Objective To analyze the clinical characteristic of spontaneous bacterial peritonitis (SBP) in patients with severe viral hepatitis, and explore its clinical classification and significance. Methods A retrospective research of 120 cases of SBP associated with severe viral hepatitis was performed, and main clinical symptoms and physical signs appeared at the early onset were classified and explored. Results Clinical manifestations of SBP in patients with severe viral hepatitis included 5 types, which were conventional type(41.7%, 50/120), symptomless type(15.8%, 19/120), hepatic coma type(13.3%, 16/120), refractory aacites type (17.5%, 21/120), and shock type (11.7%, 14/120). The germieuhure positive rate of SBP with hepatic coma type and shock type were relatively high, and the survival rate of these patients were low. Conclusions Clinical manifestations of SBP in patients with severe viral hepatitis may be atypical, and its classification help to enhancing the understanding and early diagnosis of SBP, and decreasing missed diagnosis. The prognosis of SBP in patients with hepatic coma type and shock type was poor, and then it must be taken high into account more than ever before in the clinical practice.

Objective:To analyze the worldwide development status and frontier hotspots in the field of critical care nutrition in recent 10 years, and to inform domestic future research direction.Methods:Publications on critical care nutrition researches between January 1, 2012 and December 31, 2021 were retrieved from Web of Science core database. CiteSpace and VOSviewer were used for visual analysis.Results:After screening, a total of 2,467 articles were included, with an overall increasing trend in the number of publications. A total of 11,301 authors devoted to critical care nutrition researches, among whom Daren K. Heyland (81) published the most globally and Academician Jieshou Li (9) published the most in China. The United States (812), China (221) and Canada (206) were the top 3 countries concerning numbers of publications in this field. The main research institutions were Harvard University, Queen's University and University of Leuven while Nanjing University ranked the highest domestically. Journal of Parenteral and Enteral Nutrition, Nutrition in Clinical Practice and Clinical Nutrition were the three most active journals in this field. Cluster analysis of keywords identified 11 representative cluster labels. Global focuses in critical care nutrition were influence of malnutrition, nutritional treatment pattern and energy and protein supplementation. Special interests were in the nutrition therapy in newborns, obese population and sepsis patients as well as intestinal microbial flora and coronavirus disease 2019.Conclusions:Critical care nutrition research is still under rapid development. Close collaboration between domestic core research circles and institutions should be emphasized while promoting international interactions. Researches on key issues such as energy and protein supplementation should be encouraged, so as to provide stronger evidence for better diagnosis and treatment standards in critical care nutrition.

Objective To evaluate the clinical efficacy of plasma exchange(PE)and double plasma molecular absorption system(DPMAS)in the treatment of primary biliary cholangitis(PBC)and the effect of this therapy on prognosis.Methods The clinical data on 526 PBC patients in our hospital from December 2013 to January 2022 were retrospectively analyzed.The patients were divided into different groups according to different therapies and then matched with propensity.The changes in symptoms,laboratory indexes and MELD scores were compared between two groups before and after treatment,and the clinical efficacy of artificial liver treatment for PBC patients was assessed.The effect of this treatment on the survival outcomes in these patients via comparing the cumulative survival rates at 3,6 and 12 months between the two groups.Results The efficiency was better in the group with artificial liver treatment in addition medical therapy than the group with medical treatment alone,the difference was statistically significant(76.7%vs.55.8%,χ2 = 4.214,and P = 0.040).Cox proportional risk regression showed that TBIL was an independent risk factor affecting the 3-,6-,or 12-month survival in PBC patients.Conclusions Artificial liver support system can effectively relieve symptoms,reduce levels of ALT,AST and TBIL,improve blood coagula-tion function,and lower MELD scores in PBC patients.This therapy revealed a trend of improvement in 3-,6-,or 12-month survival outcomes.

Sj?gren′s syndrome is a chronic systemic autoimmune disease characterized by lymphocyte proliferation and progressive exocrine gland damage. In China, standardized diagnosis and treatment for Sj?gren′s syndrome lags behind other common rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus. Based on the evidence and guidelines from China and other countries, Chinese Sj?gren′s Syndrome Collaborative Research Group together with stomatologist and ophthalmologist developed Standardization of diagnosis and treatment of primary Sj?gren′s syndrome. The purposes are: (1) to standardize the detection and interpretation of key indicators for the diagnosis of Sj?gren's syndrome, including serum anti SSA antibody and labial gland pathology; (2) to suggest using widely accepted disease activity index in evaluation of the disease; (3) to standardize rational management for Sj?gren′s syndrome patients with topical and systemic diseases.

Objective: To analyze the diagnostic value of ultrasound guided 14 gauge coreneedle biopsy (US-CNB) in breast nodules. Methods: We retrospectively analyzed the pathological results of US-CNB and surgical excision from 373 breast nodules in Peking University International Hospital from Sep 2016 to Nov 2018 to evaluate the accuracy of 14g US-CNB. Results: A total of 349 patients(373 nodules)underwent US-CNB. US-CNB reported 282 benign lesions(75.6%, 282/373), 20 high-risklesions(5.4%, 20/373), and 71 malignant lesions(19.0%, 71/373). For 282 CNB reported benign lesions, the surgical pathology confirmed 235 lesions , 46 for high-risk lesions and 1 for malignant lesion with a concordancy of 83.3%(235/282)and the underestimation rate was 16.7%(47/282). US-CNB identified 20 high-risk lesions. According to surgical results, 15 were high-risk lesions and 5 were malignant lesions with a concordancy of 75% (15/20)and the underestimation rate was 25%(5/20). When it comes to malignant lesions, the excision results showed that 70 were malignant lesions and 1was high-risk lesion with a concordancy of 98.6%(70/71)and the overestimation rate was 1.4%(1/71). The concordance of the histological type , calculated for 50 invasive carcinomas, was 92% (46/50) with a kappa value of 0.77.The concordance of the histological grade could be calculated for 38 invasive ductal carcinomas with the Elston-Elllis Method . It was 89.5% (34/38) with a kappa value of 0.57. Conclusions The pathology result of 14gUS-CNB is in good consistency with surgical excision for breast benign and malignant lesions.