Manejo Ortodóncico Quirúrgico de la Displasia Cleidocraneal en Pacientes en Crecimiento

El objetivo de este estudio fue describir las alternativas terapéuticas ortodóncico-quirúrgicas más utilizadas en la actualidad para el manejo de la displasia cleidocraneal en pacientes en crecimiento. Se realizó una búsqueda de literatura durante mayo de 2023 en las bases de datos Pubmed, Epitemonikos, Dentistry & Oral Sciences Source y LILACS sobre reporte de casos que presentaran estrategias de tratamiento ortodóncico-quirúrgico en pacientes menores de 18 años con displasia cleidocraneal. Seis artículos cumplieron con los criterios de inclusión. De ellos se obtuvieron siete reportes de casos. Las edades de los pacientes fluctúan entre los 10 y 16 años. Las estrategias de tratamiento consisten en al menos dos etapas de tratamiento ortodóncico quirúrgicas que involucran la extracción de dientes primarios y supernumerarios y la exposición quirúrgica de dientes permanentes retenidos para permitir su erupción y/o su tracción ortodóncica. Algunos casos son finalizados con cirugía Ortognática (Osteotomía Le Fort I de avance maxilar). La extracción de dientes primarios y supernumerarios, fenestración y tracción ortodóncica de los dientes permanentes retenidos y la cirugía ortognática al finalizar el crecimiento (cuando sea necesario) se propone actualmente como la mejor alternativa terapéutica para el tratamiento de pacientes con displasia cleidocraneal.

The objective of this study was to describe the orthodontic-surgical therapeutic alternatives most used nowadays, for the management of CCD in growing patients. A literature search for case reports was carried out through May, 2023 in PubMed, Epitemonikos, Dentistry & Oral Sciences Source and LILACS databases. We included case reports that presented complete orthodontic-surgical treatment strategies in patients with DCC under 18 years of age. Six articles met the inclusion criteria and seven case reports were identified. The age of cases ranged from 10 to 16 years. Treatment strategies consisted of at least two stages of surgical orthodontic treatment involving extraction of primary and supernumerary teeth and surgical exposure of impacted permanent teeth to allow spontaneous eruption or orthodontic traction. Some cases were completed with orthognathic surgery. Extraction of primary and supernumerary teeth, fenestration and orthodontic traction of retained permanent teeth and orthognathic surgery at the end of growth (when necessary) is currently proposed as the best therapeutic alternative for the treatment of patients with DCC.

Carcinoma sarcomatoide hepático primario metastásico, una neoplasia infrecuente / Primary hepatic sarcomatoid carcinoma, an unusual case

Resumen El carcinoma sarcomatoide primario hepático es un tumor agresivo que representa el 0.4-0.7% de todas las neoplasias primarias hepáticas. Se asocia a hepa topatía por virus hepatotropos, es más prevalente en la población asiática y en su histología se evidencian componentes de carcinoma y sarcoma. No posee carac terísticas clínicas ni imagenológicas patognomónicas y su diagnóstico se realiza en base a los hallazgos de la anatomía patológica e inmunohistoquímica. La cirugía en estadio localizado representa la única modalidad terapéutica con impacto en la sobrevida. Reportamos el caso de una paciente de 72 años, coreana, con an tecedentes de hepatopatía crónica por virus B, a quien se le diagnosticó un carcinoma sarcomatoide hepático primario con metástasis ósea y ganglionares.

Abstract Primary hepatic sarcomatoid carcinoma is a very ag gressive tumor, representing 0.4-0.7% of all primary he patic neoplasms. The disease is associated with liver dis ease due to hepatotropic viruses and is more prevalent in Asians. Histology shows sarcomatous and carcinoma components. It does not have pathognomonic clinical or imaging characteristics and its diagnosis is based on the pathological and immunohistochemistry findings. Surgery could prolong survival in localized stages. We report the case of a 72-year-old Korean patient with a history of chronic liver disease due to B virus, who was diagnosed with primary hepatic sarcomatoid carcinoma with bone and lymph node metastases.

Levodopa Versus Levodopa Sparing in Early Parkinson´s Disease: Can we Meet Halfway?

ABSTRACT Monotherapy is the recommended initial treatment for early Parkinson´s disease. The pharmacological options for initial treatment include dopaminergic agonists, monoamine oxidase B inhibitors, and levodopa formulations. Several factors should be considered when selecting the optimal treatment, such as disease severity, disease duration, age, activity level, and the risk of developing motor and non-motor complications. Early evidence on the potential role of levodopa formulations in the risk of dyskinesia led to levodopa aversion in the late 1990s and early 2000s, favoring the use of levodopa-sparing options like dopamine agonists. This shift resulted in an increase in behavioral adverse effects, such as impulse control disorders, leading to a subsequent dopamine agonist aversion in the mid-2000s. This review aims to provide a comprehensive evaluation of the existing literature regarding the benefits and drawbacks of levodopa versus levodopa-sparing strategies in drug-naive early-stage Parkinson´s disease.

Is the use of ozonated oil effective in the treatment of oral lesions? Systematic review of clinical studies / ¿Es el uso del aceite ozonizado efectivo en el tratamiento de las lesiones orales? Una revisión sistemática de estudios clínicos

Abstract The aim of this study was to perform a systematic review (SR) of the therapeutic effect of ozonated oil for oral lesions treatment. A SR was conducted according to the PRISMA guidelines. The Medline (PubMed), Embase, Cochrane Library, Scielo and LILACS were investigated, together with manual searches, to extract all publications until December 2020, including randomized and non-randomized clinical trials reporting the effects of ozonated oils on the management of oral lesions when compared with other methods. The risk of bias (RoB) of the studies included were assessed by using the RoB 2 tool and ROBINS-I. After analyzing the titles and reading the abstracts, 1932 articles were excluded; the remaining 25 passed a full-text evaluation. Ultimately, 13 articles were included in this SR. There was heterogeneity of the results regarding healing times and intervals of ozonated oil application for the treatment of each type of oral lesion, but in general, there was a shorter healing time when ozonated oil was used as therapy, and no adverse effects were reported. Despite the limited information found and the lack of rigorous methodological standards for the use of ozonated oil on oral lesions, a positive effect was suggested. The findings indicated an advantage in terms of shorter healing times when compared with other conventional treatments. No adverse effects were reported, showing safety and reliability for patient's treatment.

Resumen El objetivo de este estudio fue realizar una revisión sistemática (RS) del efecto terapéutico del aceite ozonizado sobre las lesiones orales. Se realizó una RS siguiendo las directrices PRISMA. Se realizaron búsquedas en Medline (PubMed), Embase, Cochrane Library, Scielo y LILACS, y búsquedas manuales, que abarcaron hasta diciembre de 2020, de ensayos clínicos aleatorizados y no aleatorizados que informaran sobre el efecto de los aceites ozonizados en el tratamiento de las lesiones orales en comparación con cualquier otro método. El riesgo de sesgo (RoB) de los estudios incluidos se evaluó mediante la herramienta RoB 2 y ROBINS-I. Tras analizar los títulos y leer los resúmenes, se excluyeron 1932 artículos; los 25 restantes pasaron una evaluación exhaustiva del texto completo. Finalmente, se incluyeron 13 artículos en esta RS. Hubo heterogeneidad de resultados en cuanto a los tiempos de cicatrización y los intervalos de aplicación del aceite ozonizado para el tratamiento de cada tipo de lesión oral, pero en general, hubo un menor tiempo de cicatrización cuando se utilizó el aceite ozonizado como terapia, y no se comunicaron efectos adversos. A pesar de la limitada información encontrada y de la falta de normas metodológicas rigurosas sobre el uso de aceite ozonizado en lesiones orales, se sugirió un efecto positivo del uso de aceite ozonizado para el tratamiento de lesiones orales. Los resultados indicaron una ventaja en términos de menor tiempo de curación en comparación con otros tratamientos convencionales; además, no se notificaron efectos adversos, por lo que se demostró una opción de tratamiento segura y fiable para los pacientes.

Conhecimento de estudantes de Odontologia sobre prescrição e o uso de medicamentos / Conocimientos de los estudiantes de Odontología sobre prescripción y uso de medicamentos / Knowledge of Dentistry students about prescription and use of drugs

This study aimed to analyze the knowledge of 335 dentistry students about prescription and use of drugs. The participants were divided into two groups: Group I -composed of 136 students in the last period/semester of the Dentistry course and Group II -composed of 199 students who had recently completed the discipline of Pharmacology/Therapeutics Applied to Dentistry (second semester of graduation). Students answered a questionnaire with 19 closed questions divided into three blocks of interest, Block A (5questions about their academic background); Block B (4 questions about legislation and drug prescription) and Block C (10 questions about common prescription in cases of increased risk due to comorbidities in Dentistry). The instrument was validated afterthe application of three pilot studies in 60 volunteer students who had recently completed the Pharmacology/Therapeutics Applied to Dentistry discipline. The results allowed classifying the level of knowledge as bad, moderate, good or excellent according to the stratification adopted by the authors. Most of the students interviewed were female, 22 years old. According to the results, 70% of the participants stated that the duration of the Pharmacology/Therapeutics Applied to Dentistry course was insufficient for them to feel safe when prescribing medications. The data presented showed that in block "B" only 19% of the students knew who was responsible for the prescription document. Additionally, 57% identified the mandatory items on an antimicrobial prescription. The successful rate of block "C" showed that the participants presented reasonable knowledge of most of the questions related to indication and prescription of medication both in regular and risky situations in Dentistry. The student's average knowledge regarding the indication and prescription of drugs reveals a problem in academic qualification related to drug therapy. It also highlights the need for continuing education of dental surgeons (AU).

Este estudio tuvo como objetivo analizar los conocimientos de 335 estudiantes de odontología sobre la prescripción y uso de medicamentos. Los participantes fueron divididos en dos grupos: Grupo I -compuesto por 136 estudiantes del último período/semestre de la carrera de Odontología y Grupo II -compuesto por 199 estudiantes que habían finalizado recientemente la disciplina de Farmacología/Terapéutica Aplicada a la Odontología (segundo semestre de pregrado). Los estudiantes respondieron un cuestionario con19 preguntas cerradas divididas en tres bloques de interés, Bloque A (5 preguntas sobre su formación académica); Bloque B (4 preguntas sobre legislación y prescripción de medicamentos) y Bloque C (10 preguntas sobre prescripción común en casos de mayor riesgo por comorbilidades en Odontología). El instrumento fue validado luego de la aplicación de tres estudios piloto en 60 estudiantes voluntarios que habían finalizado recientemente la disciplina Farmacología/Terapéutica Aplicada a la Odontología. Los resultados permitieron clasificar el nivel de conocimientos como malo, moderado, bueno o excelente según la estratificación adoptada por los autores. La mayoría de los estudiantes entrevistados eran mujeres, de 22 años. Según los resultados, el 70% de los participantes afirmó que la duración del curso de Farmacología/Terapéutica Aplicada a la Odontología fue insuficiente para sentirse seguros al prescribir medicamentos. Los datos presentados mostraron que en el bloque "B" sólo el 19% de los estudiantes sabían quién era el responsable del documento de prescripción. Además, el 57% identificó los artículos obligatorios en la prescripción de antimicrobianos. La tasa de éxito del bloque "C" demostró que los participantes presentaron conocimientos razonables en la mayoría de las cuestiones relacionadas con la indicación y prescripción de medicamentos tanto en situaciones habituales como de riesgo en Odontología. El conocimiento medio del estudiante sobre la indicación y prescripción de medicamentos revela un problema en la calificación académica relacionada con la farmacoterapia. También destaca la necesidad de una educación continua de los cirujanos dentistas (AU).

Este estudo teve como objetivo analisar o conhecimento de 335 estudantes de Odontologia sobre prescrição e uso de medicamentos. Os participantes foram divididos em dois grupos: Grupo I -composto por 136 alunos do último período/semestre do curso de Odontologia e o Grupo II -composto por 199 alunos que haviam concluído recentemente a disciplina de Terapêutica Medicamentosa/Farmacologia (segundo semestre da graduação). Os estudantes responderam a um questionário com 19 perguntas fechadas dividido emtrês blocos de interesse, Bloco A (5 perguntas sobre sua formação acadêmica); Bloco B (4 perguntas sobre legislação e prescrição de medicamentos) e Bloco C (10 perguntas sobre prescrição comum em casos de risco aumentado por comorbidade em Odontologia). Oinstrumento foi validado após a aplicação de três estudos piloto em 60 alunos voluntários que recentemente haviam concluído a disciplina de Terapêutica Medicamentosa/Farmacologia. Os resultados permitiram classificar o nível de conhecimento como ruim, moderado, bom ou excelente de acordo com a estratificação adotada pelos autores. A maioria dos alunos entrevistados era do sexo feminino, com 22 anos de idade. De acordo com os resultados, 70% dos participantes afirmaram que a duração da disciplina Farmacologia/Terapêutica Aplicada à Odontologia foi insuficiente para que se sentissem seguros ao prescrever medicamentos. Os dados apresentados mostraram que no bloco "B" apenas 19% dos alunos sabiam quem é o responsável pelo documento de prescrição. Além disso, 57% identificaram os itens obrigatórios em uma prescrição antimicrobiana. O índice de sucesso do bloco "C" mostrou que os participantes apresentaram conhecimento razoável envolvendo as questões sobre indicação e prescrição de medicamentos tanto em situaçõesregulares quanto em situações de risco na Odontologia. O conhecimento médio dos alunos quanto à indicação e prescrição de medicamentos revela um problema na formação acadêmica relacionada à terapia medicamentosa (AU).

Abordaje de la enfermedad por reflujo gastroesofágico refractaria / Approach to refractory gastroesophageal reflux disease

RESUMEN Un adecuado abordaje de la enfermedad por reflujo gastroesofágico refractaria (rERGE) es imprescindible para lograr el éxito terapéutico. Desde la definición precisa de rERGE hasta la detallada caracterización de sus fenotipos, establecerá el camino hacia la personalización de la terapia óptima para cada paciente. En esta revisión narrativa de la literatura, se busca proporcionar una síntesis actualizada de la utilidad de las diversas herramientas diagnósticas y explorar el amplio espectro de opciones terapéuticas, tanto médicas como invasivas disponibles para esta condición.

ABSTRACT An adequate approach to refractory gastroesophageal reflux disease (rGERD) is essential for achieving therapeutic success. From the precise definition of rGERD to the detailed characterization of its phenotypes, it will pave the way for the customization of optimal therapy for each patient. In this narrative literature review, the aim is to provide an updated synthesis of the utility of various diagnostic tools and explore the wide range of therapeutic options, both medical and invasive, available for this condition.

Research advances in the diagnosis and treatment of hepatic vein occlusion-type Budd-Chiari syndrome / 临床肝胆病杂志

Budd-Chiari syndrome is a rare liver vascular disease and can be classified into hepatic vein occlusion type， inferior vena cava occlusion type， and mixed type according to the location of hepatic outflow tract obstruction. This article reviews the hepatic vein occlusion type from the aspects of epidemiology， subtypes， clinical diagnosis， and treatment strategies.

Research advances in porto-sinusoidal vascular disease / 临床肝胆病杂志

Porto-sinusoidal vascular disease （PSVD） is a new disease nomenclature proposed in recent years， which is an important supplement to idiopathic non-cirrhotic portal hypertension. PSVD includes the patients with specific pathological conditions， but without portal hypertension symptoms， and the patients with portal vein thrombosis or viral hepatitis. This article elaborates on the naming， epidemiology， etiology， clinical manifestations， prognosis， and treatment of PSVD， in order to improve the understanding of this disease among clinicians.

An excerpt of Asia-Pacific Association for the Study of the Liver guidelines on management of ascites in liver disease （2023） / 临床肝胆病杂志

Asia-Pacific Association for the Study of the Liver published the guidelines on management of ascites in liver disease in May 2023， which introduces the diagnosis， differential diagnosis， and treatment of ascites， hyponatremia， hepatic hydrothorax， and hepatorenal syndrome in patients with liver cirrhosis and acute-on-chronic liver failure. This article summarizes the main recommendations in the guidelines， so as to provide a reference for the treatment of ascites in patients with liver diseases in China.

Role of exosomes in intrahepatic cholangiocarcinoma / 临床肝胆病杂志

Intrahepatic cholangiocarcinoma （ICC） is a special type of liver cancer with atypical clinical symptoms in the early stage， and most patients are already in the advanced stage at the time of initial diagnosis. Due to a lack of effective molecular markers and treatment options， ICC patients tend to have an extremely low five-year survival rate. Exosomes are vesicles secreted by cells that contain proteins， RNA， and lipids， and they are important carriers of intercellular communication. Recent studies have shown that exosomes play a crucial role in the development and progression of ICC， and this article reviews the role and mechanism of exosomes in the diagnosis and treatment of ICC and looks into the future treatment prospect and potential clinical application of exosomes.

Discussion on the Medication Rules of ZHONG Guang-Ling in Treating Lumbar Disc Herniation / 广州中医药大学学报

Objective To explore the medication rules of Professor ZHONG Guang-Ling's prescriptions for the treatment of lumbar disc herniation(LDH)based on data mining method,so as to provide reference for the treatment of LDH with Chinese medicine.Methods The prescriptions for the effective cases of outpatients of LDH treated by Professor ZHONG Guang-Ling in the recent 5 years were collected.The medication frequency of Chinese medicines in the included prescriptions and the distribution of their properties,flavors and meridian tropism were investigated.Moreover,the association rule analysis and cluster analysis of the high-frequency drugs were carried out.Results A total of 164 prescriptions were included and 168 Chinese medicines were used.The top 10 high-frequency drugs in descending order were Achyranthis Bidentatae Radix,Chuanxiong Rhizoma,Pheretima,Glycyrrhizae Radix et Rhizoma Praeparata cum Melle,Gentianae Macrophyllae Radix,Angelicae Sinensis Radix,Rehmanniae Radix Praeparata,Persicae Semen,Cyperi Rhizoma,and Carthami Flos.The properties of the prescribed drug were mainly warm and mild in nature,and bitter and pungent in flavor,and mainly had the meridian tropism of the liver,kidney and spleen meridians.According to the therapeutic actions,the drugs were mainly categorized as deficiency-supplementing drugs,dampness-removing and collateral-unblocking drugs,and blood-activating and stasis-removing drugs.The results of association rule analysis yielded 10 drug pairs,and cluster analysis yielded 6 core drug combinations.Conclusion For the treatment of LDH,Professor ZHONG Guang-Ling usually adopts the Chinese medicine for supplementing the deficiency and supporting healthy-qi,together with the medicines for nourishing the liver and kidney and regulating the spleen and stomach from the perspective of liver,kidney and spleen.Moreover,therapy of activating blood and removing stasis is also stressed,pathogen-eliminating medicines for removing dampness,unblocking collaterals and clearing heat are used based on syndrome differentiation,and then simultaneous application of purging and nourishing therapeutics is achieved through the utilization of purging method after supplementing method.

Promoting tear production: neurostimulation for dry eye / 中华实验眼科杂志

Dry eye syndrome is a common ocular surface disorder often caused by deficient or poor-quality tear production.There are numerous therapeutic approaches to address dry eye, however, there are quite a number of patients with unsatisfactory treatment results, and neurostimulation therapy has introduced an innovative solution to this challenge.This therapy involves stimulation of the nasal nerves to activate the lacrimal reflex pathway, thereby increasing tear secretion.Unlike traditional dry eye treatments, its unique capacity is to stimulate the natural production of tears, as opposed to simply supplementing tear components.Theoretically, this method may be more effective in restoring tear film stability.Neurostimulation is a promising alternative for the management of dry eye, with several designs successfully transitioning to commercialization after clinical trials.In clinical practice, neurostimulation can significantly promote immediate tear secretion after application.In addition, some studies have reported that long-term use of neurostimulation can relieve the symptoms and signs of dry eye in some research.Ophthalmologists and ophthalmic researchers are encouraged to pay attention to the application and investigation of neurostimulation therapy in dry eye management.Future research should focus on exploring the long-term effects of neurostimulation on dry eye symptoms and signs, how it can be integrated into existing dry eye treatment protocols, and promoting neurostimulation therapy to benefit more dry eye patients.

An interpretation of the new version of Refractive Errors Preferred Practice Pattern? / 中华实验眼科杂志

In September 2022, the American Academy of Ophthalmology released the latest version of Refractive Errors Preferred Practice Pattern? (PPP). It provides authoritative guidance for the diagnosis and treatment of refractive errors based on the best evidence-based medical updates.The new version of Refractive Errors PPP continues the rigorous, comprehensive and detailed features of the 2017 version.Updates have been made to the definition, epidemiology, classification, and diagnosis and correction of refractive errors.For example, the new version of Refractive Errors PPP defines high refractive errors as myopia≥-6.0 D, hyperopia≥+ 3.0 D, astigmatism≥-3.0 D, adds content on myopia prevention and control, recommends outdoor activities for at least 2 hours per day, selects appropriate optical prevention and control methods, and considers the use of low-concentration atropine eye drops to delay the onset and development of myopia.It enriched the evidence-based medical evidence that myopia is an interactive influence of genetic and environmental factors, and emphasized the future pandemic trend of high myopia, and the global public health significance of delaying the progression of myopia.In addition, the new version of Refractive Errors PPP emphasizes for the first time that myopia can cause irreversible visual impairment, suggesting that it is necessary to delay the onset time of myopia in children and slow the speed of myopia progression.This article introduces and interprets the main contents and updates of the new edition of the Refractive Errors PPP.

Progress towards elimination of hepatitis B / 临床肝胆病杂志

This paper summarizes the latest progress in the elimination of hepatitis B worldwide and in China. Although the global burden of hepatitis B is decreasing， there is a large difference in the progress towards elimination across different countries， and among the 20 countries with the heaviest disease burden， Bangladesh， India， Indonesia， Japan， and Russia have achieved substantial progress. China continues to maintain a high HBV vaccination coverage for neonates， with an inoculation rate of 95.6% for timely birth dose and 99.6% for 3 doses. From 2016 to 2022， the diagnosis rate of patients with chronic hepatitis B in China have increased from 19% to 24%， and treatment rate have increased from 11% to 15%； however， there is still a big gap compared with the WHO targets by 2030. Further efforts are needed to eliminate viral hepatitis by 2030 globally and in China.

Focus on the timing and strategies of antiviral therapy for special populations with chronic hepatitis B / 临床肝胆病杂志

Several factors need to be considered for special populations with chronic hepatitis B （CHB）， such as the family history of liver cirrhosis and liver cancer， age， disease stage， and antiviral response. It is necessary to select the appropriate timing of antiviral therapy and timely adjust antiviral strategies for CHB populations， which plays an important role in delaying disease progression and reducing the development of liver cirrhosis and hepatocellular carcinoma. This article elaborates on the timing and strategies for antiviral therapy in the special populations such as patients with chronic HBV infection who have an age of ≤30 years and a normal alanine aminotransferase （ALT） level， pregnant women with chronic HBV infection who have an age of >30 years and a normal ALT level， children with chronic HBV infection， and treatment-experienced HBeAg-positive CHB patients with low-level viremia， so as to help clinicians choose a better timing of antiviral therapy and optimize the strategies of antiviral therapy for special CHB populations.

Timing of antiviral therapy for pregnant women with HBV infection and normal alanine aminotransferase level aged >30 years / 临床肝胆病杂志

Guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） expanded the indications for antiviral therapy in patients with chronic hepatitis B. The guidelines recommend to initiate antiviral therapy for patients with chronic HBV infection who have a normal alanine aminotransferase （ALT） level， positive HBV DNA， and an age of >30 years. However， for pregnant women aged >30 years， no consensus has been reached on whether to start antiviral therapy immediately. Some experts believe that pregnant women with a normal ALT level are mostly in the immune-tolerant phase， and antiviral therapy tends to have an unsatisfactory therapeutic effect； in addition， medication during pregnancy may affect the safety of mothers and fetuses. Therefore， it is not recommended to start antiviral therapy immediately in early pregnancy even if the pregnant women are aged >30 years. Other experts believe that immune changes of the body during pregnancy may be a special period for HBV immune clearance， and if the patients are aged >30 years， antiviral therapy should be initiated immediately even if the patient has a normal ALT level； pregnant women may get better virologic and even serological response. With a focus on the above issues， this article elaborates on the purpose， treatment timing， and drug withdrawal timing of antiviral therapy during pregnancy.

Hepatitis B virus infection in children： Antiviral therapy for children with a normal alanine aminotransferase level / 临床肝胆病杂志

Chronic hepatitis B （CHB） is a major public health issue around the world， and there are currently about 2 million children with hepatitis B virus （HBV） infection in China. HBV infection in children tends to become chronic， leading to high risks of liver cirrhosis and liver cancer in adulthood. Traditionally， it is believed that children with HBV infection are mainly in the immune-tolerant phase and do not require antiviral therapy， and antiviral therapy is only initiated for CHB children who are in the immune-active phase or suffer from compensated or decompensated liver cirrhosis. More and more clinical studies on CHB in children have shown that CHB children tend to have a high response rate to antiviral therapy， especially interferon-based regimens， and young children are at the advantage of clinical cure； however， there are still controversies over whether antiviral therapy should be initiated for children with HBV infection who have a normal alanine aminotransferase （ALT） level and are in the immune-tolerant phase. This article reviews the features of children with HBV infection and the necessity of antiviral therapy for children with a normal ALT level， with a special focus on treatment timing.

Clinical controversies over antiviral therapy for patients in the immune-tolerant phase of hepatitis B virus infection / 临床肝胆病杂志

To achieve the goal of “eliminating viral hepatitis as a public health hazard by 2030”， extensive screening， active prevention， and antiviral therapy are currently recommended for chronic hepatitis B virus （HBV） infection； however， no consensus has been reached on whether to initiate antiviral therapy for patients in the immune-tolerant phase of chronic HBV infection. Some experts believe that patients in the immune-tolerant phase tend to have a stable liver immune microenvironment， with a low risk of disease progression and poor response to treatment， and thus it is not recommended to initiate antiviral therapy. However， various other studies have shown that patients in the immune-tolerant phase still have inflammatory damage in the liver， with a risk of disease progression and a high level of cost effectiveness， and therefore， some experts suggest that antiviral therapy should be actively initiated for patients in the immune-tolerant phase. This article performs a literature review of the definition of patients in the immune-tolerant phase of chronic HBV infection and the advantages and disadvantages of antiviral therapy and conducts a preliminary analysis based on previous studies， in order to accumulate the evidence for whether to initiate antiviral therapy in the immune-tolerant phase of chronic HBV infection and lay a foundation for standardized clinical diagnosis and treatment of patients in the immune-tolerant phase.

Key recommendations in guidelines for the prevention， diagnosis， care and treatment for people with chronic hepatitis B infection released by the World Health Organization in 2024 / 临床肝胆病杂志

In March 2024， the World Health Organization released the latest version of guidelines for the prevention， diagnosis， care and treatment for people with chronic hepatitis B infection. The guidelines were updated in several aspects， including expanding and simplifying the indications for chronic hepatitis B treatment， adding alternative antiviral treatment regimens， broadening the indications for antiviral therapy to prevent mother-to-child transmission， improving the diagnosis of hepatitis B virus， and adding hepatitis D virus （HDV） testing. This article summarizes and gives an excerpt of the recommendations in the guidelines.