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Objective: To explore the distribution of allergen-specific IgE (sIgE) for children with atopic dermatitis in Tianjin City and provide the evidences of clinical diagnosis and treatment. Methods: A retrospective cross-sectional study was conducted to analyze the children who were suspected of atopic dermatitis and tested for serum sIgE in the Tianjin Children's Hospital from March 2021 to February 2023. Using first detection results only, a total of 1 841 serum samples were tested for twenty common allergens. The method was the enzyme-linked immune capture assay. The allergen epidemiological characteristics were statistically analyzed by Chi square test based on the children's characteristics and factors such as different sexes, ages and seasons by the mass data. Results: Among the 1 841 cases, the results showed that 1 247 (67.73%) were sensitized to at least 1 allergen-sIgE, comprising to 49.86% (918/1 841) to food allergen-sIgE and 47.96% (883/1 841) to aeroallergen-sIgE. The top three food allergens-sIgE were egg 32.10% (591/1 841), milk 25.91% (477/1 841) and wheat flour 14.61% (269/1 841); the top three positive rates of aeroallergens-sIgE were house dust 24.33% (448/1 841), alternaria 20.59% (379/1 841) and dermatophagoides farinae 14.83% (273/1 841). The positive rates of food allergens-sIgE were the highest in the 1-3 years old group (64.11%, 434/677) (χ2=122.854, P<0.001), while the positive rates of aeroallergens-sIgE were higher in the 11-14 years old group (71.26%, 62/87) (χ2=134.968, P<0.001). No seasonal difference was revealed in the overall positive rate of food allergen-sIgE and aeroallergen-sIgE (χ2=4.047, P=0.256; χ2=7.549, P=0.056). The positive rates of soybean-sIgE and milk-sIgE were the highest in summer (χ2=11.329, P=0.010; χ2=28.720, P<0.001), whereas alternaria-sIgE and mugwort-sIgE were the highest in summer and autumn, respectively (χ2=8.462, P=0.037; χ2=10.641, P=0.014). Among the 1 841 cases, 32.21% were sensitized to three or more allergens-sIgE. The sIgE concentration levels of egg, milk and house dust were mainly level 1 to 2, and the proportions of level 3 and above were all under 15%; although the positive rates of crab, shrimp, and peanut were low, the proportions of grade 3 and above were all beyond 30%. Children sensitized to alternaria, dermatophagoides farinae, mugwort, and cat dander had higher sIgE concentration levels, which were 68.07%, 49.45%, 56.57% and 47.83% respectively. Conclusions: This study can reflect the epidemic characteristics of allergen-sIgE in children with atopic dermatitis in Tianjin region to a certain extent. Allergen-sIgE positivity in patients differed by age, and there were seasonal differences and grade distribution differences in the positive rates of some allergens-sIgE. It is necessary to reasonably avoid the high-risk allergens according to the epidemiological characteristics and clinical symptoms, which provide valuable information for the prevention, diagnosis and treatment of atopic dermatitis.
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Alérgenos , Dermatitis Atópica , Inmunoglobulina E , Humanos , Dermatitis Atópica/inmunología , Estudios Transversales , Alérgenos/inmunología , Niño , Estudios Retrospectivos , Inmunoglobulina E/inmunología , Inmunoglobulina E/sangre , Preescolar , Masculino , Femenino , China , Adolescente , Lactante , Hipersensibilidad a los Alimentos/inmunologíaRESUMEN
Objective: This study aims to compare the antiviral treatment similarities and differences in the population covered by the 2024 version of the World Health Organization's (WHO) hepatitis B prevention and treatment guidelines and the current Chinese hepatitis B prevention and treatment guidelines, so as to explore their impact on the indications for antiviral therapy in Chinese patients with chronic hepatitis B (CHB). Methods: The information of patients with chronic hepatitis B virus infection who did not receive antiviral treatment was collected through the registration database of the China Clinical Research Platform for Hepatitis B Elimination. Descriptive statistics were conducted on the demographic, blood, biochemical, and virological levels of patients according to the treatment recommendations of the two versions of the guidelines. The Mann-Whitney U test and χ2 test were used to compare the differences and proportional distribution of the treatment populations covered by the two guidelines. The χ2 test was used to analyze the coverage rate of different antiviral treatment indications. Results: A total of 21,134 CHB patients without antiviral treatment were enrolled. 69.4% of patients met the 2024 versions of the WHO guidelines' recommendations. 85.0% of patients met the current Chinese hepatitis B prevention and treatment guidelines. The WHO guidelines for antiviral therapy indications were met in younger patients with higher levels of ALT, AST, and APRI scores, as well as greater proportion of patients with higher viral loads (P<0.001). The WHO guidelines recommended a cut-off value of APRI>0.5, which raised the proportion of patients on antiviral therapy from 6.6% to 30.9%. 45.7% of patients met the antiviral indications for HBV DNA >2000 IU/ml with abnormal transaminase (ALT>30 U/L for males and ALT>19 U/L for females). The reduced APRI diagnostic cut-off value and ALT treatment threshold had further increased the treatment coverage rate by 91.6% in patients with chronic HBV infection in line with the 2024 versions of WHO guidelines. Conclusion: The reduction of the APRI diagnostic cut-off value and the ALT treatment threshold, based on the current hepatitis B guidelines of China, will further improve the treatment coverage of CHB patients.
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Antivirales , Hepatitis B Crónica , Guías de Práctica Clínica como Asunto , Organización Mundial de la Salud , Humanos , Antivirales/uso terapéutico , Hepatitis B Crónica/tratamiento farmacológico , Adulto , Femenino , Masculino , China/epidemiología , Persona de Mediana Edad , Adulto Joven , Adolescente , Anciano , Pueblos del Este de AsiaRESUMEN
Objective: To construct a diabetes foot prediction model for adult patients with type 2 diabetes based on retrospective cohort study using data from a regional health data platform. Methods: Using Yinzhou Health Information Platform of Ningbo, adult patients with newly diagnosed type 2 diabetes from January 1, 2015 to December 31, 2022 were included in this study and divided randomly the train and test sets according to the ratio of 7â¶3. LASSO regression model and bidirectional stepwise regression model were used to identify risk factors, and model comparisons were conducted with net reclassification index, integrated discrimination improvement and concordance index. Univariate and multivariate Cox proportional hazard regression models were constructed, and a nomogram plot was drawn. Area under the curve (AUC) was calculated as a discriminant evaluation indicator for model validation test its calibration ability, and calibration curves were drawn to test its calibration ability. Results: No significant difference existed between LASSO regression model and bidirectional stepwise regression model, but the better bidirectional stepwise regression model was selected as the final model. The risk factors included age of onset, gender, hemoglobin A1c, estimated glomerular filtration rate, taking angiotensin receptor blocker and smoking history. AUC values (95%CI) of risk outcome prediction at year 5 and 7 were 0.700 (0.650-0.749) and 0.715(0.668-0.762) for the train set and 0.738 (0.667-0.801) and 0.723 (0.663-0.783) for the test set, respectively. The calibration curves were close to the ideal curve, and the model discrimination and calibration powers were both good. Conclusions: This study established a convenient prediction model for diabetic foot and classified the risk levels. The model has strong interpretability, good discrimination power, and satisfactory calibration and can be used to predict the incidence of diabetes foot in adult patients with type 2 diabetes to provide a basis for self-assessment and clinical prediction of diabetic foot disease risk.
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Diabetes Mellitus Tipo 2 , Pie Diabético , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Pie Diabético/epidemiología , Estudios Retrospectivos , Incidencia , Factores de Riesgo , Masculino , Femenino , Modelos de Riesgos Proporcionales , Nomogramas , Persona de Mediana Edad , Hemoglobina Glucada/análisis , AdultoRESUMEN
Total mesorectal excision is the standard procedure for the treatment of low and medium rectal cancer. Anastomotic leakage has always been one of the serious complications in these patients. Blood supply, tension and intestinal condition are important factors affecting anastomotic quality. How to optimize the surgical technique and reduce the occurrence of anastomotic leakage is the goal of surgeons. Based on traditional total mesorectal excision, we integrated several surgical techniques, including (1) Preserving the left colic artery; (2) High ligation of the inferior mesenteric vein; (3) Patterned mobilization of the spleen flexure and left transverse colon; (4) Multi-plane mesocolic tailoring; (5) Selective anastomosis suturing, and proposed the concept of multi-technique integrated total mesorectal resection (MTI-TME). The application of MTI-TME in clinical practice and significance was discussed.
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Anastomosis Quirúrgica , Neoplasias del Recto , Humanos , Neoplasias del Recto/cirugía , Anastomosis Quirúrgica/métodos , Fuga Anastomótica/prevención & control , Recto/cirugíaRESUMEN
The global chronic hepatitis B (CHB) guidelines have gradually expanded treatment indications in order to accelerate the elimination and improve the treatment rate of hepatitis B virus (HBV) infection. This article analyzes the new treatment concepts for chronic hepatitis B at home and abroad from two aspects: expanding treatment by paying more attention to the long-term prognosis of the disease and maximizing the use of existing drugs in order to achieve the early goal of the World Health Organization's of eliminating viral hepatitis by 2030.
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Antivirales , Hepatitis B Crónica , Humanos , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/terapia , Antivirales/uso terapéutico , Virus de la Hepatitis B , Organización Mundial de la SaludRESUMEN
Objective: To explore the association between triglyceride glucose index (TyG)- waist to height ratio (WHtR)(TyG-WHtR) and cognitive impairment in middle-aged and elderly population. Methods: A cohort database was constructed using the data from the China Health and Retirement Longitudinal Study, with 8 946 participants in 2011 and 2015 as the baseline population. Cox proportional hazards regression models were used to estimate the association between TyG-WHtR levels at baseline and the risk of cognitive impairment in middle-aged and elderly population. The analysis was stratified by age and gender, respectively. Results: A total of 8 946 participants were included, with an average follow-up of 7.08 person-years and incidence density of cognitive impairment for 21.15 per 1 000 person-years. Compared with the Q1 level of TyG-WHtR, its Q3 and Q4 level increased the risk of cognitive impairment by 32% (HR=1.32, 95%CI: 1.09-1.60) and 47% (HR=1.47, 95%CI: 1.14-1.91), respectively. Trend test showed that the risk of cognitive impairment increased with the increase of TyG-WHtR level, and there was a dose-response relationship (P=0.001). Stratified analysis showed that in the population aged 45-59 years, compared with the Q1 level of TyG-WHtR, its Q3 level increased the risk of cognitive impairment by 34% (HR=1.34, 95%CI: 1.02-1.78). In the population aged 60 years and above, compared with the Q1 level, its Q3 and Q4 level increased the risk of cognitive impairment by 31% (HR=1.31, 95%CI: 1.01-1.72) and 63% (HR=1.63, 95%CI: 1.15-2.31), respectively. In the male group, there was no significant association between TyG-WHtR level and the risk of cognitive impairment (P>0.05). In the female group, compared with the Q1 level of TyG-WHtR, its Q4 level increased the risk of cognitive impairment by 76% (HR=1.76, 95%CI: 1.26-2.46). Conclusions: Middle-aged and elderly population with a higher TyG-WHtR level may increase the risk of cognitive impairment, and there were age and sex differences. Early cardiovascular health management and scientific and reasonable weight management are of great significance to preventing cognitive impairment.
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Disfunción Cognitiva , Triglicéridos , Humanos , China/epidemiología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/sangre , Persona de Mediana Edad , Anciano , Femenino , Masculino , Triglicéridos/sangre , Estudios Longitudinales , Factores de Riesgo , Estudios de Cohortes , Relación Cintura-Estatura , Glucemia/análisis , Modelos de Riesgos ProporcionalesRESUMEN
Objective: To analyze the clinical characteristics and prognosis of patients with infant acute lymphoblastic leukemia (IALL). Methods: A retrospective cohort study.Clinical data, treatment and prognosis of 28 cases of IALL who have been treated at Beijing Children's Hospital, Capital Medical University and Baoding Children's Hospital from October 2013 to May 2023 were analyzed retrospectively. Based on the results of fluorescence in situ hybridization (FISH), all patients were divided into KMT2A gene rearrangement (KMT2A-R) positive group and KMT2A-R negative group. The prognosis of two groups were compared. Kaplan-Meier method and Log-Rank test were used to analyze the survival of the patients. Results: Among 28 cases of IALL, there were 10 males and 18 females, with the onset age of 10.9 (9.4,11.8) months. In terms of immune classification, 25 cases were B-ALL (89%), while the remaining 3 cases were T-ALL (11%). Most infant B-ALL showed pro-B lymphocyte phenotype (16/25,64%). A total of 22 cases (79%) obtained chromosome karyotype results, of which 7 were normal karyotypes, no complex karyotypes and 15 were abnormal karyotypes were found. Among abnormal karyotypes, there were 4 cases of t (9; 11), 2 cases of t (4; 11), 2 cases of t (11; 19), 1 case of t (1; 11) and 6 cases of other abnormal karyotypes. A total of 19 cases (68%) were positive for KMT2A-R detected by FISH. The KMT2A fusion gene was detected by real-time PCR in 16 cases (57%). A total of 24 patients completed standardized induction chemotherapy and were able to undergo efficacy evaluation, 23 cases (96%) achieved complete remission through induction chemotherapy, 4 cases (17%) died of relapse. The 5-year event free survival rate (EFS) was (46±13)%, and the 5-year overall survival rate (OS) was (73±10)%.The survival time was 31.3 (3.3, 62.5) months. There was no significant statistical difference in 5-year EFS ((46±14)% vs. (61±18)%) and 5-year OS ((64±13)% vs. (86±13)%) between the KMT2A-R positive group (15 cases) and the KMT2A-R negative group (9 cases) (χ2=1.88, 1.47, P=0.170, 0.224). Conclusions: Most IALL patients were accompanied by KMT2A-R. They had poor tolerance to traditional chemotherapy, the relapse rate during treatment was high and the prognosis was poor.
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Leucemia-Linfoma Linfoblástico de Células Precursoras , Masculino , Niño , Lactante , Femenino , Humanos , Estudios Retrospectivos , Hibridación Fluorescente in Situ , Pronóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Cariotipo Anormal , RecurrenciaRESUMEN
Objective: To examine the willingness of HIV non-occupational post-exposure prophylaxis (nPEP) among MSM and factors related were also assessed. Methods: The respondent-driven sampling method was used to recruit MSM for a face-to-face interview with a structured questionnaire,the sample size was estimated at 600 subjects. Demographic data, sexual behavior, awareness, and willingness regarding nPEP were collected. The factors related to willingness to nPEP were assessed using complex logistic regression. Results: A total of 14 rounds were recruited and 608 MSM subjects were included in the study. The average age was (41.6±11.0) years. 55.4% (95%CI: 49.4%-59.4%) were aware of nPEP, and 4.5% (95%CI: 2.9%-6.2%) have used its. 35.9% (95%CI: 31.1%-40.7%) expressed interest in taking nPEP if needed. Among the reasons for not being willing to take nPEP, 68.9% (244/354) were never heard of nPEP, and 24.6% (87/354) were a fluke mentality. The multivariate logistic analysis results showed that the willingness of nPEP awareness of MSM was related to the group aged 25-39 years old (aOR=1.80, 95%CI: 1.01-3.20), knowing a group of HIV prevention knowledge (aOR=2.43, 95%CI: 1.52-3.90), group of consistent condom use in anal sex in the past half of year (aOR=1.76, 95%CI: 1.11-2.79). Conclusions: The use rate of nPEP among MSM in Beijing was low, and the willingness to use in the future also needs to be improved. The training of social organizations should be strengthened to improve the role of peer education in promoting nPEP.
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Infecciones por VIH , Minorías Sexuales y de Género , Masculino , Humanos , Adulto , Persona de Mediana Edad , Beijing , Homosexualidad Masculina , Profilaxis Posexposición , Conducta Sexual , Infecciones por VIH/prevención & controlRESUMEN
A normal liver can develop cirrhosis through long-term and repeated stimulation from various etiologies. Histological manifestations like the collapse of hepatic lobular structure (including microvascular structure) and the formation of pseudolobules can lead to portal hypertension and even decompensated cirrhosis. More and more evidence suggests that effective etiological treatment can not only delay but also reverse the progression of cirrhosis. The mechanism of cirrhosis reversal mainly includes the degradation of extracellular matrix, hepatocyte regeneration, and hepatic lobular remodeling. The "gold standard" for the evaluation of cirrhosis reversal at present is still a liver biopsy. Therefore, the histopathological evaluation of cirrhosis reversal is very important for determining the disease's prognosis, efficacy, and mechanism of exploration.
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Hipertensión Portal , Cirrosis Hepática , Humanos , Cirrosis Hepática/patología , Hígado/patología , Hepatocitos/patología , PronósticoRESUMEN
1. This study developed a comprehensive sensory evaluation system that consisted of descriptions corresponding to United States Department of Agriculture photos to evaluate overall acceptability, albumen and yolk appearances and odours. It determined physiochemical parameters of eggs stored at 7°C (7W12 and 7U12 for washed and unwashed, respectively) for 12 weeks and stored at 25°C (25W4 and 25U4 for washed and unwashed, respectively) for four weeks.2. Throughout storage, there was a general downward trend in Haugh units (HU) and yolk index and an upward trend in air cell size, weight loss and S-ovalbumin content were observed (P < 0.05). The 25W4 and 25U4 egg quality rapidly deteriorated from grade AA (HU 81.7) to grade B after two weeks (HU 46.5 and 49.6), whereas 7W12 and 7U12 eggs remained grade A after 12 weeks (HU 67.3 and 66.9). High correlations were observed between the sensory and physiochemical parameters (i.e., R2 = 0.93, 0.93, 0.88 and 0.94 for albumen appearance, yolk appearance, sensorial odour and overall acceptability, respectively, with HU in 25W4 eggs).3. Eggs stored at 25°C and classified into 'premium', 'class I', and 'class II' on the basis of their HU had estimated shelf life of 0.5, 1.5 and 2.5 weeks, while shelf lives of 4, 9 and 15 weeks were estimated for 7°C-stored premium, class I and II eggs, respectively.4. In conclusion, distinct HU requirements for eggs of different quality classes under two storage temperatures need to be established. Incorporating sensory evaluation with conventional physiochemical analyses is promising to assess and estimate egg quality changes. Further research work about the influences of different storage temperatures and possible temperature fluctuations during storage on egg quality changes is needed.
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Pollos , Óvulo , Animales , Temperatura , Albúminas , Huevos/análisisRESUMEN
Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association update the guidelines for the prevention and treatment of chronic hepatitis B (version 2022) in 2022. The latest guidelines recommend more extensive screening and more active antiviral treating for hepatitis B virus infection. This article interprets the essential updates in the guidelines to help deepen understanding and better guide the clinical practice.
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Gastroenterología , Hepatitis B Crónica , Hepatitis B , Humanos , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B/tratamiento farmacológico , Virus de la Hepatitis B , Antivirales/uso terapéuticoRESUMEN
Patients with HBeAg-positive and negative chronic hepatitis B (CHB) have different immunological states and disease progression. Hence, the previously recommended antiviral therapy strategies for the two are different. In recent years, the antiviral indications have gradually eased, and the treatment goal has began to pursue clinical cure, as experts and scholars have gradually attached importance to the potential risk of disease progression in hepatitis B patients. Antiviral treatment strategies are gradually becoming uniform for patients with HBeAg-positive and negative. However, among them, HBeAg-negative patients can be combined with HBsAg quantification and other indicators to further screen the clinically cured dominant population in order to formulate the next treatment strategy.
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Hepatitis B Crónica , Humanos , Hepatitis B Crónica/tratamiento farmacológico , Antígenos e de la Hepatitis B , ADN Viral , Antivirales/uso terapéutico , Antígenos de Superficie de la Hepatitis B , Resultado del Tratamiento , Virus de la Hepatitis B/genéticaRESUMEN
Objective: To analyze the epidemiological characteristics and transmission chain of an epidemic of COVID-19 in Haidian district, Beijing. Methods: Descriptive epidemiological method was used to analyze the epidemiological characteristics of the epidemic, and field investigation and big data technology were used to analyze the transmission chain of the epidemic. Results: From April 27 to May 13, 2022, an epidemic of COVID-19 occurred in Haidian district. The strains isolated from the cases were identified by whole genome sequencing as Omicron variant (BA.2.2 evolutionary branch). A total of 38 infection cases were detected, including 34 confirmed cases and 4 asymptomatic cases. Most cases were mild ones (88.2%), no severe, critical or death cases occurred. The early clinical symptoms were mainly sore throat (50.0%) and cough (29.4%). The epidemic lasted for 17 days, resulting in 7 generations of the cases and involving 3 community transmissions, 2 working place transmissions and 8 family transmissions; the main infection routes were co-residence (47.6%) and co-space exposure (31.6%). The intergenerational interval M(Q1, Q3)was 3 (1, 6) days. The overall secondary attack rate was 1.5% (37/2 482), and the family secondary attack rate was 36.7% (18/49). Conclusions: The cases in this COVID-19 epidemic caused by Omicron variant had mild clinical symptoms, but the case clustering in families and communities was obvious, the transmission was rapid, and the risk for co-space exposure was high. It is necessary to use information technology to identify close contacts in the local population for the rapid and effective blocking of the epidemic spread.
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COVID-19 , Epidemias , Humanos , COVID-19/epidemiología , Beijing/epidemiología , SARS-CoV-2RESUMEN
Hepatic fibrosis is a response to various types of hepatic injury, which can lead to cirrhosis and its complications. In recent years, in patients with viral hepatitis, nonalcoholic steatohepatitis, alcoholic liver disease, autoimmune liver disease and others the fibrosis or even early cirrhosis can be regressed if the etiology are controlled. Liver biopsy is still the gold standard for assessing fibrosis reversal, but non-invasive methods such as transient elastography hold great promise due to the ease to use for dynamic monitoring. Mechanisms of hepatic fibrosis reversal include extracellular matrix degradation, hepatocyte regeneration, and vascular remodeling. Presently, novel agents targeting the steps of fibrosis are urgently need for achieving regression of liver fibrosis.
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Diagnóstico por Imagen de Elasticidad , Enfermedad del Hígado Graso no Alcohólico , Fibrosis , Humanos , Hígado/patología , Cirrosis Hepática/patología , Enfermedad del Hígado Graso no Alcohólico/patologíaRESUMEN
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.
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Várices Esofágicas y Gástricas , Várices , Antivirales/uso terapéutico , Várices Esofágicas y Gástricas/tratamiento farmacológico , Várices Esofágicas y Gástricas/etiología , Virus de la Hepatitis B , Humanos , Cirrosis Hepática/diagnóstico , Estudios ProspectivosRESUMEN
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.
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Hepatitis B Crónica , Hígado , Antivirales/uso terapéutico , Virus de la Hepatitis B/genética , Hepatitis B Crónica/complicaciones , Humanos , Hígado/patología , Cirrosis Hepática/patologíaRESUMEN
The Chinese Society of Hepatology, Chinese Medical Association published "Expert Opinions on Expanding Antiviral Therapy for Chronic Hepatitis B" in 2022, with a focus on "active screening of the existing patients, paying attention to the potential risk of disease progression, and active intervening of the low level viremia," and recommended that specific actions be taken to further optimize the expanding screening, widening the antiviral indications, and scale up the diagnosis and treatment of low level viremia.
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Antivirales , Hepatitis B Crónica , Humanos , Antivirales/uso terapéutico , Progresión de la Enfermedad , Virus de la Hepatitis B , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/tratamiento farmacológico , Viremia/tratamiento farmacológicoRESUMEN
Objective: To investigate the clusters of COVID-19 associated with a market (market Y) in Haidian District, Beijing, and analyze the chain of transmission and provide reference for effective prevention and control of COVID-19. Methods: The investigation of field epidemiology and cluster epidemic was used to describe the distributions of all COVID-19 cases. The time sequence diagram of the cases, disease onset was drawn and transmission chains were analyzed. Real-time RT-PCR assay was conducted for SARS-CoV-2 nucleic acid test by using the respiratory samples of the cases. Results: The COVID-19 epidemic, originated from a wholesale farm produce market (market X) in Fengtai District, Beijing, was introduced by a marketer in the market Y who had exposed to market X, causing 8 clusters of 20 confirmed cases of COVID-19 and one asymptomatic case, including 8 men and 13 women, in market Y, surrounding communities, food plaza, companies,families and other places. The incidence peaked during June 10-14, 2020; the median age of the cases was 45 years, ranging from 5 years to 87 years. The initial symptoms of the cases included fever (10/20) and pharynx discomfort (7/20). The median of incubation period was 5 days (IQR:3-8). The median of serial interval between primary case and secondary cases was 5 days with a secondary attack rate of 3.7%(20/538), and the secondary attack rate in household close-contacts was 14.0% (7/50). Conclusions: The clusters of COVID-19 associated with market Y were caused by several modes of transmission, including human-to-human, contaminated material-to-human, etc. The combined public-health response measures were effective to control the COVID-19 epidemic in Haidian district of Beijing.
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COVID-19 , Epidemias , Beijing/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , SARS-CoV-2RESUMEN
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.
Asunto(s)
Diabetes Mellitus Tipo 2 , Enfermedad del Hígado Graso no Alcohólico , Biopsia , Femenino , Fibrosis , Humanos , Hígado/patología , Cirrosis Hepática/epidemiología , Cirrosis Hepática/patología , Masculino , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Enfermedad del Hígado Graso no Alcohólico/patología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Objective: To explore the effect of perioperative airway management based on the concept of enhanced recovery after surgery (ERAS) on the improvement of preoperative pulmonary function in patients with aspirin intolerance triad (AIT). Methods: Thirty patients with AIT (including 13 males and 17 females, aged from 29 to 75 years old) for sinus surgery from January 2018 to December 2019 were selected, 172 patients (including 105 males and 67 females, aged from 17 to 83 years old) with chronic rhinosinusitis with nasal polyps (CRSwNP) without lower airway disease were selected by random number table at the same period, and their clinical data and preoperative pulmonary function were analyzed and compared retrospectively. FEV1%pred<80% after bronchodilation test was considered as high risk for surgery. Preoperative evaluation and standardized drug intervention were applied in patients with pulmonary function abnormalities at risk for surgery, and improvement of preoperative pulmonary function and tolerability to general anesthesia surgery in the two groups were evaluated. All the statistical analyses were conducted using SPSS 22.0. Results: The main pulmonary function indexes (FEV1%pred, FEV1/FVC%pred, FEF50%pred, FEF75%pred, MMEF%pred) in AIT group decreased significantly than those in CRSwNP group (t values were 10.882, 10.506, 9.141, 10.182, 9.099, respectively, all P<0.001). At admission 86.7% (26/30) patients in the AIT group and 11.6% (20/172) patients in CRSwNP group had high surgical risk for lung function, with significantly difference (χ2 = 81.788, P<0.05); after 3 days with individualized drug intervention, 57.7% (15/26) patients in AIT group reached the standard for surgery, which was significantly less than 90.0% (18/20) patients in CRSwNP group (χ²=4.335,P<0.05); and after 6 days with drug intervention, the patients who reached the standard for surgery in pulmonary function accounted for 92.3% (24/26) in the AIT group and 100% (20/20) in the CRSwNP group. FEV1%pred in the two groups before surgery were significantly improved compared with those at admission respectively ((90.00±6.32)% vs. (64.79±13.60)%,t value was 10.110 in AIT group; (91.65±11.86)% vs. (76.40±9.35)%, t value was 9.346 in CRSwNP group; all P<0.05), and also FEV1/FVC%pred, FEF50%pred, FEF75%pred and MMEF%pred were all significantly improved (all P<0.05). Surgery was completed successfully in the two groups of patients with lung function meeting the surgical standard, and no intraoperative or postoperative airway adverse events occurred. Conclusion: AIT patients have high airway risk for sinus surgery due to poor pulmonary function. Standardized airway management based on the concept of ERAS can improve the pulmonary function of patients, and decrease the incidence of perioperative airway adverse events.