Diagnosis and management of benign recurrent intrahepatic cholestasis and psychosocial stressors in an adolescent:A case report

BACKGROUND Benign recurrent intrahepatic cholestasis(BRIC)is a rare autosomal recessive disorder,characterized by episodes of intense pruritus,elevated serum levels of alkaline phosphatase and bilirubin,and near-normal-glutamyl transferase.These episodes may persist for weeks to months before spontaneously resolving,with patients typically remaining asymptomatic between occurrences.Diagnosis entails the evaluation of clinical symptoms and targeted genetic testing.Although BRIC is recognized as a benign genetic disorder,the triggers,particularly psychosocial factors,remain poorly understood.CASE SUMMARY An 18-year-old Chinese man presented with recurrent jaundice and pruritus after a cold,which was exacerbated by self-medication involving vitamin B and paracetamol.Clinical and laboratory evaluations revealed elevated levels of bilirubin and liver enzymes,in the absence of viral or autoimmune liver disease.Imaging excluded biliary and pancreatic abnormalities,and liver biopsy demonstrated centrilobular cholestasis,culminating in a BRIC diagnosis confirmed by the identification of a novel ATP8B1 gene mutation.Psychological assessment of the patient unveiled stress attributable to academic and familial pressures,regarded as potential triggers for BRIC.Initial relief was observed with ursodeoxycholic acid and cetirizine,followed by an adjustment of the treatment regimen in response to elevated liver enzymes.The patient's condition significantly improved following a stress-related episode,thanks to a comprehensive management approach that included psychosocial support and medical treatment.CONCLUSION Our research highlights genetic and psychosocial influences on BRIC,emphasizing integrated diagnostic and management strategies.

Microstructure and properties of probeless friction stir spot welding of AZ31 magnesium alloy joints

The AZ31 magnesium alloy with a thickness of 1.8 mm was welded by the probeless friction stir spot welding process without Zn interlayer.The influence of process parameters on joint microstructure and mechanical properties was investigated by using different rotating speeds and dwell time.Microstructure of joints is divided into three regions:stir zone,thermomechanically-affected zone and heat-affected zone.With the increase of rotation speed and dwell time,the depth of stir zone gradually increases,and hook defects extend from the interface of two plates to the surface of the upper plate.The tensile shear strength of joints and two fracture modes(shear fracture and plug fracture)are closely related to hook defects.The maximum tensile shear strength of the joint is 4.22 kN when rotation speed and dwell time are 1180 r/min and 9 s,respectively.Microhardness value and its fluctuation in upper sheet are evidently higher than those of the lower sheet.