Baveno VII criteria for recompensation predict transplant-free survival in patients with hepatitis B-related decompensated cirrhosis.

Background & Aims: The latest Baveno VII consensus has provided guidance for identifying patients who have truly recompensated from those with hepatic decompensation. This study aimed to evaluate patients' transplant-free survival in three different stages of cirrhosis. Methods: All patients with chronic HBV infection and liver cirrhosis treated with oral nucleos(t)ide analogues from March 2006 to December 2022 were identified from a territory-wide database in Hong Kong. Patients with follow-up duration of <1 year were excluded. Participants were classified into three mutually exclusive groups: (1) no decompensated events (i.e. compensated group); (2) decompensated events occurred (i.e. decompensated group); or (3) decompensated events occurred followed by recompensation according to Baveno VII criteria (i.e. recompensated group). A time-dependent Cox proportional hazard model was adopted for evaluation. The follow-up period was 5 years. Results: A total of 4,701 patients with cirrhosis and HBV who were treated with entecavir, tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide fumarate (TAF) were identified. During a median follow-up of 5 years (interquartile range 3.7, 5 years), 3,327 (70.8%), 1,347 (29.2%), and 265 (5.6%) patients had compensated, decompensated, and recompensated cirrhosis, respectively, at least once before the end of the study. In the time-dependent multivariable model, the recompensated group had similar transplant-free survival compared with the compensated group (adjusted hazard ratio 1.16; 95% CI 0.72-1.86; p = 0.536). The 5-year transplant-free survival rate was 89.3% for the compensated group, whereas it was 76.0% for the recompensated group, reflecting a minimal difference between the two groups. Conclusions: The clinical significance of recompensation of cirrhosis in improving patient outcomes for individuals with CHB infection was highlighted in this study. Early identification and treatment with nucleos(t)ide analogues might promote hepatic recompensation and thus reduce mortality in patients with CHB. Impact and implications: The latest Baveno VII consensus introduces the new concept of hepatic recompensation, which refers to the reversal of the structural and functional changes of cirrhosis after removal, cure, or suppression of the aetiology of cirrhosis. It is essential to investigate the transplant-free survival rates of patients who are able to achieve hepatic recompensation, as this has significant implications for the medical resources required to manage liver failure and transplantation. This study features the clinical significance of hepatic recompensation by comparing patient outcomes of those who achieve it to those who do not. The early identification and use of antiviral treatment with nucleos(t)ide analogues is a pivotal strategy to promote hepatic recompensation, which has the potential to significantly reduce mortality rates in patients with chronic HBV infection and ultimately aid in the elimination of hepatitis.

Helicobacter pylori bacteremia presenting as seizure and unconsciousness: The brief case.

BACKGROUND: Helicobacter pylori bacteremia is rare and difficult to make a definite diagnosis. CASE PRESENTATION: This is a 40-year-old woman represented as fever and unconsciousness accompanied by tics. She was diagnosed as Helicobacter pylori bacteremia and received emergency endotracheal intubation and antibiotics. Her symptoms resolved and she was discharged from ICU at the sixth day. CONCLUSIONS: Helicobacter pylori bacteremia is rare and hard to identify. Varied clinical manifestations leading to more difficult to make a definite diagnosis.

Digital Economy, Environmental Regulation and Corporate Green Technology Innovation: Evidence from China.

Background: As human beings enter the digital age, the impact of the digital economy on environmental regulation and corporate green technology innovation (CGTI) is expanding. In order to effectively strengthen the efficacy of environmental regulation and improve the green technology innovation ability of corporate, this paper conducts in-depth research on the influence process of the digital economy and environmental regulation on the CGTI. Methods: Based on the mediating variable environmental regulation, this paper explores the influence process of the digital economy on CGTI. Combined with empirical analysis methods such as the fixed-effect model, mediating effect model, spatial model and regression analysis, the authors reveal the influence process of the digital economy on CGTI. Results: The digital economy can directly promote the improvement of the green technology innovation level of CGTI. The digital economy can indirectly affect the CGTI through the mediating variable of environmental regulation, marginal effect and spatial spillover effect. Conclusions: The digital economy and CGTI had a significant spatial correlation among different regions in China. In different regions of China, there are significant differences in the relationship between the digital economy, environmental regulation and CGTI.

Clinical characteristics and outcomes of adult patients with acquired thrombotic thrombocytopenic purpura: a single center retrospective study.

BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is a rare disease and a potentially life-threatening thrombotic microangiopathy. Although the diagnostic and therapeutic techniques have improved, it is still difficult for clinicians to identify early due to different initial clinical manifestations and the incidence and survival rate are reported inconsistently. This study investigated the clinical characteristics, treatment strategies, and treatment outcomes of adult patients with acquired TTP. METHODS: A retrospective analysis of 55 patients (35 females and 20 males) treated for acquired TTP from January 1, 2013 to December 31, 2017 was conducted. The analysis included clinical manifestations at onset, treatment efficacy measures, survival, cause of death, and the APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (sequential organ failure assessment) scores. RESULTS: At onset, in addition to thrombocytopenia and hemolysis, 50 patients (90.91%) presented with neurological abnormalities, but only 19 (34.55%) showed the classic TTP pentad of symptoms. The overall mortality rate was 34.55%. Plasma exchange (PEX) was performed in 49 patients. The most effective treatment was PEX with a normal dose of corticosteroid and rituximab which showed a response rate of 81.25%. The main cause of death was cerebral hemorrhage. The APACHE II and SOFA scores were higher in non-survivors compared to survivors (APACHE II: 20.12±7.83 vs. 11.50±4.49, P<0.05; SOFA: 12.06±3.27 vs. 7.74±2.10, P<0.05). Non-survivors had higher levels of lactic dehydrogenase (LDH; 1,646.94±1,269.48 vs. 942.76±740.58 IU/L, P=0.015), and higher numbers of schistocytes (6.18%±4.69% vs. 3.44%±3.13%, P=0.035) compared to survivors. CONCLUSIONS: TTP progressed rapidly, and its clinical manifestations varied between patients. The diagnosis depended on the clinical features and laboratory tests. Combination therapy with PEX, immunosuppressive therapy, and rituximab may be useful. Higher APACHE II and SOFA scores, higher LDH levels, and a greater degree of schistocytosis were associated with the severity and outcome of TTP.

Expression of nuclear factor erythroid-2-related factor 2, broad complex-tramtrack-bric a brac and Cap'n'collar homology 1 and γ-glutamic acid cysteine synthase in peripheral blood of patients with chronic obstructive pulmonary disease and its clinical significance.

The purpose of the present study was to explore the relationship between nuclear factor erythroid 2-related factor 2 (Nrf2)/BTB-CNC allogeneic 1 (Bach1)/γ-glutamic acid cysteine synthase (γ-GCS) and chronic obstructive pulmonary disease (COPD). The expression of Nrf2, Bach1, γ-GCS mRNA and protein in the peripheral blood mononuclear cells (PBMCs) of 80 COPD patients and 40 healthy volunteers were studied. Then, the correlation between Nrf2, Bach1, γ-GCS and lung function, inflammation and oxidative stress indicators was analyzed. Compared with healthy controls, Nrf2, Bach1 mRNA and protein levels were significantly increased in the PBMCs of COPD patients, while γ-GCS mRNA and protein levels were significantly decreased. Nrf2 and Bach1 protein levels in the nucleus were significantly elevated in acute exacerbation COPD patients compared with patients with a stable stage of COPD, while γ-GCS mRNA levels were significantly reduced. In addition, it was found that Nrf2 nuclear protein levels were significantly reduced in COPD patients compared with the control group, while Bach1 nuclear protein levels were significantly increased. Correlation analysis in COPD group demonstrated that γ-GCS mRNA was positively correlated with Nrf2 nuclear protein level, but negatively correlated with Bach1 nuclear protein level. Further analysis demonstrated that γ-GCS mRNA and Nrf2 protein in the nucleus was positively correlated with forced expiratory volume in one second (FEV1)/forced vital capacity (FVC)% and FEV1% predicted, and Bach1 protein in the nucleus was negatively correlated with FEV1/FVC% and FEV1% predicted. Additionally, the expression levels of Nrf2, Bach1 and γ-GCS were also associated with smoking. The expression of Nrf2, Bach1 and γ-GCS in peripheral blood mononuclear cells of patients with COPD was dysregulated and related to lung function, which provides a new basis for exploring further the pathogenesis of COPD.

Taxonomic assignment of the benthic toxigenic dinoflagellate Gambierdiscus sp. type 6 as Gambierdiscus balechii (Dinophyceae), including its distribution and ciguatoxicity.

Recent molecular phylogenetic studies of Gambierdiscus species flagged several new species and genotypes, thus leading to revitalizing its systematics. The inter-relationships of clades revealed by the primary sequence information of nuclear ribosomal genes (rDNA), however, can sometimes be equivocal, and therefore, in this study, the taxonomic status of a ribotype, Gambierdiscus sp. type 6, was evaluated using specimens collected from the original locality, Marakei Island, Republic of Kiribati; and specimens found in Rawa Island, Peninsular Malaysia, were further used for comparison. Morphologically, the ribotype cells resembled G. scabrosus, G. belizeanus, G. balechii, G. cheloniae and G. lapillus in thecal ornamentation, where the thecal surfaces are reticulate-foveated, but differed from G. scabrosus by its hatchet-shaped Plate 2', and G. belizeanus by the asymmetrical Plate 3'. To identify the phylogenetic relationship of this ribotype, a large dataset of the large subunit (LSU) and small subunit (SSU) rDNAs were compiled, and performed comprehensive analyses, using Bayesian-inference, maximum-parsimony, and maximum-likelihood, for the latter two incorporating the sequence-structure information of the SSU rDNA. Both the LSU and SSU rDNA phylogenetic trees displayed an identical topology and supported the hypothesis that the relationship between Gambierdiscus sp. type 6 and G. balechii was monophyletic. As a result, the taxonomic status of Gambierdiscus sp. type 6 was revised, and assigned as Gambierdiscus balechii. Toxicity analysis using neuroblastoma N2A assay confirmed that the Central Pacific strains were toxic, ranging from 1.1 to 19.9 fg P-CTX-1 eq cell-1, but no toxicity was detected in a Western Pacific strain. This suggested that the species might be one of the species contributing to the high incidence rate of ciguatera fish poisoning in Marakei Island.

An unusual case of perforation of the alimentary canal following Bigu: A Taoist fasting technique.

RATIONALE: Bigu is a Taoist fasting technique interpreted as avoiding grains in the Encyclopedia of China. This technique has been used from ancient times to the present day in China and other parts of the world to achieve good health, weight loss, longevity, and even immortality. A variety of health problems have been identified in relation to the severe diet during Bigu. However, perforation of the alimentary canal has not been reported to be associated with Bigu. In the present study, we illustrated an unusual case of perforation of the alimentary canal in relation to Bigu. PATIENT CONCERNS: A 36-year-old woman was admitted to our hospital after falling into a coma. One month before admission, she had black stool accompanied by dizziness and fatigue, while the symptoms progressively worsened. The patient reported that she stopped the intake of meat for 5 years, and further practiced Bigu for 5 months, eating only fruits and vegetables, and avoiding grains and meat. DIAGNOSIS: Preformation of the alimentary canal. INTERVENTIONS: Gastric bypass operation, also known as Roux-en-Y anastomosis, was undertaken. Since the patient developed thrombus with edema on the right upper limb after surgical intervention, she was subsequently treated with anticoagulation therapy using low-molecular weight heparin. OUTCOMES: The patient's symptoms were remarkably improved and exhibited signs of recovery in follow-up examinations. LESSONS: The case has raises serious concerns about practicing Bigu. Furthermore, it is strongly advocated that a state of Bigu for a long period of time can even be dangerous.

Comparative study on twinning characteristics during two post-weld compression paths and their effects on joint enhancement.

Friction stir welding (FSW) has promising application potential in Mg alloys. However, the texture distribution in stir zone (SZ) is usually complicated for Mg alloys, which deterioriates the joint performance. In this study, the texture distribution in SZ was tailored by applying two kinds of post-weld compression deformation along normal direction (ND) or welding direction (WD) of the FSWed AZ31 Mg alloy plates. The twinning behavior and texture change in the various regions of SZ were then evaluated by electron back scatter diffraction (EBSD) characterization. The effect of texture change on the joint performance was discussed in terms of Schmid factors (SFs) for basal slip and extension twinning. The results showed that profuse extension twins were formed through the whole SZ for the sample subjected to compression along ND, whereas they were observed mainly in SZ-side for the sample compressed along WD. Most of the twins were present in the forms of twin bands or chains. The directions of the twin bands or chains were related to the habit plane traces of selected twin variants. The ND post-weld compression had better strengthening effects on the joints compared to the WD compression, and the underline mechanism was discussed.