Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis

AIM To evaluate the differences in acute kidney injury(AKI) between acute-on-chronic liver failure(ACLF) and decompensated cirrhosis(DC) patients. METHODS During the period from December 2015 to July 2017, 280 patients with hepatitis B virus(HBV)-related ACLF(HBV-ACLF) and 132 patients with HBV-related DC(HBV-DC) who were admitted to our center were recruited consecutively into an observational study. Urine specimens were collected from all subjects and the levels of five urinary tubular injury biomarkers were detected,including neutrophil gelatinase-associated lipocalin(NGAL), interleukin-18(IL-18), liver-type fatty acid binding protein(L-FABP), cystatin C(CysC), and kidney injury molecule-1(KIM-1). Simultaneously, the patient demographics, occurrence and progression of AKI, and response to terlipressin therapy were recorded. All patients were followed up for 3 mo or until death after enrollment. RESULTS AKI occurred in 71 and 28 of HBV-ACLF and HBV-DC patients, respectively(25.4% vs 21.2%, P = 0.358). Among all patients, the levels of four urinary biomarkers(NGAL, CysC, L-FABP, IL-18) were significantly elevated in patients with HBV-ACLF and AKI(ACLF-AKI), compared with that in patients with HBV-DC and AKI(DC-AKI) or those without AKI. There was a higher proportion of patients with AKI progression in ACLF-AKI patients than in DC-AKI patients(49.3% vs 17.9%, P = 0.013). Fortythree patients with ACLF-AKI and 19 patients with DC-AKI were treated with terlipressin. The response rate of ACLFAKI patients was significantly lower than that of patients with DC-AKI(32.6% vs 57.9%, P = 0.018). Furthermore, patients with ACLF-AKI had the lowest 90 d survival rates among all groups(P < 0.001).CONCLUSION AKI in ACLF patients is more likely associated with structural kidney injury, and is more progressive, with a poorer response to terlipressin treatment and a worse prognosis than that in DC patients.

Superinfective Hepatitis E Virus Infection Aggravates Hepatocytes Injury in Chronic Hepatitis B

Hepatitis E virus(HEV)infection is a major cause of morbidity in endemic areas.Its consequences among chronic hepatitis B(CHB)patients have been under-reported.The aim of this study was to assess the impact of superinfective HEV infection(acute and past)on virological and clinical features of patients with CHB infection.Clinical,biochemical,virological and immunological data of 153 CHB patients including 98 with hepatitis B virus(HBV)monoinfection and 55 with HBV-HEV superinfection with both HEV and HBV infection was retrospectively investigated and analyzed in this study conducted in Wuhan,China.An overall anti-HEV IgG seroprevalence was found to be 35.9% in CHB patients.HBV-HEV superinfection patients showed significantly higher rate of complications(ascites,hepato-renal syndrome&encephalopathy)(all with P=0.04),cirrhosis(P<0.001)and acute-on-chronic liver failure(P<0.001)than HBV monoinfection patients.They also displayed elevated ALTs(P<0.001)and total serum bilirubin(P<0.001)with diminished albumin(P<0.001)and HBV viral load(P<0.001).Cytokines assay revealed increased expression of IL-6(P=0.02),IL-10(P=0.009)and TNF-α(P=0.003)in HBVHEV superinfection patients compared to HBV monoinfection patients.Our study demonstrated that HEV superinfection in CHB patients was associated with progressive clinical manifestation,which is likely due to the enhanced expression of cytokines related with hepatocytes necrosis.HEV was also associated with repressed HBV replication,but the underlying mechanism requires further investigation.

Study protocol:A cross-sectional study on psychology and behavior investigation of Chinese residents,PBICR

Objective:This study protocol identifies the basic research route and framework of psychological and behavioral surveys among Chinese residents,aims establishing a database through a multicenter,large-sample cross-sectional survey in China to provide strong data support for research development in various fields and a more comprehensive and systematic understanding of the physical and mental health status of the public.Method:The study was conducted from June 20,2022 to August 31,2022,using stratified sampling and quota sampling methods,a total of 148 cities,202 districts and counties,390 townships/towns/sub-districts,and 780 communities/villages(excluding Hong Kong,Macao,and Taiwan)from 23 provinces,5 autonomous regions,and 4 municipalities directly under the central government in China were selected.The questionnaire was distributed one-on-one and face-to-face to the public by trained investigators,and the questionnaire included eight aspects:personal basic information,personal health status,family basic information,social environment in which they were located,psychological level scale,behavioral level scale,other scales,and attitude towards social hot issues.Data analysis will be performed after questionnaire return.Results:Data collection is ongoing.These findings will support physical and mental health research and strategy development in China and even globally,guiding policy-makers and health care organizations to reform their programs to ensure the best interests of residents and their families.

Kinesio tape in the treatment of postoperative lymphedema of breast cancer

The Kinesio tape was originally developed by Dr. Kenzo Kase, a Japanese chiropractor, which was used for pain of joint and muscle, the elastic tape is capable of stretching up to 130-140% of its resting static length ensuring free mobility of the applied muscle or joint. It is claimed that Kinesio tape supports injured muscles and joints and helps relieve pain by lifting the skin and allowing improved blood and lymph flow. Therefore, Kinesio Taping has become a very popular treatment for several health conditions over the last decade. Nowadays, lymphatic drainage is a new function of Kinesio taping in the field of physical therapy. This article explores the application of Kinesio tape in breast cancer-related lymphedema in order to provide a new treatment for patients with lymphedema after breast cancer surgery.

Impact of the interval after endoscopic dacryocystorhinostomy on the outcomes of intraocular surgery: a 4-year retrospective study

Background:Patients with dacryocystitis should be treated for their infection by endoscopic dacryocystorhinostomy(EN-DCR)before any intraocular surgery.However,there is no unified standard for the specific time interval between the two surgeries.This study aimed to determine the appropriate interval for intraocular surgery in patients with previous EN-DCR for chronic dacryocystitis.Methods:The medical files of all patients who underwent intraocular surgery after EN-DCR surgery in our hospital from 2016 to 2019 were reviewed.The EN-DCR data of patients undergoing intraocular surgery at different time intervals and the incidence of endophthalmitis after intraocular surgery were compared.Results:A total of 116 patients(92 females and 24 males,mean age 64.06±7.78 years)underwent EN-DCR and intraocular surgery met the inclusion criteria.The interval between EN-DCR and intraocular surgery varied from 5-475 days.The number of patients undergoing cataract surgery after EN-DCR is the largest(75,64.7%).All patients(100%)who had previously undergone EN-DCR did not develop endophthalmitis infection after intraocular surgery at a follow-up of 12 months.Conclusions:For patients with dacryocystitis who have undergone EN-DCR surgery,there is no time limit when choosing the timing of intraocular surgery.For patients requiring intraocular surgery,operation can be arranged as soon as possible to solve their problems as long as the patients had patency on lacrimal passage irrigation and no secretions.

The importance and clinical significance of the development of Miao Medicine PRO scale

As an important part of national medicine,Miao medicine has established a unique theoretical system in its process of continuous development and improvement.Through clinical practice and application,it has been proven to have natural and therapeutic effects.It has the advantages of wide application range,authentic medicinal materials and easy price acceptance.With more attention paid to the Patient's subjective feeling,Patient Reported Outcome from the standpoint of patients,this advanced and scientific method of clinical efficacy evaluation takes the feelings directly transmitted by patients as the"index"to evaluate the clinical efficacy,so as to guide the clinical plan,improve the medical quality and improve the therapeutic effect and clinical outcome.Therefore,summarizing and studying the models of Patient Reported Outcome scales at home and abroad,and developing the Patient Reported Outcome scale unique to Miao Medicine,is of great significance for us to guide and improve the clinical treatment of the motherland medicine.