Current approach to treatment of minimal hepatic encephalopathy in patients with liver cirrhosis

Minimal hepatic encephalopathy(MHE)corresponds to the earliest stage of hepatic encephalopathy(HE).MHE does not present clinically detectable neurological-psychiatric abnormalities but is characterized by imperceptible neurocognitive alterations detected during routine clinical examination via neuropsychological or psychometrical tests.MHE may affect daily activities and reduce job performance and quality of life.MHE can increase the risk of accidents and may develop into overt encephalopathy,worsening the prognosis of patients with liver cirrhosis.Despite a lack of consensus on the therapeutic indication,interest in finding novel strategies for prevention or reversion has led to numerous clinical trials;their results are the main objective of this review.Many studies address the treatment of MHE,which is mainly based on the strategies and previous management of overt HE.Current alternatives for the management of MHE include measures to maintain nutritional status while avoiding sarcopenia,and manipulation of intestinal microbiota with non-absorbable disaccharides such as lactulose,antibiotics such as rifaximin,and administration of different probiotics.This review analyzes the results of clinical studies that evaluated the effects of different treatments for MHE.

Protein post-translational modifications after spinal cord injury

Deficits in intrinsic neuronal capacities in the spinal cord,a lack of growth support,and suppression of axonal outgrowth by inhibitory molecules mean that spinal cord injury almost always has devastating consequences.As such,one of the primary targets for the treatment of spinal cord injury is to develop strategies to antagonize extrinsic or intrinsic axonal growth-inhibitory factors or enhance the factors that support axonal growth.Among these factors,a series of individual protein level disorders have been identified during the generation of axons following spinal cord injury.Moreover,an increasing number of studies have indicated that post-translational modifications of these proteins have important implications for axonal growth.Some researchers have discovered a variety of post-translational modifications after spinal cord injury,such as tyrosination,acetylation,and phosphorylation.In this review,we reviewed the post-translational modifications for axonal growth,functional recovery,and neuropathic pain after spinal cord injury,a better understanding of which may elucidate the dynamic change of spinal cord injury-related molecules and facilitate the development of a new therapeutic strategy for spinal cord injury.

Effects of thermal ablation on thyroid function in patients with thyrotoxicosis

To the Editor:Thermal ablation(TA)techniques have been widely used for the management of benign thyroid nodules(BTNs)and have been suggested as an alternative to surgery in some authoritative guidelines.[1]In theory,TA causes follicle destruction in the BTNs and a large release of the thyroid hormone stored in the follicles into the bloodstream;then,a dramatic change in thyroid function may occur.However,for euthyroid patients,researchers believe that TA treatment can preserve thyroid function and that these patients rarely develop thyroid dysfunction in the long term.[2]Nevertheless,for patients with preexisting thyrotoxicosis,whether the release of thyroid hormone causes thyroid storm(TS)and how their thyroid function changes after TA are unknown.Therefore,we retrospectively summarized these cases of patients with subclinical or overt thyrotoxicosis before TA in our institute,aiming to provide more information about the effects of TA on these patients with pre-existing thyrotoxicosis.