Objective To explore the recurrence of chronic hepatitis B(CHB) after stopping nucleoside (acid) analogue(NAs) and the impact of residual amount of serum hepatitis B virus(HBV) DNA on recurrence. Methods Seventy-nine CHB patients, who received treatment of NAs and achieved standard withdrawal were enrolled in this study. According to lab examination, there were 47 hepatitis B e antigens (HBeAg)-positive patients and 32 HBeAg-negative patients. Meanwhile, 33 CHB patients received lamivudine treatment (LAM group), 27 CHB patients received adefovir treatment (ADV group), and 19 CHB patients received entecavir treatment (ETV group). The biochemical and virological indicators of CHB patients′recurrence would be recorded after 48 weeks. Results There were 43 CHB patients (54.4%), whose indicators of HBV DNA turned positive after discontinuity of treatment with NAs of 48 weeks. There were 27 CHB patients (55.3%), the HBV DNA of whom turned positive among 47 HBeAg-positive patients, and 17 patients(53.1%) among 32 HBeAg-negative patients, and there was no significant difference (P>0.05). In addition, the positive conversion rate after stopping treatment with NAs of 48 weeks in LAM group, ADV group and ETV group had no significant difference:54.5%(18/33), 51.9%(14/27), 11/19, P > 0.05. Moreover, there were 36 patients (45.6%) whose index of alanine aminotransferase(ALT) increased again after discontinuity of treatment with NAs of 48 weeks . There were 20 CHB patients (42.6%) in HBeAg-positive patients, and 16 patients (50.0%) in HBeAg-negative patients, and there was no significant difference (P>0.05). The rate of ALT increase again in LAM group, ADV group and ETV group had no significant difference: 48.5%(16/33), 40.7%(11/27), and 9/19, P >0.05. According to the results of serum samples of 79 CHB patients with Roche reagent when stopping using NAs, in 35 CHB patients (44.3%) serum HBV DNA>12 × 103 U/L was detected. However, serum HBV DNA>5 × 105 U/L was detected in 25 CHB patients (71.4%)among 35 patients with serum HBV DNA > 12 × 103 U/L after 48 weeks, and merely in 18 CHB patients (40.9%) among 44 patients with serum HBV DNA < 12 × 103 U/L, and there was significant difference (P < 0.01). Conclusions The CHB patients with standard withdrawal still have high recurrence rate after stopping treating, whatever medicine was used. Then, residual amount of serum HBV DNA is an important indicator for predicting relapse of CHB. Meanwhile, the retreatment of these patients should be researched further.

Objective To evaluate the effects of patient education for hypertension on hypertension control.Methods Of 169 eligible patients (systolic blood pressure ≥160 mmHg and/or diastolic blood pressure ≥95 mmHg), 60 were assigned to educational group (group E, antihypertensive drug treatment with an addition of patient education) and 109 to routine group (group R, antihypertensive drug treatment alone). The average follow-up approximated to 3 years.Results The blood pressure was reduced from at baseline and sustained in the three-year follow-up by 20/13 mmHg in group E and by 22/13 mmHg in group R. For this similar blood pressure reduction, about 10 mg less of metoprolol and 6 mg less of nitrendipine were used in group E than in group R. The percentage of the patients in whom goal blood pressure (under 160/90 mmHg) was achieved during follow-up was higher and progressively increased in group E (1st year: 65%, 2nd year: 72%) in comparison with in group R (1st year: 45%; 2nd year: 55%). Body weight was significantly reduced by 1.36 and 1.81 kg from at baseline to at the 1st and 2nd year repeated measurements in group E. The significant reduction from at baseline to at the 2nd year was significantly different from that in group R (P=0.02). For 24-hour urinary sodium excretion, it was decreased in the group E, whereas it was increased in the group R. The cumulative rates of hypertension-related complications were 4.43% in group E and 7.02% in group R (absolute difference=2.59%, P=0.48). The rate of missed appointments was somewhat higher in group R (10%) than in group E (7%) during the first year but lower in the 2nd and 3rd year (R vs E: 10% vs 2% in the 2nd year; 8% vs 2% in the 3rd year). Four patients lost to follow-up in group R (6.87%) and 1 patient in group E (1.74%, P=0.08). Conclusion The findings of this study suggest that patient education is of some benefits to the hypertension control.

Objective:To summarize the clinical characteristics of children with dystonia 28 (DYT28) caused by KMT2B gene variations so as to improve clinicians′ understanding of the disease. Methods:The clinical manifestations, treatment and gene variation data of 11 children with DYT28 caused by KMT2B gene variations were retrospectively collected and analyzed.The subjects were recruited from the Department of Neurology, Beijing Children′s Hospital, Capital Medical University from March 2018 to January 2021.The patients were followed up. Results:There were 8 males and 3 females.The age at onset was ranging from 1 month to 6 years without inducement.Eight cases were gene-ralized dystonia and 3 cases were multifocal dystonia.The initial symptoms of 7 cases were unilateral or bilateral lower limbs tiptoeing.Four cases presented dysarthria, retching or swallowing difficulties at onset.As the disease progressed, all the cases had laryngeal dystonia, 10 cases had lower limbs dystonia, and 8 cases had upper limbs dystonia.Six cases were complicated with other dyskinesia symptoms.Ten cases had varying degrees of short stature, microcephalus, micrognathia, musculoskeletal abnormalities, intellectual disability, endocrinopathies and sleep difficulties.The brain magnetic resonance imaging showed abnormal in only 1 case.Eleven KMT2B gene pathogenic variants were found, including 8 frameshift variants, 1 in-frame variant and 2 missense variants.Four variants were novel.Eleven cases were followed up at the age of 1 year and 7 months to 17 years and 9 months.One case wasn′t given therapy.The dystonia in 3 cases was mildly improved after medication.Dysfunction of urination and defecation was disappeared in 1 case after medication.The symptom of 6 cases had no improvement after drug therapy.Among the above 6 cases, 5 drug refractory cases had deep brain stimulation, and their dystonia symptoms are all obviously improved; 2 cases had normal control of urination and defecation after deep brain stimulation.The motor scores in the Burke-Fahn-Marsden dystonia rating scale were improved by 55.8%-90.7%, and the disability scores were improved by 14.8%-69.6%. Conclusions:DYT28 caused by KMT2B gene variations is one of the most common and early-onset genetic dystonia in children.The dystonia symptom progresses from local parts to the whole body, prominently involving laryngeal muscles and lower limbs.Control of urination and defecation requires attention.Patients with mild dystonia symptoms can be effectively treated by drugs.However, patients with severe dystonia symptoms were drug refractory, and their dystonia symptoms can be effectively improved by deep brain stimulation.