ABSTRACT
Chronic hepatitis B virus (HBV) infection is a major cause of viral hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). From chronic HBV infection to HCC, most patients go through the stages of chronic hepatitis, liver cirrhosis, and HCC. During this long process, the ongoing integration of HBV DNA into host DNA increases the risk of HCC, and the death and compensatory proliferation of hepatocytes caused by persistent liver inflammation may promote the accumulation of oncogenic mutations and finally lead to the malignant transformation of hepatocytes. Currently, nucleos(t)ide analogues are widely used anti-HBV drugs, which controls infection by inhibiting HBV replication and can thus effectively slow down disease progression and end-stage liver disease; however, anti-HBV therapy often starts late and has a relatively low treatment rate, and there is still a tendency of increase in the incidence rate of HBV-related HCC. Therefore, how to improve current antiviral strategies to further reduce the risk of HBV-related end-stage liver disease including HCC has become a hotspot in clinical practice. This article summarizes the previous studies supporting the expansion of antiviral therapy and suggests that antiviral therapy should be initiated as early as possible to inhibit viral replication and the sequential events of HBV DNA integration and ultimately reduce the risk of HCC in patients with chronic HBV infection.
ABSTRACT
Objective To analyze the distribution of Virchow-Robin spaces (VRS) in migraine by MRI,and to study the effects of the duration of the disease,the attack frequency and the migraine with or without aura on the number of VRS in order to provide imaging support for migraine diagnosis.Methods Fifty migraine patients were enrolled as migraine group and 50 healthy people as control group during January 2013 to December 2016 from Department of Neurology,the Second Affiliated Hospital of Zhengzhou University.The number of VRS in the fronto-parietal subcortical white matter,semioval central,and basal ganglia areas was calculated and compared between groups and within the group by performing a MRI scan of the same sequence,and the impact of the history of migraine,the attack frequency and the migraine with or without aura on the number of VRS was investigated.Results The VRS were found in 48 cases in the migraine group,accounting for 96％,significantly higher than in the control group (41 cases,accounting for 82％),the difference being statistically significant (x2 =5.00,P ＜ 0.05).In the migraine group,the sum of the number of VRS (13.00 (6.75,20.00)) was significantly higher than that of the control group (8.00 (5.00,12.00);Z=3.33,P＜ 0.01).In the migraine group the VRS numbers in the fronto-parietal subcortical white matter,semioval central and basal ganglia areas were 6.00(4.00,12.00),2.00(0.00,4.00)and 4.00 (2.00,6.00) respectively,while the numbers of VRS in the same areas of the control group were 0.00 (0.00,2.00),2.00 (0.75,4.00) and 4.00 (3.50,6.00).The total number of VRS in different areas was significantly different within the two groups (migraine group x2 =39.86,P ＜ 0.01;control group x2 =40.15,P ＜0.01).In the migraine group,the VRS was mainly located in fronto-parietal subcortical white matter,whereas in the control group the VRS was mainly distributed in the basal ganglia.The total number of VRS in the migraine with aura group (20.00 (14.50,26.00)) was more than that in the migraine without aura group (11.00 (6.00,20.00);Z =2.52,P =0.02).The numbers of VRS in the fronto-parietal subcortical white matter,semioval central and basal ganglia areas of the migraine with aura group were 12.00(9.00,14.00),2.00(2.00,6.00) and 4.00(2.50,7.50) respectively;The numbers of VRS in the same areas of the migraine without aura group were 6.00(4.00,10.00),1.00(0.00,4.00) and 4.00 (2.00,6.00) respectively;The numbers of VRS in different areas within the two groups were significantly different (with aura group x2 =16.31,P ＜0.01;without aura group x2 =29.48,P ＜0.01).There were statistically significant differences in the number of VRS among migraine without aura patients with different duration and frequency of episodes.Conclusions The incidence rate of perivascular space in migraine is high.VRS is mainly distributed in the fronto-parietal subcortical white matter,which may provide an imaging assistant basis for the diagnosis of migraine.Migraine with aura is more prone to VRS than those without aura.The disease course and the attack frequency have a certain impact on occurrence of VRS.
ABSTRACT
Objective To analyze the MRI characteristics of vestibulocochlea neurovascular compression in patients with vestibular paroxysmia (VP) and to investigate the effect of the compression,its site and degree,on the occurrence of VP.Methods Twenty-eight cases of VP (VP group) and 28 cases of vertiginous patients other than VP (control group) were retrospectively reviewed.Three dimensional magnetic resonance angiography (3D-MRA) was performed and the data were used for neurovascular crosscompression (NVCC) analysis.The frequency and type of NVCC,the origin of the offending vessel and the distance between compression site and brainstem were compared between the two groups.Results The frequency of NVCC was 96.4％ (27/28) in VP group,with a significant difference compared with control group (13/28,46.4％ ;x2 =17.15,P ＜0.01).The most common NVCC type was vascular loop compression at vestibulocochlear nerve (15/35,42.9％).Anterior inferior cerebellar artery was the most common offending vessel (25/35,71.4％) in VP group.There were no significant differences between the two groups in the type of NVCC or the origin of the offending vessel.The frequency on the distortion and (or) displacement of vestibulocochlear nerve which was severely compressed by vessel in VP group (7/56,12.5％) was significantly higher than that in control group (0; P =0.013).The distance between compression site and brainstem was (8.57 ± 5.08) mm in VP group,and (8.93 ± 4.64) mm in control group,showing no significant difference.The ratio that the distance was less than 15 mm between compression site and brainstem in unilateral NVCC of VP group (100％) was significantly higher than unilateral NVCC of control group (7/10,P =0.033).Conclusions The VP patients have higher NVCC incidence and the most common NVCC type is vascular loop compression at vestibulocochlear nerve which is mainly caused by anterior inferior cerebellar artery.NVCC in VP patients mostly occurs in the central myelin portion of vestibulocochlear nerve.The site and degree of neurovascular compression may relate to the occurrence of VP.