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Background This study aimed to assess the global, regional, and national burden of liver cirrhosis and other chronic liver diseases between 1990 and 2019, considering five etiologies (hepatitis B, hepatitis C, alcohol use, NAFLD and other causes), age, gender, and sociodemographic index (SDI). Methods Data on liver cirrhosis and other chronic liver diseases mortality, incidence, and disability-adjusted life years (DALYs) were collected from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2019. Results In 2019, liver cirrhosis and other chronic liver diseases accounted for 1,472,011 (95% UI 1,374,608-1,578,731) deaths worldwide, compared to 1,012,975 (948,941-1,073,877) deaths in 1990. Despite an increase in absolute deaths, the age-standardized death rate declined from 24.43 (22.93–25.73) per 100,000 population in 1990 to 18.00 (19.31–16.80) per 100,000 population in 2019. Eastern sub-Saharan Africa exhibited the highest age-standardized death rate (44.15 [38.47–51.91] per 100,000 population), while Australasia had the lowest rate (5.48 [5.05–5.93] deaths per 100,000 population in 2019). The age-standardized incidence rate of liver cirrhosis and other chronic liver diseases attributed to hepatitis B virus has declined since 1990, but incidence rates for other etiologies have increased. Age-standardized death and DALYs rates progressively decreased with higher SDI across different GBD regions and countries. Mortality due to liver cirrhosis and other chronic liver diseases increased with age in 2019, and the death rate among males was estimated 1.51 times higher than that among females globally. Conclusion Liver cirrhosis and other chronic liver diseases continues to pose a significant global public health challenge. Effective disease control, prevention, and treatment strategies should account for variations in risk factors, age, gender, and regional disparities.

BackgroundLaparoscopic splenectomy (LS) has been proven to be a safe and advantageous procedure. To ensure that resections of appropriate difficulty are selected, an objective preoperative grading of difficulty is required. We aimed to develop a predictive difficulty grading of LS based on intraoperative complications.MethodsA total of 272 non-traumatic patients who underwent LS were identified from a regional medical center. Patients were randomized into a training cohort (n = 222) and a validation cohort (n = 50). Data on demographics, medical and surgical history, operative and pathological characteristics, and postoperative outcome details were collected. Univariate and multivariate analyses of risk factors for intraoperative complications were performed to develop a difficulty scoring system. The Spearman correlation coefficient was used to evaluate the relationship between the difficulty grading score and intraoperative outcomes. Receiver operating characteristic (ROC) curve was used to evaluate the discriminatory power of this scoring system.ResultsThree preoperative factors (spleen weight, esophagogastric varices, and INR) had a significant effect on operative time, bleeding, and conversion to open surgery. We created a difficulty grading score with three levels of difficulty: low (≤ 4 points), medium (5–6 points), and high (≥ 7 points), based on the three preoperative parameters. The correlation was highly significant (P < 0.01) according to Spearman’s correlation. The area under the ROC curve was 0.695 (95% CI 0.630–0.755). The external validation showed significant correlations with the present model, with an AUC of 0.725 (95% CI 0.580–0.842). The comparison between our difficulty score and the previous grading system in the 272-patient cohort presented a significant difference in the AUC (0.701, 95% CI 0.643–0.755 vs. 0.644, 95% CI 0.584–0.701, P = 0.0452).ConclusionThe present difficulty scoring system, based on preoperative factors, has good performance in predicting the risk of intraoperative complications of LS and could be helpful for enabling appropriate case selection with respect to the current experience of a surgeon.

ObjectivesThe objective of this study was to assess the impact of unresected primary tumor, as well as extrahepatic metastasis, on the long-term prognosis of patients undergoing hepatic resection for non-functional neuroendocrine liver metastasis (NF-NELM).MethodsPatients who underwent hepatic resection for NF-NELM were identified from a multi-institutional database. Data on clinical and pathological details, as well as the long-term overall survival (OS) were obtained and compared. Propensity score matching was performed to generate matched pairs of patients.ResultsAmong the 332 patients with NF-NELM, 281 (84.6%) underwent primary tumor resection, while 51 (15.4%) did not. Patients who underwent primary resection were more likely to have a pancreatic primary and metachronous NELM. The long-term OS of patients who did and did not have the primary neuroendocrine tumor (NET) resected was comparable on both unmatched (10-year survival rate 66.8% vs. 54.0%, p = 0.192) and matched (10-year survival rate 75.7% vs. 60.4%, p = 0.271) analyses. In contrast, patients with NF-NELM and extrahepatic metastasis had a worse OS following resection compared with patients who had intrahepatic-only metastasis on unmatched (10-year survival rate 37.5% vs. 69.3%, p = 0.002) and matched (10-year survival rate 37.5% vs. 86.3%, p = 0.011) analyses. On multivariable analysis, while resection of the primary NET was not associated with OS (hazard ratio [HR] 0.7, 95% confidence interval [CI] 0.4–1.2, p = 0.195), the presence of extrahepatic metastasis was independently associated with long-term risk of death (HR 3.9, 95% CI 1.7–9.2, p = 0.002).ConclusionsWhile surgery should be considered for patients with NF-NELM who have an unresectable primary tumor, operative resection of NF-NELM may not be as beneficial in patients with extrahepatic disease.

Background：Magnetic anchored surgical instruments （MASI）,relying on magnetic force,can break through the limitations of the single port approach in dexterity.Individual characteristic abdominal wall thickness （ICAWT） deeply influences magnetic force that determines the safety of MASI.The purpose of this study was to research the abdominal wall characteristics in MASI applied environment to find ICAWT,and then construct an artful method to predict ICAWT,resulting in better safety and feasibility for MASI.Methods：For MASI,ICAWT is referred to the thickness of thickest point in the applied environment.We determined ICAWT through finding the thickest point in computed tomography scans.We also investigated the traits of abdominal wall thickness to discover the factor that can be used to predict ICAWT.Results：Abdominal wall at C point in the middle third lumbar vertebra plane （L3） is the thickest during chosen points.Fat layer thickness plays a more important role in abdominal wall thickness than muscle layer thickness.＂BMI-ICAWT＂ curve was obtained based on abdominal wall thickness of C point in L3 plane,and the expression was as follow：f（x） =P1 × x^2 ＋ P2 x x ＋ P3,where P1 =0.03916 （0.01776,0.06056）,P2 =1.098 （0.03197,2.164）,P3 =-18.52 （-31.64,-5.412）,R-square：0.99.Conclusions：Abdominal wall thickness of C point at L3 could be regarded as ICAWT.BMI could be a reliable predictor of ICAWT.In the light of ＂BMI-ICAWT＂ curve,we may conveniently predict ICAWT by BMI,resulting a better safety and feasibility for MASI.

Objectives To characterize the prognostic implication of jaundice and preoperative biliary drainage on postoperative outcomes among patients with gallbladder cancer (GBC) undergoing surgical resection. Methods Patients who underwent surgical resection of GBC identified from a multicenter database between January 2000 and December 2019 were retrospectively analyzed. Data on clinical and pathological details, as well as short- and long-term overall survival (OS), were obtained and compared among patients with and without preoperative jaundice and biliary drainage. Results Among 449 patients with GBC, median and 1‐, 3‐, and 5‐year OS were 17.4 months, 63.7%, 28.4%, and 22.1%, respectively. Patients who presented with preoperative jaundice ( n  = 100, 22.3%) were more likely to have advanced disease, a lower incidence of R0 resection (29.0% vs. 69.1%, p  < 0.001), as well as a higher incidence of postoperative liver failure (4% vs. 0, p  = 0.002), and worse long-term survival versus patients without jaundice (median OS, 10.4 vs. 27.1 months, p  < 0.001). Preoperative biliary drainage was performed for the majority of jaundiced patients (77.0%) and was associated with decreased risk of postoperative liver failure (1.3% vs. 13.0%, p  = 0.041); preoperative biliary drainage failed to improve long-term survival (median OS, 10.2 months vs. 12.0 months, p  = 0.679). On multivariable analysis, R0 resection (17.5 vs. 7.6 months, p  < 0.001) and adjuvant therapy (15.6 vs. 6.6 months, p  = 0.027) were associated with improved long-term survival among jaundiced patients. Conclusions While preoperative biliary drainage of jaundiced GBC patients decreased the risk of postoperative liver failure, it did not impact long-term outcomes. Rather, preoperative jaundice was associated with a lower chance at R0 resection and worse long-term survival.

Hemispheric lateralization, recognized as a pivotal feature in both the structural and functional organization of the human brain, may undergo alterations in specific psychiatric disorders. However, the time-varying patterns of hemispheric lateralization in individuals with major depressive disorder (MDD) and the relationship between these patterns and gene expression profiles remain largely unexplored thus far. Using a large multi-site resting-state functional magnetic resonance imaging (rs-fMRI) data encompassing 2611 participants (1660 MDD patients and 1341 healthy controls), we examined MDD-related abnormalities in dynamic laterality and its association with clinical symptoms, meta-analytic cognitive functions, and neurotransmitter receptor profiles, respectively. And the biological basis behind these changes was investigated through gene enrichment analysis and cell-specific analysis. Here we found revealed pronounced fluctuations in lateralization primarily in the regions in default mode network, attention network and control network in MDD patients when compared to healthy controls. In addition, these fluctuations exhibited significant correlations with higher-order cognition terms and the distributions of disease related neurotransmitters. Further, through gene enrichment and cell-specific analysis, we identified a molecular genetic basis for these changes, highlighting synaptic function-related genes and neuronal cells. Collectively, these results demonstrated robust altered brain lateralization patterns in MDD and its molecular genetic basis, providing new clues to understand the pathophysiology of MDD.

Aim： The aim of the present study was to investigate the relationship between R219K, M883I, and R1587K variants of the ATP-binding cassette transporter subfamily A number 1 （ABCA1） gene and response to rosiglitazone treatment in newly diagnosed patients with type 2 diabetes. Methods： A total of 105 diabetic patients with no history of antihyperglycemia medication were treated with rosiglitazone （4 or 8 mg daily） for 48 weeks. Three non-synonymous variants R219K, M883I, and R1587K, were genotyped in all patients. Results： Ninety-three patients completed the entire study. The R219K variant of ABCA1 had an effect on rosiglitazone response with the per-allele odds ratio of 2.04 for treatment failure （P〈0.05）. The RR homozygotes had a better improvement in indicators of insulin sensitivity, as determined by a significantly greater decrease in the homeostasis model assessment index of insulin resistance （-2.39±0.46 vs -0.69±0.51, P〈0.05）. No genotype- phenotype association was detected for M883I and R1587K. Conclusion： The R219K variant of ABCA1 was associated with the therapeutic effect of rosiglitazone. The RR homozygotes had a better response to rosiglitazone treatment in terms of insulin sensitivity improvement than minor K allele carriers. Neither the M883I nor R1587K variant of the ABCA1 gene was associated with rosiglitazone response.

Aim： The aim of the present study was to explore whether renin angiotensin system （RAS） inhibitor can reduce the production of vascular endothelium growth factor （VEGF）. Further, we sought to elucidate the correlation between VEGF level and certain clinical parameters, such as albumin excretion rate （AER）, before and after treatment with angiotensin type 1 receptor blocker. Methods： We recruited 166 type 2 diabetic patients at various stages of diabetic nephropathy （DN） and 46 healthy control subjects for a cross-sectional study. We recruited another 42 hypertensive type 2 diabetic patients with microalbuminuria for a longitudinal study involving a 6-month irbesartan treatment protocol. Urinary VEGF （uVEGF） levels were determined using ELISA. Results： In the cross-sectional study, hypertensive type 2 diabetic patients who received RAS inhibitor presented lower uVEGF levels than those who did not receive the RAS inhibitor. Statistical analysis indicated that uVEGF level was independently correlated with the AER. In the longitudinal study involving the 6-month irbesartan treatment, we demonstrated that uVEGF levels decreased significantly in patients who achieved a 50% AER reduction （remission group, n=32）. In contrast, uVEGF levels remained unchanged in patients who did not exhibit a 50% AER reduction （nonremission group, n=10）. Furthermore, the change in uVEGF was significantly correlated with the change in AER （r=0.65, P〈0.01） before and after 6 months of irbesartan treatment. This result held true even after we had adjusted for the decrease in average blood pressure. Conclusion： The protective effect of the RAS inhibitor in DN patients is associated with the suppression of VEGF. Accordingly, it may be possible to use uVEGF as a marker of DN progression. We suggest that uVEGF may be an important target for therapeutic intervention in the context of DN.

Aim： The aim of this study was to investigate the association of KCNJll E23K and ABCC8 exon 16-3T/C with the therapeutic effect of repaglinide in patients with type 2 diabetes. Methods： A total of 100 Chinese patients with newly diagnosed type 2 diabetes were treated with repaglinide for 24 weeks. Arginine stimulation tests were performed to evaluate beta cell function. Gene variations were detected with PCR-restriction fragment length polymorphism. Responders were defined by a greater than 25% decrease in fasting plasma glucose or a greater than 20% decrease in hemoglobin A lc （HbAlc） values （or both） after the 24 week repaglinide treatment. Results： Both baseline HbAlc and the decrease of HbAlc were significantly higher in patients with E/K and K/K genotypes of the KCNJ11 E23K variant when compared with E/E homozygotes （P=0.0103 and 0.0221, respectively）. The decrease in 2 h postprandial plasma glucose （2hPG） was significantly greater in E/K heterozygotes than E/E homozygotes （P=0.0367）. There was a significant difference in the response rate to repaglinide treatment between the E and K alleles （68% vs 82%, P=0.0324）. The changes in fasting insulin and the homeostasis model assessment of insulin resistance were significantly greater in patients with ABCC8 exon 16-3 C/C versus the T/C and T/T genotypes （P=0.0372 and 0.0274, respectively）. Conclusion： The KCNJ11 E23K variant was associated with the therapeutic effect of repaglinide. In addition, The C/C homozygotes of the ABCC8 exonl6-3T/C variant responded better to repaglinide in insulin sensitivity than the T/C and T/T genotypes.

Permeability characteristics of compacted loess is always an important topic in soil mechanics and geotechnical engineering. This study explored the permeability characteristics of compacted loess under different dry densities and wetting-drying cycles, and found that as the dry density increases, the compacted loess surface became denser, the saturation permeability coefficient and saturation infiltration rate decreased. However, the wetting-drying cycle presented the opposite result. Meanwhile, the evolution of the microstructure was investigated by Scanning Electron Microscope (SEM) and Nuclear Magnetic Resonance (NMR) to explain the change of its permeability characteristics. The size of compacted loess aggregates was quantitatively analyzed by Image-Pro Plus (IPP) software. It showed that the size of compacted loess aggregates for different dry densities were concentrated from 10–100 μm, occupying 65.0%, 58.19%, and 51.64% of the total aggregates area respectively. And the interesting finding was that the area occupied by 10–50 μm aggregates remained basically unchanged with the number of wetting-drying cycles increasing. Therefore, the size of 10–50 μm aggregates represented the transition zone of compacted loess. NMR analyses revealed that with increasing dry density, the volume of macropores in the compacted loess rapidly decreased, the volume of mesopores and small pores increased. Meanwhile, the change in micropores was relatively small. The pore volume of the compacted loess after three wetting-drying cycles increased by 8.56%, 8.61%, and 6.15%, respectively. The proportion of macropores in the total pore volume shows the most drastic change. Variations in aggregate size and connection relationships made it easier to form overhead structures between aggregates, and the increased of macropore volume will form more water channels. Therefore, the change in permeability characteristics of compacted loess is determined by aggregate size, loess surface morphology, and the total pore volume occupied by macropores.