Treating chronic hepatitis B virus:Chinese physicians' awareness of the 2010 guidelines

AIM: To investigate Chinese physicians' awareness of the 2010 guidelines on the treatment of chronic hepatitis B virus(HBV) infection.METHODS: This was a quantitative survey that investigated the characteristics and practices of physicians who were treating patients with hepatitis B, the profile of their patients and physician practices regarding the diagnosis and treatment of HBV at the time of the survey. Participants were randomly selected from available databases of Chinese physicians and requested to complete either an online or paper-based survey. Data from the survey responses were analysed. For data validation and interpretation, qualitative in-depth interviews were conducted with 39 of the respondents.RESULTS: Five-hundred completed surveys, from 663 physicians were available for analysis. A mean of 175 chronic hepatitis B(CHB) patients was seen by each physician every month, of whom 85(49%) were treated in line with therapeutic indications stated in the 2010 guidelines. A total of 444(89%) physicians often(> 60% of the time) adhered to the guidelines. Most physicians used antiviral medications as recommended. For patients with compensated and decompensated cirrhosis, 342(68%) and 336(67%) of physicians, respectively, often followed the recommendation to use potent nucleos(t)ide analogues with a high genetic barrier to resistance, using the appropriate treatment more than 60% of the time. Physicians from infectious disease or liver disease departments were better informed than those from gastrointestinal or other departments.CONCLUSION: The majority of Chinese physicians often adhere to Chinese 2010 CHB guidelines and are well-informed about the use of antiviral medications for hepatitis B.

Prolonged propagation of rat neural stem cells relies on inhibiting autocrine/paracrine bone morphogenetic protein and platelet derived growth factor signals

Continuous expansion of rat neural stem cell lines has not been achieved due to proliferation arrest and spontaneous differentiation in vitro. In the current study, neural precursor cells derived from the subventricular zone of adult rats spontaneously underwent astroglial and oligodendroglial differentiation after limited propagation. This differentiation was largely induced by autocrine or paracrine bone morphogenetic protein and platelet derived growth factor signals. The results showed that, by inhibiting bone morphogenetic protein and platelet derived growth factor signals, adult rat neural precursor cells could be extensively cultured in vitro as tripotent stem cell lines. In addition to adult rat neural stem cells, we found that bone morphogenetic protein antagonists can promote the proliferation of human neural stem cells. Therefore, the present findings illustrated the role of autocrine or paracrine bone morphogenetic protein and platelet derived growth factor signaling in determining neural stem cell self-renewal and differentiation. By antagonizing both signals, the long-term propagation of rat neural stem cell lines can be achieved.

Association between brain N-acetylaspartate levels and sensory and motor dysfunction in patients who have spinal cord injury with spasticity:an observational case-control study

Spinal cord injury is a severe and devastating disease,and spasticity is a common and severe complication that is notoriously refractory to treatment.However,the pathophysiological mechanisms underlying spasticity and its development remain largely unknown.The goal of the present study was to find differences,if any,in metabolites of the left precentral gyrus and basal ganglia of patients who have spinal cord injury with or without spasticity,and to explore the relationship between the brain metabolite concentrations and clinical status.Thirty-six participants were recruited for magnetic resonance spectroscopic examination:23 with spinal cord injury(12 with spasticity and 11 without spasticity)and 13 healthy controls.We acquired localized proton spectra from the precentral gyrus and basal ganglia via 10 mm^(3) voxels.Notably,univariate linear regression analysis demonstrated that the lower that the N-acetylaspartate concentration(a marker for neuronal loss)was in the precentral gyrus of the patients,the lower their ASIA(American Spinal Injury Association)light-touch scores,pinprick scores,and motor scores.Additionally,longer durations of injury were associated with higher N-acetylaspartate levels in the precentral gyrus.Compared with the healthy participants and patients without spasticity,N-acetylaspartate levels in the patients with spasticity were significantly lower in both the precentral gyrus and basal ganglia.Lower N-acetylaspartate levels also correlated with greater sensory and motor dysfunction in the patients who had spinal cord injury with spasticity.

Role of adhesion molecules in mobilization of hematopoietic cells

To study the changes of adhesion molecules' expressions during the recombinant h u man granulocyte colony stimulating factor (rhG CSF) mobilization in periphera l blood stem cell transplantation (PBSCT), and to confirm the influence of rhG CSF on hematopoietic stem cells, which are proposed to guide mobilization in PBS CT Methods Mice were injected subcutaneously with diluted rhG CSF or normal saline for 7 d ays The blood Sca 1 + stem cell count and bone marrow (BM) nucleated cell co unt were enumerated The expressions of CD49d and CD44 and the adhesive ability of mononuclear cells to bone marrow matrix (fibronectin) were examined by flow c ytometry and 51 Cr adhesive assay, respectively Results The mobilizing effect of rhG CSF on mice was the same as on humans The number of Sca 1 + cells in peripheral blood reached the peak on the seventh day, the BM nucleated cell count was reduced, and the expressions of CD49d and the cells ' adhesive ability in BM and PB declined Conclusions rhG CSF can reduce some cell adhesion molecules' expressions and the adhesive a bility of hematopoietic stem cells to BM matrix, therefore mobilizing hematopoie tic stem cells (HSC) from the BM to the peripheral blood

White Matter Deficits Underlying the Impaired Consciousness Level in Patients with Disorders of Consciousness

In this study, we aimed to （1） identify white matter （WM） deficits underlying the consciousness level in patients with disorders of consciousness （DOCs） using diffusion tensor imaging （DTI）, and （2） evaluate the relationship between DTI metrics and clinical measures of the consciousness level in DOC patients. With a cohort of 8 comatose, 8 unresponsive wakefulness syndrome/ vegetative state, and 14 minimally conscious state patients and 25 patient controls, we performed group comparisons of the DTI metrics in 48 core WM regions of interest （ROIs）, and examined the clinical relevance using correlation analysis. We identified multiple abnormal WM ROIs in DOC patients compared with normal controls, and the DTI metrics in these ROIs were significantly correlated with clinical measures of the consciousness level. Therefore, our findings suggested that multiple WM tracts are involved in the impaired consciousness levels in DOC patients and demonstrated the clinical relevance of DTI for DOC patients.

Therapeutic Effect of Warm Needling Therapy Combined with Rehabilitation Therapy for Brachial Plexus Injury after Surgery

Objective： To observe the therapeutic effect of warm needling therapy plus rehabilitation in treating brachial plexus injury after surgery. Methods： Thirty patients suffered from brachial plexus injury after surgery were divided into two groups randomly, 16 in each group. The treatment group was intervened by warm needling therapy together with physical rehabilitation therapy. The control group was intervened by physical rehabilitation therapy only. The warm needling was given once every other day, 3 times a week, 2 weeks as a treatment course, and 2 consecutive courses in total. The physical rehabilitation therapy was given once every day, 5 times a week, 2 weeks as a treatment course, and 2 consecutive courses in total. The Short-form McGill Pain Questionnaire and Disabilities of the Arm, Shoulder and Hand （DASH） Questionnaire were respectively used to assess pain and Ability of Daily Living （ADL）. The therapeutic effects were compared and analyzed. Results： In the treatment group, 14 patients finished 2-course treatment but 2 dropped out; in the control group, 15 finished but 1 dropped out. After treatment, there were significant differences between the two groups in comparing Sensory Pain Rating Index （S-PRI）, Affective Pain Rating Index （A-PRI）, Total Pain Rating Index （T-PRI）, Visual Analogue Scale （VAS）, Present Pain Index （PPI）, and DASH scores （P〈O.01）. The scores of all items in the treatment group had marked changes after 2 treatment courses in comparing the scores before treatment （P〈0.01）. Conclusion： The therapeutic effect of warm needling therapy combined with rehabilitation therapy is more effective than that of physical rehabilitation therapy only.

Chinese Stroke Center Alliance:a national effort to improve healthcare quality for acute stroke and transient ischaemic attack:rationale,design and preliminary findings

Background In June 2015,the Chinese Stroke Association(CSA)initiated the Chinese Stroke Center Alliance(CSCA)to establish the national hospital-based stroke care quality assessment and improvement platform.This article outlines its objectives,operational structure,patient population,quality improvement(QI)intervention tools,data elements,data collection methodology and current patient and hospital data.Methods The CSCA is a national,hospital-based,multicentre,voluntary,multifaceted intervention and continuous QI initiative.This multifaceted intervention includes stroke centre development,written care protocols,workshops and a monitoring/feedback system of evidencebased performance measures.The data coordinating centre of the CSCA resides at the China National Clinical Research Center for Neurological Diseases,Beijing Tiantan Hospital.results As of July 2017,1576 hospitals in China have contributed detailed clinical information to serve as a benchmark for the stroke care quality of 433264 patients with acute stroke/transient ischaemic attacks(TIA),including 352572(81.38%)acute ischaemic stroke,30362(7.01%)TIA,42080(9.71%)spontaneous intracranial haemorrhage,5505(1.27%)subarachnoid haemorrhage and 2745(0.63%)not specified stroke.Conclusion The CSCA programme is designed to establish a continuous national stroke registry and help healthcare providers develop stroke centres and treat patients in a consistent manner in accordance with accepted national guidelines and,ultimately,improve patient outcomes.It supports the CSA mission to reduce stroke burden in China.

Eye-Opening Alters the Interaction Between the Salience Network and the Default-Mode Network

Dear Editor,Brain networks consist of several long-distance regions that interact constantly with each other.Interactions between networks suggest that different brain functions are coordinated during complex cognitive tasks[1].A triple-network mechanism underlying cognitive control has been found across task paradigms and stimulus modalities[2].This triple-network mechanism includes the interactions among the salience network(SN),the default mode network(DMN),and the central executive network(CEN).

Multiple glomus tumor on the anteromedial side of leg

To the editor, Multiple glomus tumor is a rare benign neoplasmthat arises from the glomus body in the stratum retic-ularis of the dennis, the highly specialized arteriove-nous anastomosis for thennoregulation.1-4 Althoughseveral cases of multiple glomus tumor involving theanterior thigh,5 submandibular and parotid regions,6 thetorso,7 have been reported, radiological characteristicson MRI images for multiple glomus tumor have notbeen described.We reported here both pre-operativeand post-operative MR images from a case of 16years old girl with multiple glomus tumor that partiallycoalesced on the anterior side of the leg.

Epilepsy control during an epidemic:emerging approaches and a new management framework

Epidemics are a big threat to world health.The ongoing pandemic of corona virus disease 2019(COVID-19)has caused a series of challenges to public health.One such challenge is the management of chronic diseases such as epilepsy during an epidemic event.Studies on this topic are rather limited and the related medical practice is full of uncertainty.Here we review recent development of potential approaches for epilepsy control during an epidemic and propose a new three-level management framework to address these challenges.

Clinical Features of Adult/Adolescent Atopic Dermatitis and Chinese Criteria for Atopic Dermatitis

Background： Atopic dermatitis （AD） is an inflammatory skin disease characterized by chronic recurrent dermatitis with profound itching. Most patients have personal and/or family history of atopic diseases. Several criteria have been proposed for the diagnosis of AD. Although the clinical features of childhood AD have been widely studied, there has been less large-scale study on adult/adolescent AD. The aim of this study was to investigate the clinical features of adult/adolescent patients with chronic symmetrical eczemaJAD and to propose Chinese diagnostic criteria for adult/adolescent AD. Methods： A hospital-based study was performed. Forty-two dermatological centers participated in this study. Adult and adolescent patients （12 years and over） with chronic symmetrical eczema or AD were included in this study. Questionnaires were completed by both patients and-investigators. The valid questionnaires were analyzed using EpiData 3.1 and SPSS 17.0 software. Results： A total of 2662 valid questionnaires were collected （1369 male and 1293 female）. Of all 2662 patients, 2062 （77.5%） patients had the disease after 12 years old, while only 600 （22.5%） patients had the disease before 12 years old, suggesting late-onset eczema/AD is common. Two thousand one hundred and thirty-nine （80.4%） patients had the disease for more than 6 months. One thousand one hundred and forty-four （43.0%） patients had a personal and/or family history of atopic diseases. One thousand five hundred and forty-eight （58.2%） patients had an elevated total serum IgE and/or eosinophilia and/or positive allergen-specific IgE. Based on these clinical and laboratory features, we proposed Chinese criteria for adult/adolescent AD. Of all 2662 patients, 60.3% were satisfied with our criteria, while only 48.2% satisfied with Hanifin Rajka criteria and 32.7% satisfied with Williams criteria, suggesting a good sensitivity of our criteria in adult/adolescent AD patients. Conclusion： Late-onset of eczema or AD is common. The clinical manifestations of AD are heterogeneous. We have proposed Chinese diagnostic criteria for adolescent and adult AD, which are simple and sensitive for diagnosis of adult/adolescent AD.

Consensus of Chinese Specialists on Diagnosis and Treatment of Resistant Hypertension

INTRODUCTION Resistant hypertension has become a challenge in the treatment of hypertension.As the population continues to age and obesity,sleep apnea hypopnea syndrome,and chronic kidney disease increase in incidence,resistant hypertension has become an increasingly common issue in clinical practice.Failure to control blood pressure can impair target organs such as the heart,brain,and kidney,facilitating the occurrence of clinical cardiovascular events.

Potential benefit of high-dose intravenous vitamin C for coronavirus disease 2019 pneumonia

The coronavirus disease 2019(COVID-19)has been declared as a pandemic by the World Health Organization.[1]Most COVID-19 patients exhibit mild to moderate symptoms,while approximately 15%progress rapidly to severe pneumonia,and about 5%eventually develop acute respiratory distress syndrome(ARDS),[2]which requires mechanical ventilation(MV)and even extracorporeal membrane oxygenation.The mortality of COVID-19 patients who received MV was reported to be as high as 66%.[3]Therefore,the treatments aiming to improve mortality should focus on two aspects:first,prevention of the aggravation of the disease in mild and moderate COVID-19 patients;second,the rescue therapy for patients in serious conditions.We have been applying high-dose intravenous vitamin C(HDIVC)in the treatment of critical illnesses for almost 10 years in our center.Our previous in vivo research showed that HDIVC protected hemorrhagic shock-related multiple organ failure(MOF)by inhibiting inflammatory cytokines and oxidative indicators through activating Sirtuin1 pathway.