportion of ED in the spindle loss group was significantly higher than that in the spindle group (χ²=11.189,P<0.05). There were significant differences in age, sex, stroke history, and the proportion of EEG spindle loss between the ED group and the non-ED group (t=-3.804,χ²=4.071-11.189,P<0.05). The multivariate logistic regression analysis showed that age (OR=1.197,95%CI=1.066-1.344) and intraoperative EEG spindle loss (OR=6.062,95%CI=1.384-26.543) were indepen-dent risk factors for ED. Conclusion In elderly patients undergoing joint replacement surgery under general anesthesia, intrao-perative EEG spindle loss is associated with the occurrence of ED. Intraoperative EEG spindle loss and age are independent risk factors for ED and may be important reference indicators for predicting the occurrence of ED.

Objective To investigate the value of preoperative CT evaluation of extramural vascular invasion in evaluating the prognosis of gastric cancer patients. Methods The patients who underwent gastrectomy in our hospital from January 2016 to December 2018 were enrolled as subjects, and preoperative CT examination was performed to evaluate extramural vascular invasion. The patients were followed up after surgery to observe overall survival (OS) and disease-free survival (DFS); the K-M curve and the log-rank test were used to analyze the association of extramural vascular invasion with OS and DFS, and the COX regression model was used to investigate the influencing factors for OS and DFS. Results The patients with a tumor diameter of ≥5 cm and TNM stage Ⅲ gastric cancer had a significantly higher incidence rate of extramural vascular invasion on preoperative CT evaluation than those with a tumor diameter of <5 cm and TNM stage Ⅰ-Ⅱ gastric cancer (χ²=7.745,7.011,P<0.05). Compared with the gastric cancer patients without extramural vascular invasion on preoperative CT evaluation, the patients with extramural vascular invasion had significantly shorter DFS and OS (χ²=6.245,5.388,P<0.05). Extramural vascular invasion and TNM stage were the influencing factors for DFS, and extramural vascular invasion, tumor diameter, and TNM stage were the influencing factors for OS in gastric cancer patients. Conclusion Preoperative CT evaluation of extramural vascular invasion is of great value in evaluating the prognosis of patients with gastric cancer.

Objective To investigate the diagnosis and treatment data of neonates with necrotizing enterocolitis (NEC) undergoing surgical treatment in our hospital, and to provide a reference for the selection of optimal surgical timing and approach in clinical practice. Methods A retrospective analysis was performed for the clinical data of 84 neonates with NEC who were admitted to our hospital from January 2015 to December 2020, and all neonates underwent plain abdominal radiography. During the surgery, enterostomy or resection of the necrotic intestinal canal followed by intestinal anastomosis was performed according to the location and extent of necrotic intestinal canal. The neonates were followed up to observe the changes in diet, defecation, and body weight, and their surgical outcome was summarized. Results Among the 84 neonates, 2 underwent intestinal decompression and peritoneal drainage; 72 underwent enterostomy, among whom 67 underwent ileostomy and 5 underwent distal jejunostomy; 7 underwent resection of the necrotic intestinal canal followed by intestinal anastomosis; 3 were withdrawn from treatment. Of all neonates, 77 had good prognosis; 2 had poor prognosis and required regular parenteral nutrition support due to short bowel syndrome; 2 died of necrotic enteritis at 6 months after surgery; 3 were withdrawn from treatment due to extensive bowel necrosis observed during surgery. Conclusion Neonates with NEC tend to have a high mortality rate, and enterostomy is the main treatment method at present. Timely surgical treatment has a good therapeutic effect on children with NEC.

Objective To investigate the effect of high-intensity focused ultrasound (HIFU) assisted by Hisense compu-ter-assisted system (CAS) in the treatment of pancreatic cancer. Methods A total of 22 patients with pancreatic cancer who were scheduled to undergo HIFU in our hospital from January 2020 to May 2021 were enrolled. Before surgery, two-dimensional CT images were reconstructed into three-dimensional images using Hisense CAS, which were then used to clarify the adjacent relationship between pancreatic tumor and the surrounding intestinal tract and organs. Response Evaluation Criteria in Solid Tumors were used to evaluate the efficacy of local ablation, and postoperative complications were recorded. Results The results of three-dimensional digital reconstruction by Hisense CAS clearly displayed the adjacent relationship between pancreatic tumor and the surrounding intestinal tract and organs and helped to achieve precise ablation. The 22 patients with pancreatic cancer had a complete remission rate of 9.1%, a partial remission rate of 68.2%, a stable disease rate of 13.6%, and a progressive disease rate of 9.1%. No serious complications such as gastrointestinal perforation, acute pancreatitis, pancreatic fistula, and gastrointestinal bleeding were observed after HIFU, and only 1 patient had superficial Ⅱ-degree skin burn. Conclusion HIFU ablation assisted by Hisense CAS has a good clinical effect in the treatment of advanced pancreatic cancer and thus holds promise for clinical application.

Objective To investigate the clinical application value of blood heparin-binding protein (HBP), procalcitonin (PCT), and C-reactive protein(CRP) in the early diagnosis of childhood sepsis. Methods A retrospective analysis was performed for 20 children with general sepsis (general sepsis group), 16 children with severe sepsis (severe sepsis group), and 12 children with septic shock (septic shock group) who were admitted to the pediatric intensive care unit and the neonatal intensive care unit of our hospital from November 2017 to May 2019, and 22 non-sepsis children with local infection (local infection control group) and 18 children with non-infectious disease (non-infection control group) who were admitted to the general ward during the same period of time were enrolled as control group. The levels of blood HBP, PCT, and CRP were measured and compared between groups, and the receiver operating characteristic (ROC) curve was used to investigate the value of each index in the early diagnosis of sepsis. Results The septic shock group had significantly higher levels of blood HBP and PCT than the severe sepsis group and the general sepsis group (P<0.05), and the severe sepsis group and the general sepsis group had significantly higher levels of blood HBP and PCT than the local infection control group and the non-infection control group (P<0.05). There was no significant diffe-rence in blood CRP between the septic shock group, the severe sepsis group, and the general sepsis group (P>0.05), but all these three groups had a significantly higher level of blood CRP than the non-infection control group (P<0.05). HBP had a significantly larger area under the ROC curve than PCT and CRP in the diagnosis of childhood sepsis (0.984 vs 0.954/0.897), and HBP had the best diagnostic performance at the cut-off value of 28.225 μg/L, with a sensitivity of 94.4% and a specificity of 96.9%. Conclusion HBP has a higher application value than PCT and CRP in the early diagnosis of childhood sepsis and has a similar value to PCT in terms of clinical classification, and therefore, it can be used to guide clinical practice.

Objective To investigate the ocular clinical features and diagnostic and therapeutic protocol of patients with endogenous endophthalmitis (EE) secondary to Klebsiella pneumoniae liver abscess (KPLA). Methods Six patients (seven eyes) with EE secondary to KPLA who attended our hospital from January 2019 to December 2020 were enrolled and analyzed in terms of clinical manifestation, examination findings, treatment regimen, and prognosis. Results All six patients were male, among whom five had pyrexia. All patients had impaired vision, and at initial diagnosis, there were four patients (five eyes) with no light perception, one patient (one eye) with manual vision, and one case (one eye) with light perception. All patients had the typical clinical manifestations of endophthalmitis such as impaired vision, conjunctival congestion and edema, ocular swelling and pain, and inflammatory response in the anterior chamber, and postoperative microbial culture of intraocular fluid showed positive Klebsiella pneumoniae. At the last visit, four patients (four eyes) had loss of vision, one patient (one eye) did not cooperate in vision check, and one patient (two eyes) was lost to follow-up. Conclusion EE secondary to KPLA is highly destructive to eyeball structure and visual function, and patients with KPLA who develop systemic symptoms (such as fever) or ocular discomfort (such as loss of vision, eye redness, and eye pain) should attend the outpatient service of ophthalmology department and receive regular follow-up examination to be alert to the development of endophthalmitis.

Objective To investigate the clinical effect of different doses of octreotide in the treatment of patients with severe acute pancreatitis (SAP). Methods A total of 154 patients with SAP who were admitted to our hospital from October 2018 to October 2022 were enrolled and randomly divided into observation group and control group, with 77 patients in each group. In addition to the conventional treatment methods including ulinastatin, the patients in the control group received intravenous drip of 0.6 mg octreotide, and those in the observation group received intravenous drip of 1.2 mg octreotide, once a day for 12 consecutive days. The two groups were compared in terms of overall response rate, proportion of patients with adverse reactions, time to clinical symptom disappearance, and time to normalization of blood amylase on day 12 of treatment, as well as the changes in the serum levels of inflammatory factors [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6)], the levels of T lymphocytes, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, and modified CT severity index (MCTSI) score. Results The observation group had a significantly higher overall response rate than the control group (χ²=5.140,P<0.05), and compared with the control group on day 12 of treatment, the observation group had significantly shorter time to symptom disappearance (pyrexia, abdominal distension, and abdominal pain) and time to normalization of blood amy-lase (t=14.703-22.543,P<0.01). Compared with the control group, the observation group had significantly greater changes in CRP, TNF-α, IL-6, CD8⁺, CD4⁺, and CD4⁺/CD8⁺ ratio after treatment (t=4.706-17.498,P<0.05), as well as significantly greater changes in APACHE Ⅱ and MCTSI scores after treatment (t=15.629,19.676,P<0.01). There was no significant diffe-rence in the proportion of patients with adverse reactions between the two groups (P>0.05). Conclusion High-dose octreotide can effectively improve the treatment outcome of patients with SAP, enhance their immune function, and reduce inflammatory response with a favorable safety profile, and therefore, it holds promise for clinical application.

Objective To investigate the morphological changes of pelvic diaphragm hiatus after vaginal delivery in primipara by perineal 3D ultrasound and its value in predicting pelvic organ prolapse. Methods A total of 112 primipara who were admitted to our hospital and had vaginal delivery from October 2016 to February 2020 were enrolled as study group, and 84 healthy women without pregnancy and history of childbirth who underwent physical examination in our hospital during the same period of time were enrolled as control group. The two groups were compared in terms of the proportion of patients with pelvic organ prolapse, parameters of pelvic diaphragm hiatus (anteroposterior diameter, left-right diameter, and area of pelvic diaphragm hiatus), thickness of levator ani muscle, and Young’s modulus after one year follow-up. The receiver operating characteristic (ROC) curve was plotted to analyze the efficacy of various parameters in predicting pelvic organ prolapse. Results There were significant differences in each parameter of pelvic diaphragm hiatus, the thickness of levator ani muscle, and Young’s modulus of the left and right sides under the resting state, the anal contraction state, and the Valsalva state between the study group and the control group and between the prolapse subgroup and the non-prolapse subgroup (t=4.645-37.691,P<0.05). The ROC curve analysis showed that for the subjects in the study group at 6 weeks postpartum, perineal 3D ultrasound at the resting state obtained a cut-off value of 5.15 cm for the anteroposterior diameter of pelvic diaphragm hiatus, 3.45 cm for the left-right diameter of pelvic diaphragm hiatus, 14.99 cm² for the area of pelvic diaphragm hiatus, 0.47 cm for the thickness of levator ani muscle, 22.15 kPa for Young’s modulus of the left side, and 20.05 kPa for Young’s modulus of the right side in predicting pelvic organ prolapse (P<0.05); at the anal constriction state, the cut-off values of these indices were 4.31 cm, 3.39 cm, 13.83 cm², 0.68 cm, 31.17 kPa, and 28.34 kPa, respectively, in predicting pelvic organ prolapse (P<0.05); at the Valsalva state, the cut-off values of these indices were 5.47 cm, 4.08 cm, 16.82 cm², 0.57 cm, 26.88 kPa, and 25.02 kPa, respectively, in predicting pelvic organ prolapse (P<0.05). Conclusion Perineal 3D ultrasound for primipara after vaginal delivery can accurately reflect the morphological changes of pelvic diaphragm hiatus and provide a reference for predicting postpartum pelvic organ prolapse in women and developing individualized rehabilitation training regimens.

Objective To study the characteristics and advantages of the tight trusteeship mode, and to provide expe-rience and suggestions for promoting the sinking of high-quality medical resources. Methods By literature analysis, the process and characteristics of hospital trusteeship reforms in China were summarized. Based on the “structure-process-results” theory, the tight, semi-tight, and loose trusteeship modes were compared using comparative research methods to summarize the main characteristics and advantages of the tight trusteeship mode. Through analyzing a case of tight trusteeship of a large provincial tertiary public hospital in Shandong Province, the specific practical measures, effectiveness, and existing problems of the tight trusteeship mode were discussed. Results The tight trusteeship mode is usually a comprehensive government trusteeship, where the trustee hospital provides a unified leadership to manage the entrusted hospital as a campus, integrating and homogenizing personnel ma-nagement, financial management, business management, informationization, and other aspects, achieving more stable collaboration and better performance. Conclusion The tight trusteeship mode is more conducive to channeling large public hospitals’ high-quality medical resources including brand, workforce, technology, and information towards primary medical institutions, which is an effective way to promote the expansion and sinking and regional balance of high-quality medical resources in the new era.

Objective To investigate the clinical value of preimplantation of protective guide wire during transcatheter aortic valve replacement (TAVR) for patients with high coronary risk. Methods Clinical data were collected from two patients with high coronary risk who received the preimplantation of protective guide wire during TAVR in Department of Cardiac Surgery in our hospital in 2021, and a retrospective analysis was performed for their perioperative clinical data. Results Both patients underwent a successful TAVR surgery, among whom one patient had a coronary stent implanted in the left coronary artery, and the other patient only received pre-protection with coronary guide wire and stent, which were removed after surgery. Postoperative angiography showed that both patients had good opening of the artificial interventional valve, mild regurgitation, and coronary artery patency, with varying degrees of alleviation or disappearance of heart failure symptoms after surgery. After 3 months of postoperative follow-up, echocardiography of the two patients showed normal function of the artificial biological valve of the aortic valve, with slight perivalvular regurgitation, and coronary CT angiography showed no obvious abnormality in the coronary artery. Conclusion The technique of protective wire preimplantation is safe and effective in preventing coronary artery occlusion during TAVR.

Objective To explore the diagnostic value of the ovarian-adnexal reporting and data system (O-RADS) in differentiating between benign and malignant ovarian tumors, and to analyze risk factors for malignant ovarian tumors. Methods The clinical data of 417 patients with ovarian tumors diagnosed by pathology were retrospectively analyzed. With pathological results as the gold standard, the patients were divided into malignant group and benign group. The clinical data of the two groups were compared. At the same time, the patients were classified according to ultrasound characteristics and O-RADS. A receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of O-RADS. Results The univariable and mul-tivariable analyses showed that the risk factors for ovarian malignancy included cyst wall thickness ≥3 cm, solid components, blood flow score of 3-4 points, ascites, and peritoneal nodules (P<0.05). Compared with O-RADS 5, using O-RADS 4-5 to diagnose ovarian malignancy significantly increased the sensitivity, accuracy, and area under the ROC curve (χ²=6.28-18.84,P<0.05). Conclusion O-RADS can well differentiate between benign and malignant ovarian tumors. When using O-RADS 4-5 to indicate a high risk of ovarian malignancy, the diagnostic efficacy is best.

Objective To investigate the experience in the clinical management of pregnancy and delivery after split liver transplantation (SLT). Methods Related clinical data were collected from a patient who became pregnant and delivered successfully after SLT in the Organ Transplantation Center of our hospital, and a literature review was also performed. Results The patient underwent allogeneic orthotopic SLT due to decompensated liver cirrhosis after autoimmune hepatitis and developed mild acute rejection after surgery, which was improved after the adjustment of immunosuppressive drugs. The patient became pregnant spontaneously at 2 years after surgery, and due to the medication history of mycophenolate sodium enteric-coated tablets, she decided to terminate pregnancy and withdraw from this drug. The patient became pregnant again at 3 years after surgery and expe-rienced fluctuations in graft function, and a series of treatments were given, such as adjustment of the dose of anti-rejection drugs, liver-protecting symptomatic treatment, and tocolytic therapy for threatened preterm labor. Finally under the guidance of liver transplantation, obstetrics, and neonatology, the patient gave birth to a healthy girl by cesarean section at 35 weeks of gestation. Conclusion Although SLT recipients may experience the situations such as fluctuations in graft function and preterm birth, they can achieve a satisfactory prognosis under multidisciplinary collaboration, scientific medication guidance, and close follow-up monitoring.

Objective To investigate the clinical efficacy of domino liver transplantation (DLT) and to provide a refe-rence for expanding the sources of donor livers. Methods The clinical data of two cases who underwent DLT at our hospital in 2021 were collected, and a literature review was performed. Results Donor 1 was a healthy subject, recipient 1 (DLT donor) was a patient with ornithine transcarbamylase deficiency, and recipient 2 (DLT recipient) was a patient with Cirgler-Najiar syndrome. Donor 2 was a brain-dead donor as per the internationally standardized definitions, recipient 3 (DLT donor) was a patient with familial hypercholesterolemia, and recipient 4 (DLT recipient) was a patient with malignant liver tumor. After transplantation, all patients experienced recovery of their liver function in 1 week, and were discharged from the hospital after 2 to 4 weeks of hospitalization. Recipient 2 developed thrombosis in the left portal vein on day 4 after operation; after emergent thrombolysis and anticoagulant therapy, the blood flow of the portal vein was effectively improved, and no serious outcomes were identified; the bilirubin level of the patient returned to normal at 1 week after operation. Recipient 4 developed hyperlipidemia after operation and was treated with atorvastatin and ezetimibe for lipid regulation; the patient was followed up till now with no additional complications found. Conclusion DLT can effectively expand the sources of donor livers.

Objective To investigate the nutritional status of patients undergoing concurrent chemoradiotherapy for malignant tumor and its influencing factors. Methods A self-designed questionnaire was used to collect related clinical data of the patients who underwent concurrent chemoradiotherapy for malignant tumor in Beijing Cancer Hospital from March to May, 2019. Patient-generated Subjective Global Assessment (PG-SGA) was used to investigate the nutritional status of these patients and related influencing factors. Results A total of 150 usable questionnaires were collected. The median PG-SGA score was 6.0 (3.0,11.0) for all 150 patients. Among these 150 patients, 56 (37.3%) had severe malnutrition and 49 (32.7%) had moderate malnutrition. The univariate analysis showed that old age, esophageal cancer or head and neck cancer, stage Ⅳ tumor, more than 15 sessions of radiotherapy, more than 4 sessions of chemotherapy, and paclitaxel+platinum regimen or platinum monotherapy were influencing factors for malnutrition in these patients (Z=-3.839--2.087,P<0.05). The binary logistic regression analysis showed that old age, esophageal cancer or head and neck cancer, and more than 15 sessions of radiotherapy were independent risk factors for severe malnutrition in patients (P<0.05). Conclusion There is a relatively high proportion of patients with malnutrition among the patients undergoing concurrent chemoradiotherapy for malignant tumor, especially among elderly patients, patients with esophageal cancer or head and neck cancer, and patients in the late stage of concurrent chemoradiotherapy. Medical staff should dynamically assess and monitor the nutritional status of patients and give timely intervention.

Objective To investigate the value of U-wave inversion combined with fragmented QRS (fQRS) on electrocardiogram in predicting the prognosis after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods A total of 123 patients with ACS admitted to The Third People’s Hospital of Henan Province from October 2017 to September 2019 were included. All the patients underwent PCI after electrocardiogram examination, followed by 3 months follow-up. The percentages of U-wave inversion, fQRS, and a poor prognosis were analyzed to determine the predictive value of U-wave inversion combined with fQRS for post-PCI outcome in patients with ACS. Results Among the 123 patients with ACS, the percentages of U-wave inversion, fQRS, and a poor prognosis were 39.84%, 33.33%, and 23.58%, respectively. The patients with a poor outcome showed significantly higher percentages of U-wave inversion and fQRS than those with a good outcome (χ²=20.547,26.080,P<0.05). U-wave inversion plus fQRS showed significantly higher specificity, accuracy, and area under the curve in predicting a poor prognosis following PCI in patients with ACS, as compared with U-wave inversion and fQRS alone (χ²=3.291-11.132,Z=3.543,4.861,P<0.05). Conclusion Patients with ACS have a high risk of a poor prognosis after PCI, which could be well predicted using U-wave inversion in combination with fQRS.

Optical coherence tomography angiography (OCTA) is a new noninvasive fundus angiography technique that has been widely used in recent years, and compared with traditional optical coherence tomography, OCTA has a higher resolution and a faster scanning speed. Compared with fundus fluorescein angiography and indocyanine green angiography, OCTA has its own advantages in the diagnosis and treatment of various fundus diseases, such as no need for the injection of contrast agent, a short time for examination, and clear display of the three-dimensional structure of retina and choroid. Although OCTA cannot replace fundus fluorescein angiography in clinical practice at present, it can still be used as an important auxiliary examination in the diagnosis of fundus diseases. Fer this reason, our article reviews the advances in the application of OCTA in the diagnosis of common fundus diseases such as senile macular degeneration, retinal vein occlusion, diabetic retinopathy, and central serous chorioretinopathy.

Hemorrhagic shock is a common acute and critical disease caused by trauma in clinic. In particular, local tissue hypoperfusion and cell hypoxia caused by renal ischemia and hypoxia can easily lead to acute kidney injury. In clinical practice, safer, practical, and effective resuscitation methods for patients with hemorrhagic shock are constantly explored to achieve the purpose of better protection of the kidney, such as the applications from colloidal crystal liquid to hypertonic fluid, from normal-pressure resuscitation to low-pressure resuscitation, from correcting blood pressure to restoring oxygen supply to tissue cells, from maintaining hemodynamic stability to inhibiting apoptosis, and from vasoactive drugs to Chinese traditional medicines to enzyme inhibitors. This article reviews the research progress of kidney protection for patients with hemorrhagic shock in recent years.

Hepatic hemangioma in children is the most common benign angiogenic tumor of the liver in infancy. It is difficult to differentiate hepatic hemangioma from malignant liver tumors in some children, and there is also the possibility of malignant transformation and life-threatening complications. This article reviews the classification, clinical features, diagnosis, treatment, and prognosis of hepatic hemangioma, in order to provide a reference for the clinical diagnosis and treatment of this disease.