OBJECTIVE To investigate the clinical characteristics of drug-induced liver injury （DILI） induced by glucagon- like peptide-1 receptor agonists （GLP-1RAs）， and to provide a reference for safe clinical medication. METHODS Using search terms such as “GLP-1”“GLP-1RAs”“semaglutide” “drug-induced liver injury”， relevant studies from PubMed， Embase， the Cochrane Library， CNKI， Wanfang Data and VIP were retrieved. Descriptive analysis was performed on cases of DILI induced by GLP-1RAs. RESULTS A total of 11 studies， comprising 11 patients， were included. Among them， 4 were male （36.4%） and 7 were female （63.6%）. Patient ages ranged from 17 to 64 years； 5 patients （45.5%） were between 50 and 65 years old. Six patients were treated for diabetes， and five for weight loss. Ten patients had underlying diseases. The shortest time to the onset of DILI was 5 days after medication， while the longest was approximately 180 days. The DILIs induced by GLP-1RAs were mainly hepatocellular injury type （6 cases）； severity levels included severe （3 cases）， moderate （6 cases）， and mild （2 cases）. Gastrointestinal symptoms and jaundice were the most common clinical manifestations. The association between DILI and GLP- 1RAs was assessed as “probable” in 10 cases and “possible” in 1 case. All 11 patients improved after drug discontinuation and （or） corresponding treatment. CONCLUSIONS DILI induced by GLP-1RAs is relatively concentrated in patients aged 50-65， with a higher incidence in females. The risk may be further increased in patients with underlying diseases. Clinical use of these agents should enhance pharmaceutical care， including identification of high-risk populations and patient education （especially symptom recognition）. When relevant symptoms appear， the drug should be discontinued immediately， with liver-protective therapy initiated when necessary， to ensure patient safety of drug use.

Objective:To analyze the clinical and radiological features of patients with resected pancreatic serous cystic neoplasm (SCN).Methods:A retrospective analysis was conducted on the clinical and radiological data of 172 patients with pancreatic SCN who underwent surgical resection and were pathological confirmed at Peking Union Medical College Hospital from September 2014 to April 2022. These patients were categorized into two cohorts including 2014—2018 cohort ( n=84) and 2019—2022 ( n=88) for comparative analysis based on the operation time. Results:The radiological diagnostic accuracy for SCN was found to be notably low at 11.6%(20/172), which was mostly misdiagnosed as mucinous cystic neoplasms (86/172, 50.0%) and intraductal papillary mucinous neoplasms (35/172, 20.3%). No statistically significant variance was observed on the misdiagnosis rate between the two cohorts. There was a substantial increase of the number of lesions located in pancreatic body and tail (76.1% vs 53.6%, P=0.004) and a marked decrease in the number of those located in pancreatic head and neck (22.7% vs 39.3%, P=0.019) in 2019-2022 cohort, compared to the 2014-2018 cohort. Furthermore, there was a significant reduction in the occurrence of SCN calcification and peri-lesional venous alterations (22.8% vs 45.1%, P=0.006; 25.0% vs 46.4%, P=0.003), a decrease in the presence of fibrous scarring within SCN (31.8% vs 45.2%, P=0.070), and an increase in cases with dilatation of the upstream main pancreatic duct (28.2% vs 16.3%, P=0.065). The clinical characteristics and the rate of postoperative complications did not significantly differ between the two cohorts. Complication rates after pancreatoduodenectomy were significantly higher than those following distal pancreatectomy (46.4% vs 22.9%, P=0.010). The presence of clinical symptoms was significantly linked to the size of SCN and the expansion of the main pancreatic duct (45.4% vs 29.3%, P=0.032; 64.9% vs 31.2%, P<0.001). Conclusions:The accuracy of preoperative radiological diagnosis for SCN is still low, with a noted increase in the proportion of SCN exhibiting atypical radiological features in recent years. The frequency of postoperative complications is relatively high and does not have an obvious decreased trend.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Fat accumulation "sensitizes" the liver to insult and leads to nonalcoholic steatohepatitis (NASH). G protein-coupled receptor 35 (GPR35) is involved in metabolic stresses, but its role in NAFLD is unknown. We report that hepatocyte GPR35 mitigates NASH by regulating hepatic cholesterol homeostasis. Specifically, we found that GPR35 overexpression in hepatocytes protected against high-fat/cholesterol/fructose (HFCF) diet-induced steatohepatitis, whereas loss of GPR35 had the opposite effect. Administration of the GPR35 agonist kynurenic acid (Kyna) suppressed HFCF diet-induced steatohepatitis in mice. Kyna/GPR35 induced expression of StAR-related lipid transfer protein 4 (STARD4) through the ERK1/2 signaling pathway, ultimately resulting in hepatic cholesterol esterification and bile acid synthesis (BAS). The overexpression of STARD4 increased the expression of the BAS rate-limiting enzymes cytochrome P450 family 7 subfamily A member 1 (CYP7A1) and CYP8B1, promoting the conversion of cholesterol to bile acid. The protective effect induced by GPR35 overexpression in hepatocytes disappeared in hepatocyte STARD4-knockdown mice. STARD4 overexpression in hepatocytes reversed the aggravation of HFCF diet-induced steatohepatitis caused by the loss of GPR35 expression in hepatocytes in mice. Our findings indicate that the GPR35-STARD4 axis is a promising therapeutic target for NAFLD.

ABSTRACT OBJECTIVE To investigate the current situation of pediatric pharmacist-managed clinic in China, and to provide reference for pediatric pharmacist-managed clinic construction and improvement. METHODS Domestic Children's hospitals, Women's & Children's Hospital, and general hospitals with pediatric unit were selected as the survey objects, questionnaires were distributed through the Wenjuanxing Application, and SPSS 26.0 was used to describe the data. The development of pediatric pharmacist-managed clinic, the qualification of visiting pharmacists, the situation of post training and training needs were analyzed. RESULTS A total of 101 valid questionnaires were collected. Pediatric pharmacist-managed clinics had been set up in 55(54.5%) hospitals, of which 35 were independent pharmacists' clinics, and most had well medical document and patient management processes. However, about 70% of hospitals did not charge registration fees, and more than half of hospitals had fewer than 5 patient-visits per day. 85.5% of the hospitals were visited by clinical pharmacists, and about half of them were senior clinical pharmacists with more than 10 years of working experience. But only 3.6% of visiting pharmacists had the right of specific prescription. In 101 hospitals relevant post training for pharmacists had been carried out in 36 hospitals, of which 25 hospitals had set up pharmacist-managed clinic. In addition to pharmaceutical expertise, more than 50% of pharmacists had a strong demand for the improvement of physician-patient communication and problem-solving ability, and 30%-40% of the demand was focused on the collection of medication history, psychological counseling ability, and case-based learning in the pharmacist-managed clinic. CONCLUSION At present, the domestic pediatric pharmacist-managed clinic shows a vigorous development trend, however, there are insufficient registration fees, visits, and post training. Appropriate service methods of pediatric pharmacist-managed clinic should be actively explored, and a pediatric specialized training system for should be well constructed to improve the competency.

Objective    To summarize our experience in the treatment of esophageal foreign bodies. Methods    A retrospective analysis of 149 patients of esophageal foreign bodies in the Second Affiliated Hospital of Air Force Military Medical University from December 2011 to May 2019 was carried out, including 75 (50.3%) females and 74 (49.7%) males with an average age of 57 (2-85) years. Results    There were 146 patients confirmed by endoscopy, and 3 patients were not found foreign body. Among the confirmed patients, 127 patients were removed by gastroscope and 19 patients were treated by operation. Esophageal foreign bodies are mainly related to the types of food. Jujube seed is the most common food foreign body in the northwest China. The injury rate of mucosal was 47.54% within 48 hours. The complication rate of taking out the foreign body after 48 hours was 100.0%. The success rate by endoscopy decreased (P=0.005), if the foreign body combined perforation. There was no statistical difference between the neck and other parts when using ultra-fine gastroscope (P=0.157). Conclusion    The sharper the foreign body is, the easier the perforation is. The earlier the foreign body is removed, the less complications are. The size of the foreign body determines the difficulty of endoscopic removal. Gastroscopy is the first choice for diagnosis and treatment, especially ultra-fine gastroscopy, and the foreign bodies that cannot be removed by endoscopy need surgical treatment.

BACKGROUND: Electromagnetic navigation bronchoscopy is a tool that can accurately navigation peripheral lung lesions. Because of electromagnetic navigation bronchoscopy (ENB) is too expensive, it has not been widely used in China. It is urgent for us to summarize experience in clinical application, especially in the diagnosis of pulmonary nodules. METHODS: The clinical data of patients with pulmonary peripheral lesions (PPLs) in our department undergoing ENB biopsy between July 2017 and December 2018 were retrospectively analyzed. RESULTS: There were 18 patients with 21 PPLs (10 males and 8 females). Among them, 11 patients got the final pathological diagnosis, 8 cases were diagnosed with adenocarcinoma lung cancer, 1 case was diagnosed with tuberculosis and 2 cases were diagnosed with small cell lung cancer. The positive rate of diagnosis was 61.1%. The sensitivity was 73.3%. The positive diagnosis rate is related to the size of the lesion, the positive diagnosis rate for lesions >2 cm is 100.0% (P=0.04). CONCLUSIONS Electromagnetic navigation bronchoscope is safe and effective in clinic. It has a high positive rate for the diagnosis of peripheral lung lesions larger than 2 cm, ENB has broad clinical application prospects.

Objective To summarize the outcomes and clinical experiences of renal transplantation in human immunodeficiency virus (HIV)-positive patients .Methods The clinical data were retrospectively analyzed for one HIV-positive case of renal transplantation .Diagnosed as chronic renal insufficiency 1 year ago ,he received hemodialysis .After a positive screen for HIV ,he received highly active antiretroviral therapy (HAART) and HIV RNA turned negative 3 months later .CD4 + T cell count was 331 cell/μl at pre-operation and there was no HIV-rated opportunistic infection or cancer . Her mother donated her kidney . Basiliximab and steroid pulse therapy were used preoperatively and immunosuppressants were used after transplantation , including tacrolimus , corticosteroids and mycophenolate mofetil .Results The kidney was transplanted successfully and serum creatinine declined to a normal level at day 4 after transplantation .Because of an interaction between efaverenz and tacrolimus ,the blood concentration of tacrolimus was extremely low and the dose of tacrolimus had to be raised to 0 .2 mg/(kg·d) .Antiroviral therapy remained unchanged .No rejection and other complications were observed .And HIV RNA remained negative .Conclusions Renal transplantation is optimal for HIV-positive patients whose HIV status is completely under control .However ,drug interactions needs to be considered during perioperative and postoperative periods .

Objective This study was conducted to analyze the clinical characteristics and pituitary function of patients with primary empty sella (PES).Methods The clinical data from 123 hospitalized adult patients with PES from January 2010 to May 2016 were retrospectively studied.Results (1) The average age of the 123 (male 43,female 80) PES patients was (59.2 ± 13.6) years (ranging 24-92 years),among whom 61％ patients were in the age group between 50-69 years.(2) The symptoms of the patients included fatigue (56.1％),headache (34.1％),nausea and vomiting (17.9％),gonadal dysfunction (17.1％),visual disturbance (5.7％) and hypopituitarism crisis (3.3％).(3) Hypopituitarism was found in 66 of the 123 patients.Among them,36.6％,31.7％ and 17.1％ were central hypoadrenalism,hypogonadism,and hypothyroidism,respectively.The percentage of hypopituitarism in complete PES was significantly higher than that in partial PES (P ＜ 0.05).(4) Sixteen patients were concomitant with other autoimmune diseases including 11 patients with Graves' disease and 2 with Cushing's syndrome due to adrenal adenoma.Conclusions The incidence of hypopituitarism in PES was 53.7％,in which the pituitary-adrenal axis hypofunction was more common.An overall evaluation of the pituitary function was essential for the patients who had headache and fatigue,or with suspected PES.The patients with hypopituitarism should be given hormone replacement therapy in time and followed up afterword.

[ ABSTRACT] AIM:To investigate the effect of storage temperature in renal biopsy tissue frozen section on immu-nofluorescence results.METHODS:One hundred renal biopsy samples of Zhejiang Province People’ s Hospital from Janu-ary to June, 2015 were enrolled.Two sets of cutting slices were stored in -70 ℃ low temperature refrigerator as experi-mental group and in -12 ℃ freezing cryostat as control group.The immunoglobulins ( IgG, IgA and IgM) and comple-ments (C3, C4 and C1q) as well as fibrinogen were detected with direct immunofluorescence in the next day.The typeⅣcollagen a3 and a5 chains were also detected by indirect immunofluorescence, and the qualitative and semi-quantitative re-sults were observed under the fluorescence microscope.RESULTS:There were 16 cases of 3+~4+IgG in the experi-mental group, while the corresponding IgG was all 1+~2+in control group, significantly weaker than that in experimen-tal group.There were 99 cases of 3+~4+a3 and 3+~4+a5 in experimental group, white there were 92 cases of 1+~2+a3/a5 and 8 cases negative in control group.The positive intensity was decreased in control group with statistical difference between the 2 groups ( P<0.05) .There were 15 cases of 4+IgA, 19 cases of 3+IgA, 15 cases of 3+IgM, 11 cases of 2+IgM, 13 cases of 4+C3, and 12 cases of 3+C3 in experimental group.The control group were similar to the results of experimental group, and no difference between the 2 groups was observed.CONCLUSION:The immunoflu-orescence results of renal biopsy frozen sections are highly affected by the section storage temperature, which has greater in-fluence on the immunofluorescence positive intensity of IgG and typeⅣcollagen.The renal biopsy frozen section should be stored in -70 ℃low temperature refrigerator.

Objective To investigate the incidence, imaging and clinical characteristics in elderly patients with coronary artery ectasia (CAE). Methods A retrospective analysis was conducted on patients with CAE who underwent coronary angiography between January 2006 and December 2012. According to age, the enrolled patients were divided into two groups (elderly group, age≥ 65 years; non-elderly group, age < 65 years). The clinical feature, imaging characteristics and the 5-year survival rate of the two groups were compared.Results The preva-lence of CAE in elderly patients was 0.33%. Patients in elderly group were found to have significantly higher proportion of female (30.1%vs. 10.1%,P< 0.001), three-vessel disease (60.5%vs. 45.2%,P = 0.003) and localized ectasia (55.0%vs. 40.2%,P = 0.003). In addition, body mass index (20.90 ± 2.71 kg/m2vs. 22.31 ± 2.98 kg/m2,P < 0.001) and percentage of current smokers (45.0%vs. 64.6%,P < 0.001) were significantly lower in elderly group. Cumulative survival curves demonstrated reduced 5-year cumulative survival at the follow-up in the elderly group compared with the non-elderly group (88.0%vs. 96.0%,P = 0.002). But the 5-year event free survival rate failed to show a significant difference between the two groups (31.0%vs. 35.0%,P= 0.311).ConclusionThe prevalence of CAE in elderly patients was 0.33%, which was about 1/3 of the entire numbers of CAE patients. There were significant differences between the elderly and the non-elderly patients with CAE in terms of coronary artery disease risk factors and coronary artery ectatic characteristics. CAE might be asso-ciated with increased mortality risk in the elderly.