[Progress in drug therapy of Wilson's disease].

Wilson's disease, also known as hepatolenticular degeneration, is an inherited disorder of copper metabolism caused by homozygous or compound heterozygous variants in the ATP7B gene, which is mainly clinically manifested as liver disease and/or neurological/psychological disorders, and Kayser-Fleischer ring in the peripheral cornea. Patients with Wilson's disease are currently treated with lifelong use of chelating agents that promote copper ion excretion and/or zinc agents that reduce copper absorption, but there is still an unmet clinical need because some patients who receive treatment have poor efficacy, disease progression, or serious adverse drug reactions. In recent years, new therapeutic drugs have been developed rapidly. This article will summarize the advances in drug treatment of Wilson's disease, shedding new light on the treatment of Wilson's disease.

Effect of flipped venous catheter combined with spinal cord electrical stimulation on functional recovery in patients with sciatic nerve injury.

OBJECTIVE: This study aimed to explore the effect of flipped venous catheters combined with spinal cord electrical stimulation on functional recovery in patients with sciatic nerve injury. PATIENTS AND METHODS: 160 patients with hip dislocation and sciatic nerve injury were divided into conventional release and flipped catheter + electrical stimulation groups according to the treatment methods (n=80). Motor nerve conduction velocity (MCV) and lower limb motor function were compared. Serum neurotrophic factors brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) were compared. The frequency of complications and quality of life were also compared. RESULTS: The MCV levels of the common peroneal nerve and tibial nerve in the flipped catheter + electrical stimulation group were greater than the conventional lysis group (p<0.05). After treatment, the lower extremity motor score (LMEs) in the flipped catheter + electrical stimulation group was greater than the conventional lysis group (p<0.05). The serum levels of BDNF and NGF in the flip catheter + electrical stimulation group were higher than the conventional lysis group (p<0.05). The complication rate in the flipped catheter + electrical stimulation group was lower than in the conventional release group (6.25% vs. 16.25%, p<0.05). The quality-of-life score in the flip catheter + electrical stimulation group was greater than the conventional lysis group (p<0.05). CONCLUSIONS: The flipped venous catheter combined with spinal cord electrical stimulation can improve nerve conduction velocity, lower limb motor function, serum BDNF and NGF levels, reduce complications, and help improve the quality of life of sufferers with sciatic nerve injury. Chictr.org.cn ID: ChiCTR2400080984.

[Current status and reflection on minimal access breast surgery].

Minimal access breast surgery with the assistance of an endoscopy or robot has been an important advancement in surgical treatment in recent years. Compared to conventional open surgery, minimal access breast surgery only requires small incisions in concealed areas such as axillary fossa, avoiding visible scars on the surface of the breast, significantly improving the postoperative aesthetic appearance and patient satisfaction. With the rapid development of minimal access breast surgery, several institutions have established their own distinctive techniques. The concept of membrane anatomy in the breast, for example, has led to more natural-looking breast reconstruction following endoscopic procedures. The adoption of the reverse space dissection technique has greatly optimized the workflow of endoscopic breast cancer resection. Intraoperative navigation system for endoscopic breast-conserving surgery could allow precise localization of excision margins. Furthermore, the widespread use of the cold dissection technique for flap separation has reduced surgical duration and minimized flap damage. The emergence of unique techniques in the field of minimal access breast surgery promises to further advance and promote the adoption of minimal access breast surgery in China.

[A retrospective cohort study of the postoperative prothesis-related complications of single-port endoscopic assisted versus open surgery on nipple sparing mastectomy and immediate prosthesis breast reconstruction].

Objective: To examine the postoperative prosthesis-related complications, short-term surgical outcomes and patient satisfaction with breast reconstruction between patients who underwent endoscopic assisted versus conventional nipple sparing mastectomy and immediate prothesis breast reconstruction. Methods: This study was a retrospective cohort study. A retrospective analysis was performed on clinical data of 104 women with breast cancer who received nipple sparing mastectomy and immediate prothesis breast reconstruction from August 2021 to August 2022 at the Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. They were divided into two groups according to the surgical approach. A total of 53 patients, aged (43.3±9.9) years (range: 25 to 66 years), underwent endoscopic nipple sparing mastectomy (E-NSM group) and immediate prothesis breast reconstruction. The other 51 patients aged (39.9±7.8) years (range: 25 to 54 years) underwent conventional open surgery (C-NSM group). Short-term surgical outcomes including operation time, postoperative hospital stay, postoperative blood loss, and postoperative drainage volume in 2 days were recorded. Patient satisfaction with breast reconstruction was compared using the Wilcoxon rank sum test. Postoperative prothesis-related complications were investigated to determine the experience to deal with them. Results: No postoperative prosthesis-related infection, prosthesis loss, or necrosis of the nipple-areola complex occurred in the E-NSM group, while 1 patient suffered from hematoma, whose wound was skinned with resuture after disinfection. Five patients in the C-NSM group had prosthesis-related infection, 2 of them received prosthesis removal surgery combined with sufficient antimicrobial agent, another one underwent surgery for subcutaneous placement of the drain, as well as antimicrobial agent therapy, and the rest of them healed up only with antimicrobial agent therapy. All recovered well after treatment. One patient recovered from necrosis of the nipple-areola complex through periodic iodophor disinfection and dressing which ended in improvement of necrotic areas, another patient who had hematoma accepted the same treatment mentioned above and also healed. All the patients mentioned above are now in stable conditions. Patients in the E-NSM group had higher satisfaction with the cosmetic results of the breast prosthesis implant than those in the C-NSM group (Z=-4.511, P<0.01). Conclusions: Both surgical approaches were proven to be safe and effective with a low rate of postoperative prosthesis-related complications. Patients in the E-NSM group were more satisfied with the cosmetic results of breast reconstruction than those in the C-NSM group.

Clinical efficacy analysis of minimally invasive intramedullary nailing in the treatment of humeral shaft fractures combined with radial nerve injury.

OBJECTIVE: The aim of this study was to research the therapeutic effectiveness of radial nerve damage paired with a humeral shaft fracture and intramedullary nailing. PATIENTS AND METHODS: Retrospective research was performed on the medical records of 58 individuals who had humeral shaft fractures and radial nerve injuries. The admission period was between June 1, 2020, and June 31, 2022. All study subjects that satisfied the requirements for inclusion were separated, using the random number table approach, into two groups: one for internal fixation (group N), which included 29 cases, and one for minimally invasive procedures (group W), which included 29 patients. Group W received minimally invasive intramedullary nail treatment, and group N received internal fixation with compression plates. The changes in the clinical effects, surgery-related indicators, joint function, nerve function, and levels of stress indicators of the two groups of treatment were analyzed. The changes in adverse reactions and satisfaction of patients were compared. RESULTS: The effective rate of group W was 89.66% (26/29), and that of group N was 72.41% (21/29). Although group W's effective rate was higher than group N's, there was no discernible disparity between the two groups (p>0.05). Surgical blood loss and incision length were much smaller in group W than in group N, and overall operation duration and length of stay were considerably shorter in group W than in group N (p<0.05). The excellent and good rate of elbow joint function in group W was 93.10% (27/29), whereas the excellent and good rate of group N was 65.52% (19/29). The excellent and good rate of elbow joint function in group W was considerably greater than that of group N (p<0.05). In group W, the excellent and good rate of shoulder joint was 96.55% (28/29), and that in group N was 68.97% (20/29), and group W had a considerably greater probability of excellent shoulder joint function than group N (p<0.05); the excellent and good rate of neurological function was 82.76% (24/29) in group W and 58.62% (17/29) in group N, and group W had much greater rates of excellent and good neurological function than group N (p<0.05). prostaglandin E-2 (PGE2), C-reactive protein (CRP) and Substance P (SP) levels in the W group and the N group were substantially higher after the surgery than they were prior to it (p<0.05), and in the W group, the aforementioned stress markers were much lower than they were in the N group (p<0.05). Group W experienced a 3.45% (1/29) rate of adverse events, while group N saw a 24.14% (7/29) incidence. The incidence of adverse responses was substantially lower in group W than in group N (p<0.05). The contentment rate of group W was 93.10% (27/29), and that of group N was 72.41% (21/29). Group W had a much greater contentment percentage than group N (p<0.05). CONCLUSIONS: Minimally invasive intramedullary nailing is a successful therapeutic approach for humeral shaft fractures with radial nerve damage, which may successfully enhance patients' shoulder and elbow joint function and nerve function, reduce patients' stress response, and has the characteristics of minimal adverse responses and high contentment, which is worthy of popularization and deployment.

Risk avoidance of screw-induced suprascapular nerve injury in arthroscopic Latarjet procedure and reliable anatomical landmark analysis of Latarjet surgery.

OBJECTIVE: Shoulder dislocation represents a prevalent category within joint dislocation, accounting for about 40% of all joint dislocations, and anterior dislocation stands out as the prevailing type. It has been reported that in 1.6% of patients, the Latarjet procedure performed under arthroscopy involves transferring the coracoid process to the anterior-inferior aspect of the glenoid and fixing it with two bicortical screws. The tip of the screws may impinge the suprascapular nerve located behind the scapula, resulting in shoulder pain and weakness. This study was performed to analyze the risk of suprascapular nerve (SSN) injury caused by bicortical screws during arthroscopic Latarjet surgery and to identify reliable anatomical landmarks for Latarjet surgery. MATERIALS AND METHODS: Dissection was conducted on 23 fresh adult intact shoulder joint specimens, and the experimental protocol complied with the hospital's ethical requirements for research. Using the glenoid clock face as a reference, the distances between the suprascapular nerve and the anterior edge of the glenoid were measured at the 12:00, 11:00, 10:00, and 9:00 positions, as well as at the level of the suprascapular notch and the level of the spinoglenoid notch. The distances between the suprascapular nerve and the narrowest point of the glenoid rim and the clock scale were recorded. The scapula was divided into three zones, and the number of nerve branches in each zone was recorded. The collected data were subjected to statistical analysis. The suprascapular nerve trunk and branches were marked using radiopaque lines, and measurements were taken at three positions in computed tomography horizontal scans: the suprascapular foramen, the spinoglenoid notch, and the point of entry of the outermost nerve branch into the muscle. RESULTS: The suprascapular nerve originates from the brachial plexus, passes downward and backward through the suprascapular foramen, closely adheres to the bone surface, and runs outward and downward deep to the supraspinatus muscle. The distances between the suprascapular nerve and the glenoid rim at the 12:00, 11:00, 10:00, and 9:00 positions were 335.18±2.31 mm, 28.23±3.47 mm, 22.32±2.78 mm, and 22.12±2.07 mm, respectively. There was a mean of 1.12 nerve branches in zone 1, 2.86 in zone 2, and 3.64 in zone 3. In the neutral position of the shoulder joint, the horizontal distance between point A and the axillary nerve was 27.37 (19.80, 34.55) mm, and the vertical distance was 16.67 (12.85, 20.35) mm. CONCLUSIONS: The use of bicortical screws, especially upper screws, for Latarjet fixation at the level of the spinoglenoid notch, is associated with the risk of suprascapular nerve injury. The narrowest distance between the glenoid rim and the suprascapular nerve was found between 9:00 and 9:30 at the glenoid clock surface. Therefore, caution should be exercised when performing any procedure related to this area. Overall, the Latarjet procedure is a reliable and effective surgical technique, providing benefits such as favorable positioning of the coracoid graft and low bone absorption rate, while also avoiding the potential for suprascapular nerve injury.

[Clinical features and long-term prognosis of primary biliary cholangitis in patients with past hepatitis B virus infection].

Objective: To investigate the clinical features and long-term prognosis of primary biliary cholangitis (PBC) in patients with past hepatitis B virus (HBV) infection. Methods: 353 cases with PBC who visited the Liver Disease Center of Beijing Friendship Hospital Affiliated to Capital Medical University between January 2000 and January 2018 were retrospectively analyzed and were divided into the past HBV infection group (156 cases) and the no HBV infection group (197 cases). The two groups' baseline clinical features were compared. Ursodeoxycholic acid response rate after one year, GLOBE score, UK-PBC score, and long-term liver transplantation-free survival rate were compared through outpatient and telephone follow-up. Results: PBC with past HBV infection had a significantly reduced female proportion compared to the no HBV infection group (91.9% vs. 79.5%, P = 0.001). However, there were no statistically significant differences in age, biochemical indices, immunological indicators, platelet count, cirrhosis proportion, and others. Ursodeoxycholic acid biochemical response rate was reduced in patients with past HBV infection at the end of one year of treatment, but the difference was not statistically significant (65.8% vs. 78.2%, P = 0.068). In addition, there were no statistically significant differences between the GLOBE score (0.57 vs. 0.59, P = 0.26) and UK-PBC 5-year (2.87% vs. 2.87%, P = 0.38), 10-year (9.29% vs. 8.2%, P = 0.39) and 15-year liver transplantation rates (16.6% vs. 14.73%, P = 0.39). Lastly, the overall 5-year liver transplantation-free survival rate had no statistically significant difference between the two groups of patients (86.4% vs. 87.5%, P = 0.796). Conclusion: Primary biliary cholangitis had no discernible effect in terms of age at onset, biochemical indices, immunological indicators, cirrhosis proportion, ursodeoxycholic acid response rate after one year, GLOBE score, UK-PBC score, or overall liver transplantation-free survival rate in patients with past hepatitis B virus infections.

DTI of Opioid-Exposed Fetuses Using ComBat Harmonization: A Bi-Institutional Study.

BACKGROUND AND PURPOSE: The underlying mechanisms leading to altered cognitive, behavioral, and vision outcomes in children with prenatal opioid exposure are yet to be fully understood. Some studies suggest WM alterations in infants and children with prenatal opioid exposure; however, the time course of WM changes is unknown. We aimed to evaluate differences in diffusion tensor imaging MRI parameters in the brain between opioid exposed fetuses and normal controls. MATERIALS AND METHODS: This is a pilot, prospective cohort study in which subjects in the third trimester of pregnancy underwent fetal DTI of the brain with 20 noncolinear diffusion directions and a b-value of 500 s/mm2 at 2.5-mm isotropic resolution. RESULTS: The study included a total of 26 fetuses, 11 opioid-exposed (mean gestational age, 32.61 [SD, 2.35] weeks) and 15 unexposed controls (mean gestational age, 31.77 [SD, 1.68] weeks). After we adjusted for gestational age, fractional anisotropy values were significantly higher in opioid-exposed fetuses relative to controls in 8 WM tracts: the bilateral lemniscus (left: P = .017; right: P = .020), middle cerebellar peduncle (P = .027), left inferior cerebellar peduncle (P = .026), right sagittal stratum (P = .040), right fornix stria terminalis (P = .022), right inferior fronto-occipital fasciculus (P = .011), and the right uncinate fasciculus (P = .033). Significant alteration was also identified in other DTI indices involving a series of brain regions. CONCLUSIONS: Our data demonstrate initial evidence of cerebral WM microstructural differences between opioid-exposed fetuses and unexposed controls. Further studies in larger patient populations will be needed to fully understand these findings.

[Analysis of change in esophageal varices and clinical characteristics in hepatitis B virus-related cirrhosis after antiviral therapy].

Objective: To clarify the effect and related factors of antiviral therapy on the change of esophageal varices in patients with hepatitis B virus-related cirrhosis. Methods: Fifty-two cases with hepatitis B virus-related cirrhosis who underwent endoscopy before and after antiviral therapy were selected from prospective cohorts. Patients were divided into three groups: no, mild, and moderate-severe based on the degree of esophageal varices. The changes in the severity of esophageal varices in each group were compared after antiviral therapy. Clinical characteristics (platelet, liver and kidney function, liver stiffness, and virological response) of patients with different regressions were analyzed. Measurement data were analyzed by independent sample t-test, one-way ANOVA, Mann-Whitney U test and Kruskal-Wallis H test, and Chi-Square test was used for count data. Results: All patients received entecavir-based antiviral therapy. The median treatment time was 3.1 (2.5-4.4) years. The proportion of patients without esophageal varices increased from 30.8% to 51.9%, the proportion of mild esophageal varices decreased from 40.4% to 30.8%, and the proportion of patients with moderate-to-severe esophageal varices decreased from 28.8% to 17.3% (χ2=14.067, P=0.001). A total of 40.4% of patients had esophageal varices regression, and 13.5% had esophageal varices progression. The progression rate was significantly higher in patients with moderate-severe esophageal varices than patients with mild and no esophageal varices (χ2=28.126, P<0.001), and 60.0% of patients with moderate-severe esophageal varices still remained in moderate-severe state after antiviral treatment. Baseline platelet count and 5-year mean change rates were significantly lower in patients with progressive moderate-to-severe esophageal varices than in those without progression (+3.3% vs. +34.1%, Z=7.00, P=0.027). Conclusion: After effective antiviral treatment, 40.4% of patients with hepatitis B virus-related cirrhosis combined with esophageal varices has obtained esophageal varices regression, but those with moderate to severe esophageal varices still have a considerable risk of progression while receiving mono antiviral treatment only. Thrombocytopenia and without significant improving are the clinical signs of progression risk after receiving antiviral treatment.

[Histological regression and clinical benefits in patients with liver cirrhosis after long-term anti-HBV treatment].

Objective: Our study aims to determine histological regression and clinical improvement after long-term antiviral therapy in hepatitis B virus-related cirrhosis patients. Methods: Treatment-naïve chronic hepatitis B patients with histologically or clinically diagnosed liver cirrhosis were enrolled. Liver biopsies were performed after 5 years entecavir-based antiviral treatment. Patients were followed up every 6 months. Cirrhosis regression was evaluated based on Metavir system and P-I-R score. Clinical improvement was evaluated before and after the long-term treatment. Kruskal Wallis test and Wilcoxon signed-rank test were used for continuous variables, Fisher's exact test was used for categorical variables and multivariate analysis was performed using logistic regression analysis. Results: Totals of 73 patients with HBV-related liver cirrhosis were enrolled. Among them, 30 (41.1%) patients were biopsy proved liver cirrhosis and the remaining 43 (58.9%) cirrhotic patients were diagnosed by clinical features. Based on Metavir system and P-I-R score, 72.6% (53/73) patients attained histological regression. Furthermore, 30.1% (22/73) were defined as significant regression (Metavir decrease ≥2 stage), 42.5% (31/73) were mild regression (Metavir decrease 1 stage or predominantly regressive by P-I-R system if still cirrhosis after treatment) and 27.4% (20/73) were the non-regression. Compared to levels of clinical characteristics at baseline, HBV DNA, ALT, AST, liver stiffness(decreased from 12.7 to 6.4 kPa in significant regression, from 18.1 to 7.3 kPa in mild regression and from 21.4 to 11.2 kPa in non-regression)and Ishak-HAI score significantly decreased after 5 years of anti-HBV treatment, while serum levels of platelets and albumin improved remarkably (P<0.05). In multivariate analysis, only the pre-treatment liver stiffness level was associated with significant regression (OR=0.887, 95%CI: 0.802-0.981, P=0.020). Conclusions: After long-term antiviral therapy, patients with HBV-related cirrhosis are easily to attain improvements in clinical parameters, while a certain percentage of these patients still cannot achieve histological reversal.

[Liver involvement in endocrine diseases].

As a secondary endocrine organ, the liver is closely related to the endocrine system. Liver involvement is not uncommon in endocrine diseases, such as hyper/hypothyroidism, diabetes, dysfunction of adrenal and gonadal. It can be manifested in a variety of forms, including hepatocyte injury (elevated transaminase), bile duct injury (cholestasis), hepatocyte steatosis, vascular injury and liver tumor. Direct and indirect liver injury caused by abnormal hormone levels and side effects of drugs for the treatment of endocrine diseases are common pathogenesis. In addition, endocrine diseases can be concomitant with liver diseases, such as autoimmune thyroiditis and autoimmune hepatitis. Systemic diseases can also involve the endocrine system and liver at the same time, such as systemic lupus erythematosus and IgG4 related diseases. For patients with unexplained liver injury, endocrine system diseases should be considered as the differential diagnosis.

[Connective tissue diseases and the liver injury].

Connective tissue disease (CTD) are closely related to liver abnormality. CTD can affect the liver causing various degrees of liver injury, coexist with other liver diseases, especially autoimmune liver disease (ALD). Medications for CTD can also lead to liver injury or reactivate the hepatitis B virus. CTD patients can also be positive for ALD-related autoantibodies without corresponding manifestation; and vis versa. The diagnosis and differential diagnosis should be made on integrating clinical presentation, laboratory, imaging, and histological studies, not solely relying on autoantibody positivity.

[Liver manifestation of circulatory disorders].

The liver is abundant in blood supply and receives 25% of the cardiac output via the hepatic artery and portal vein. Circulatory disorders may cause hepatic injury, resulting in congestive hepatopathy(CH) and ischemic hepatitis(IH). Hepatic congestion arising from increased hepatic venous pressure and decreased cardiac output is the common pathophysiological basis of both CH and IH. In addition, extensive arteriovenous shunts affect portal pressure and cardiac function, leading to alterations of hepatic blood supply. The current review summarizes the pathophysiology, clinical manifestations and therapeutic interventions of the above diseases, in order to provide reference for clinical practice.

[Chronic kidney disease after adrenalectomy in a patient with primary aldosteronism].

We report one case of estimated glomerular filtration rate (eGFR) decline after taking unilateral adrenalectomy due to aldosterone adenoma. A 60-year-old male with 23-year history of hypertension was reported to the endocrinologist due to hypokalemia (serum potassium 3.01 mmol/L). Urine microalbumin/creatinine (ALB/CR) was 70.15 mg/g, serum creatinine was 82 µmol/L and eGFR was 89.79 mL/(min·1.73 m2). Random serum aldosterone was 172.2-203.5 ng/L, and random plasma rennin activity was 0-0.17 µg/(L·h). His captopril challenge test suggested that his aldosterone le-vels were suppressed by 8% (< 30%) and the adrenal enhanced computed tomography scan revealed a left adrenal tumor. The patient was diagnosed with primary hyperaldosteronism (PA), aldosterone adenoma and underwent left laparoscopic adrenalectomy. Histological examination confirmed adrenal cortical adenoma. One week after the operation, his serum creatinine was increased to 127 µmol/L compared with preoperative level; eGFR was 32.34 mL/(min·1.73 m2). His systolic blood pressure (SBP) was 110 mmHg and diastolic blood pressure (DBP) was 60 mmHg (hypotensive drugs discontinued), and serum potassium level was 5.22 mmol/L. At the end of the 2-year follow up, the serum creatinine of this patient remained at 109-158 µmol/L and eGFR fluctuated from 63.28-40.12 mL/(min·1.73 m2). PA is one of the most common causes of secondary hypertension. Several studies have reported renal function deterioration of PA patients after unilateral adrenalectomy, like the patient in this article. Age, preoperative plasma aldosterone concentration, albuminuria and preoperative potassium level might be significant predictors of a decrease in the eGFR. Growing evidence suggests that aldosterone could contribute to structural kidney damage, arterial injury and hemodynamic disorder. At the same time, patients with PA exhibit glomerular hyperfiltration and glomerular vascular hypertension, leading to the misinterpretation of renal function in PA patients as subtle kidney damage may be masked by the glomerular hyperfiltration before treatment. After a unilateral adrenalectomy, glomerular hyperfiltration by aldosterone excess is resolved and renal damage can be unmasked. In conclusion, kidney function deterioration after adrenalectomy can be detected in some patients with PA. Thus, accurate evaluation of kidney function in patients with PA may be essential, especially for those with preoperative risk factors for postoperative renal impairment. After unilateral adrenalectomy, close monitoring of renal function and adequate management are required for PA patients.

Maternal Obesity during Pregnancy is Associated with Lower Cortical Thickness in the Neonate Brain.

BACKGROUND AND PURPOSE: Recent studies have suggested that maternal obesity during pregnancy is associated with differences in neurodevelopmental outcomes in children. In this study, we aimed to investigate the relationships between maternal obesity during pregnancy and neonatal brain cortical development. MATERIALS AND METHODS: Forty-four healthy women (28 normal-weight, 16 obese) were prospectively recruited at <10 weeks' gestation, and their healthy full-term neonates (23 boys, 21 girls) underwent brain MR imaging. All pregnant women had their body composition (fat mass percentage) measured at ∼12 weeks of pregnancy. All neonates were scanned at ∼2 weeks of age during natural sleep without sedation, and their 3D T1-weighted images were postprocessed by the new iBEAT2.0 software. Brain MR imaging segmentation and cortical surface reconstruction and parcellation were completed using age-appropriate templates. Mean cortical thickness for 34 regions in each brain hemisphere defined by the UNC Neonatal Cortical Surface Atlas was measured, compared between groups, and correlated with maternal body fat mass percentage, controlled for neonate sex and race, postmenstrual age at MR imaging, maternal age at pregnancy, and the maternal intelligence quotient and education. RESULTS: Neonates born to obese mothers showed significantly lower (P ≤ .05, false discovery rate-corrected) cortical thickness in the left pars opercularis gyrus, left pars triangularis gyrus, and left rostral middle frontal gyrus. Mean cortical thickness in these frontal lobe regions negatively correlated (R = -0.34, P = .04; R = -0.50, P = .001; and R = -0.42, P = .01; respectively) with the maternal body fat mass percentage measured at early pregnancy. CONCLUSIONS: Maternal obesity during pregnancy is associated with lower neonate brain cortical thickness in several frontal lobe regions important for language and executive functions.

[Effects of different fluid resuscitation on renal function and glycocalyx in septic shock rats].

To investigate the effects of different fluid resuscitation on renal function and glycocalyx in septic shock rats. The septic shock SD rats (induced by lipopolysaccharide) were randomly divided into control group, normal saline resuscitation group, Lactate Ringer's solution resuscitation group and succinyl gelatin resuscitation group (n=6 each). The mean arterial pressure, heart rate, serum creatinine (Scr), urea nitrogen (BUN), renal blood flow, renal tissue pathology, serum interleukin-6, tumor necrosis factor α and glycocalyx were measured at baseline, the development of septic shock, 0 hour and 8 hours after resuscitation. When shock was established, the renal blood flow significantly decreased (P<0.05) and recovered to normal at 0 hour and 8 hours after resuscitation. Compared with normal saline group and succinyl gelatin group, the levels of Scr, BUN and glycocalyx components (heparan sulfate, syndecan-1) were significant lower in Lactate Ringer's solution group (P<0.05). The pathology of kidney tissue suggested that the microscopic ischemic damage with Lactate Ringer's solution were minor than the other two groups. Compared with normal saline and succinyl gelatin, Lactate Ringer's solution can reduce the damage of renal function and glycocalyx in septic shock rats.

[Comparative study of clinicopathological features, and risk factors of advanced fibrosis between genders with non-alcoholic fatty liver disease].

Objective: To comparatively study the similarities and differences between the clinical, pathological, and risk factors of advanced fibrosis in men and women with non-alcoholic fatty liver disease (NAFLD). Methods: 267 patients with NAFLD diagnosed by liver biopsy were retrospectively included, and were divided into male and female groups. The difference of clinical and pathological indexes were compared between the two groups. The measurement data were in accordance with normal distribution. The comparison between the two groups was performed by independent sample t-test. The non-parametric test was used for non-normal distribution. The classification data were expressed as a percentage, and the chi-square test was used for comparison between groups. Logistic regression analysis was used to analyze the risk factors. Results: The age of onset of NAFLD was significantly lower in male than female patients (P < 0.01). There was no statistically significant difference between the male and female groups in terms of body mass index and the prevalence of type 2 diabetes (P > 0.05). Biochemical index: The levels of alanine aminotransferase, albumin, total bilirubin and uric acid were significantly higher in male than female patients (P < 0.01). Liver pathology: The proportion of ballooning degeneration was significantly lower in male than female patients (P < 0.01). There was not statistically significant difference between the two groups in the proportion of steatohepatitis score, non-alcoholic steatohepatitis (52.0% vs. 61.5%, P = 0.283) and advanced liver fibrosis (14.3% vs. 17.8%, P = 0.162). Thrombocytopenia was a common independent risk factor for advanced stage liver fibrosis (OR = 0.984, 0.978~0.989, P < 0.01). Type 2 diabetes was only an independent risk factor for advanced stage liver fibrosis in men (OR = 6.557, 1.667~25.782), P < 0.01). Elevated AST was only an independent risk factor for advanced stage liver fibrosis in women (OR = 1.016, 1.003~1.028, P = 0.012). Conclusion: In NAFLD patients, there are some clinical and pathological differences between genders. Platelets are a common predictor of advanced liver fibrosis in men and women. Type 2 diabetes in men and elevated aspartate aminotransferase in women can be regarded as independent risk factors for advanced liver fibrosis.

[Evaluation of clinical application of transjugular liver biopsy in 61 cases].

Objective: To evaluate the effectiveness and safety of transjugular liver biopsy (TJLB) in clinical applications. Methods: Clinical data of patients who underwent TJLB in the Beijing Friendship Hospital Affiliated to Capital Medical University from November 2017 to March 2019 were retrospectively reviewed. Clinical characteristics, indications and biopsy complications and the samples quality were analyzed. Results: Among 61 cases who underwent TJLB, 32 were males and 29 were females, aged 16 to 79 years. There were 43 cases (70.5%) with abnormal coagulation function, among which the prothrombin time activity percentage (39%) and platelet count (24×10(9)/L ) were lowest. 38 cases (62.3%) had perihepatic fluid. One case was obese, and had a body mass index of 31kg/m2. 56 cases (91.8%) were successfully biopsied. 51 cases (83.6%) liver tissue samples were assessed with pathological diagnosis. Five cases (8.2%) had serious complications. 14 cases (23.0%) had mild complications, and no patients died. Conclusion: TJLB is a safe and feasible method for patients who have contraindications to percutaneous liver biopsy.

Clinical epidemiology and outcome of HIV-associated talaromycosis in Guangdong, China, during 2011-2017.

OBJECTIVES: Talaromycosis is an invasive mycosis endemic to Southeast Asia. This study aimed to investigate the epidemiology, clinical features and prognostic factors of HIV-associated talaromycosis in Guangdong, China. METHODS: We retrospectively evaluated HIV patients hospitalized with histopathology- or culture-confirmed talaromycosis between 2011 and 2017. Factors associated with poor prognosis were identified using logistic regression. RESULTS: Overall, 1079 patients with HIV-associated talaromycosis were evaluated. Both the number and prevalence of talaromycosis among HIV admissions increased from 125 and 15.7% in 2011 to 253 and 18.8% in 2017, respectively, reflecting the increase in HIV admissions. Annual admissions peaked during the rainy season between March and August. Common clinical manifestations included fever (85.6%), peripheral lymphadenopathy (72.3%), respiratory symptoms (60.8%), weight loss (49.8%), skin lesions (44.5%) and gastrointestinal symptoms (44.3%). Common laboratory abnormalities were hypoalbuminaemia (98.6%), anaemia (95.6%), elevated aspartate aminotransferase level (AST) (76.9%), elevated alkaline phosphatase level (55.8%) and thrombocytopenia (53.7%). The median CD4 count was 9 cells/µL. Talaromyces marneffei was isolated from blood and bone marrow cultures of 66.6% and 74.5% of patients, respectively. The rate increased to 86.6% when both cultures were performed concurrently. At discharge, 14% of patients showed worsening conditions or died. Leucocytosis, thrombocytopenia, elevated AST, total bilirubin, creatinine and azole monotherapy independently predicted poor prognosis. CONCLUSIONS: The incidence of HIV-associated talaromycosis has increased in Guangdong with the high HIV burden in China. Skin lesions were seen in less than half of patients. Induction therapy with azole alone is associated with higher mortality. Findings from this study should help to improve treatment of the disease.

[Systematic evaluation of clinical trial protocols of new drugs as a cure of chronic hepatitis B].

Objective: To describe the current status of registration and design characteristics of clinical trials of new drugs for curing hepatitis B through domestic and foreign websites, so as to provide references for the follow-up clinical trials of new hepatitis B drugs. Methods: A search was conducted on the US Clinical Trials Database and the Chinese Clinical Trial Registry Center. The search date was from the establishment of the database to May 26, 2020, and the registration trials of new drugs for curing hepatitis B at home and abroad were included. Two researchers independently searched and screened the literature and extracted the data. Results: A total of 106 registered clinical trials of new drugs for curing hepatitis B were included (94 English registration websites and 12 Chinese registration websites), and the number of registrations had increased year by year. Among them, the proportion of therapeutic vaccines and core protein inhibitors were the highest, accounting for 27.4% (n = 29) and 22.6% (n = 24), respectively. The vast majority of clinical trials (n = 96, 90.6%) were in the early stages (Phase I and II). The subjects in phase I clinical trial were mainly healthy people and treated CHB patients, while the subjects in phase II clinical trial were mainly CHB patients who had achieved viral suppression after initial or post-treatment. The main evaluation indicators of Phase I clinical trials were the safety and tolerability of new drugs. The main evaluation indicators in about half of Phase II clinical trials were HBsAg negative conversion/quantitative decline. Overall, the number of clinical trials with the new design was small, accounting for 3.8% (4 / 106). There were relatively few trials of new drugs for curing hepatitis B on domestic registration websites, and the information provided was incomplete. Conclusion: The number of clinical trials of new hepatitis B drugs at home and abroad is increasing year by year, but most of them are in phase I and II, with few adopting new designs. In addition, the information integrity of the domestic website registration center needs to be improved.