ObjectiveTo investigate the disease burden of non-alcoholic fatty liver disease （NAFLD） among young people in East Asian countries （including China， North Korea， Japan， Mongolia， and South Korea） in 1990—2023， and to provide a basis for formulating and adjusting the prevention and treatment strategies for NAFLD. MethodsRelated disease burden data of NAFLD among the young people in these five East Asian countries were collected from the Global Burden of Disease 2023 （GBD 2023） database， including incidence rate， prevalence rate， and disability-adjusted life years （DALY）， and the young people were divided into groups based on country， sex， and age. Estimated annual percentage change （EAPC） was used to comprehensively evaluate the changing trend of the disease burden of NAFLD among young people from 1990 to 2023， and the Autoregressive Integrated Moving Average model was used to predict the disease burden of NAFLD among the young people in China. ResultsIn 2023， the standardized incidence rates of NAFLD among the young people in China， North Korea， Japan， Mongolia， and South Korea were 926.57/100 000， 805.83/100 000， 412.66/100 000， 747.66/100 000， and 534.08/100 000， respectively； the standardized prevalence rates of NAFLD among the young people in China， North Korea， Japan， Mongolia， and South Korea were 16 817.94/100 000， 14 500.98/100 000， 8 534.40/100 000， 13 705.28/100 000， and 11 587.93/100 000， respectively； the standardized DALY rates of NAFLD among the young people in China， North Korea， Japan， Mongolia， and South Korea were 6.34/100 000， 10.18/100 000， 5.23/100 000， 47.93/100 000， and 6.76/100 000， respectively. From 1990 to 2023， there was a tendency of increase in the standardized incidence rate of NAFLD among the young people in China， North Korea， Japan， Mongolia， and South Korea， with an EAPC of 0.87%， 0.52%， 0.26%， 0.48%， and 0.87%， respectively； there was also a tendency of increase in the standardized prevalence rate of NAFLD among the young people in China， North Korea， Japan， Mongolia， and South Korea， with an EAPC of 0.99%， 0.49%， 0.24%， 0.59%， and 0.93%， respectively； conversely， there was a tendency of reduction in the standardized DALY rate of NAFLD among the young people in China， Japan， Mongolia， and South Korea， with an EAPC of -2.21%， -2.01%， -0.37%， and -4.62%， respectively， while the standardized DALY rate of NAFLD among the young people in North Korea remained relatively stable， with an EAPC of -0.01%. The subgroup analysis based on sex showed that there was a significant difference in the disease burden of NAFLD between the young people with different sexes in the five East Asian countries， and the subgroup analysis based on age showed that the incidence rate of NAFLD in young people decreased with the increase in age， while the prevalence rate and DALY rate of NAFLD increased with age. In addition， the standardized incidence rate and standardized prevalence rate of NAFLD among Chinese young people would further increase in the future， while there would be a reduction in standardized DALY rate in the future. ConclusionThere is a significant difference in the disease burden of NAFLD in young people across different countries， sexes， and age groups. In the future， targeted prevention and treatment measures should be developed based on the distribution characteristics of the disease burden of NAFLD， in order to effectively reduce the disease burden of NAFLD among young people.

OBJECTIVE To investigate the clinical characteristics of euglycemic diabetic ketoacidosis （euDKA） induced by empagliflozin， and provide references for safe medication. METHODS Case reports of euDKA induced by empagliflozin were retrieved and analyzed from PubMed， Web of Science， CNKI， and Wanfang Data. The Naranjo’s scale was adopted to assess the causal relationship between empagliflozin and euDKA. RESULTS A total of 29 patients were enrolled， including 16 males and 13 females，with a median age of 58 years. All patients were diagnosed with type 2 diabetes mellitus； 22 patients had at least one comorbidity. The median time to euDKA onset was 60 days after administration， and 7 cases occurred within 2 weeks of treatment. Perioperative periods，fasting，and low-carbohydrate or ketogenic diets were the main predisposing factors. Common presentations included nausea，vomiting， fatigue， tachypnea，and tachycardia. The causal relationship between empagliflozin and euDKA was assessed as “probable” in all cases. According to adverse reaction severity grading， 13 cases were grade 3 （severe） and 16 cases were grade 4 （life-threatening）. All patients discontinued empagliflozin and recovered after corresponding treatment. CONCLUSIONS euDKA is a serious adverse reaction to empagliflozin， which mostly occurs early in treatment. Perioperative periods， fasting， and ketogenic diets are prone to induce euDKA. Elderly patients and those with comorbidities are at higher risk. Risk assessment should be conducted before clinical administration； blood ketones and acid-base monitoring should be strengthened in the early medication period； withhold the drug before elective surgery， avoid prolonged fasting；upon diagnosis， discontinue empagliflozin and initiate intravenous insulin， provide fluid resuscitation promptly， and use other treatments to improve patient prognosis.

Objective To explore the correlation between helicobacter pylori(Hp)infection and inflam-matory factors,as well as its association with the progression of liver fibrosis in patients with metabolically associ-ated fatty liver disease(MAFLD)and type 2 diabetes mellitus(T2DM).Methods A total of 300 patients diag-nosed with MAFLD and T2DM who were admitted to the Hepatology Department of Hebei Hospital of Traditional Chinese Medicine between April 2023 and March 2024 were recruited.Based on Hp infection status,these patients were classified into an Hp-positive group and an Hp-negative group.Subsequently,the clinical data,inflammatory factors,and liver fibrosis indices of the two groups were comprehensively compared.Furthermore,the patients in the Hp-positive group were randomly assigned to an intervention group and a control group.The intervention group received standard Hp eradication therapy,whereas the control group was administered placebo therapy.Pearson correlation analysis was employed to investigate the associations among Hp infection,inflammatory factors,and liver fibrosis indices.Binary logistic regression analysis was utilized to identify the independent risk factors influencing the progression of liver fibrosis.Results In both the Hp-positive and Hp-negative groups,parameters including age,fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6),along with C-reactive protein(CRP)and liver stiffness measurement(LSM),were meticulously measured.Statistical analysis revealed that the differences in these parameters between the two groups were significant(P<0.05).Specifically,within the experimental setup,the levels of TNF-α,IL-6,CRP,and LSM in the intervention group were notably lower than those in the control group(P<0.05).Pearson correlation analysis was employed to explore the relation-ships among variables,and the results indicated a positive correlation between the Hp detection value(DPM)and the levels of TNF-α,IL-6,CRP,and LSM(P<0.05).Furthermore,binary logistic regression analysis was con-ducted to identify independent risk factors.The findings demonstrated that positive Hp infection,elevated TNF-α,elevated IL-6,and elevated CRP were independent risk factors for the progression of liver fibrosis(P<0.05).To evaluate the diagnostic performance,the receiver operating characteristic(ROC)curve analysis was carried out.The areas under the curve(AUC)for HP infection,TNF-α,IL-6,and CRP were 0.800,0.786,0.769,and 0.783,respectively.These values were significantly lower than the AUC of 0.896 obtained from the combined detection(P<0.05).Conclusions In MAFLD patients with T2DM,DPM is closely associated with inflammatory factors(such as TNF-α,IL-6,and CRP)and the advancement of liver fibrosis.The combined detection of these factors holds significant value in predicting the progression of liver fibrosis.It can offer a reliable foundation for the clinical assessment of the risk of liver fibrosis progression.

Objective To explore the correlation between helicobacter pylori(Hp)infection and inflam-matory factors,as well as its association with the progression of liver fibrosis in patients with metabolically associ-ated fatty liver disease(MAFLD)and type 2 diabetes mellitus(T2DM).Methods A total of 300 patients diag-nosed with MAFLD and T2DM who were admitted to the Hepatology Department of Hebei Hospital of Traditional Chinese Medicine between April 2023 and March 2024 were recruited.Based on Hp infection status,these patients were classified into an Hp-positive group and an Hp-negative group.Subsequently,the clinical data,inflammatory factors,and liver fibrosis indices of the two groups were comprehensively compared.Furthermore,the patients in the Hp-positive group were randomly assigned to an intervention group and a control group.The intervention group received standard Hp eradication therapy,whereas the control group was administered placebo therapy.Pearson correlation analysis was employed to investigate the associations among Hp infection,inflammatory factors,and liver fibrosis indices.Binary logistic regression analysis was utilized to identify the independent risk factors influencing the progression of liver fibrosis.Results In both the Hp-positive and Hp-negative groups,parameters including age,fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6),along with C-reactive protein(CRP)and liver stiffness measurement(LSM),were meticulously measured.Statistical analysis revealed that the differences in these parameters between the two groups were significant(P<0.05).Specifically,within the experimental setup,the levels of TNF-α,IL-6,CRP,and LSM in the intervention group were notably lower than those in the control group(P<0.05).Pearson correlation analysis was employed to explore the relation-ships among variables,and the results indicated a positive correlation between the Hp detection value(DPM)and the levels of TNF-α,IL-6,CRP,and LSM(P<0.05).Furthermore,binary logistic regression analysis was con-ducted to identify independent risk factors.The findings demonstrated that positive Hp infection,elevated TNF-α,elevated IL-6,and elevated CRP were independent risk factors for the progression of liver fibrosis(P<0.05).To evaluate the diagnostic performance,the receiver operating characteristic(ROC)curve analysis was carried out.The areas under the curve(AUC)for HP infection,TNF-α,IL-6,and CRP were 0.800,0.786,0.769,and 0.783,respectively.These values were significantly lower than the AUC of 0.896 obtained from the combined detection(P<0.05).Conclusions In MAFLD patients with T2DM,DPM is closely associated with inflammatory factors(such as TNF-α,IL-6,and CRP)and the advancement of liver fibrosis.The combined detection of these factors holds significant value in predicting the progression of liver fibrosis.It can offer a reliable foundation for the clinical assessment of the risk of liver fibrosis progression.

Sedentary bad habits and unhealthy diets in modern lifestyles have led to an upward trend in the incidence of obesity, and a series of diseases related to obesity have also gradually received attention. Multiple sclerosis is a chronic inflammatory disease of the central nervous system, and obesity has a common inflammatory component with most chronic diseases. Therefore, this paper reviews the research progress on the relationship between obesity and multiple sclerosis in order to better understand the role of obesity in the management of multiple sclerosis.

Objective:To analyze the clinical characteristics of monkeypox patients.Methods:The clinical data and laboratory findings of 4 patients with monkeypox patients diagnosed at Yiwu Central Hospital in July 2023 were analyzed. Herpes fluid and skin tissue samples were collected, the viruses were isolation and cultured in African green monkey kidney cells (Vero) and identified with whole gene sequencing.Results:All four patients were male, aged 24-35 years. All patients had male-to-male behavior within 21 days before onset of the disease. Among them, one patient has AIDS and one patient has syphilis. Four patients presented with perineal skin lesions with itching, and 3 patients were found to have enlarged lymph nodes upon admission. Laboratory testing: lymphocyte abnormality (4.57×10 9/L) in 1 case; increased procalcitonin (0.25 ng/mL) in 1 case; elevated IL-10 levels ( 7.11 ng/L and 9.42 ng/L) in 2 cases; increased IL-6 (66 ng/L) and IL-4 (3.24 ng/L) in 1 case, respectively. One case had abnormal myocardial zymogram with a elevated lactate dehydrogenase level of 313 U/L. The monkeypox virus was isolated from lesion tissue and herpes fluid, and the whole gene sequencing identified it as the B. 1.3 subtype of the IIb evolutionary branch, exhibiting typical pathological effects on Vero cells. Conclusion:The clinical manifestations of the 4 monkeypox patients confirmed in Zhejiang province are mild, patients had a definitive history of male-to-male sexual behavior and the virus strains belong to the B. 1.3 lineage of the IIb evolutionary branch.

The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
Humans ; Consensus ; Prone Position ; Wakefulness ; China ; Dyspnea

Multiple sclerosis (MS) is an idiopathic inflammatory demyelinating diseases of the central nervous system, the underlying cause of which has not been cleared. Previous studies have shown that the pathogenesis of MS is related to the destruction of blood brain barrier, furthermore the drugs used to treat MS have a certain protective effect on the function of blood brain barrier. Therefore, this review combines the research progress at home and abroad to clarify the relationship between the blood brain barrier and MS in pathogenesis and treatment, proposing possible orientation of development.

Objective:To summarize the experience of the precise prevention and control strategy of novel coronavirus infection in the pediatric intensive care unit(PICU)during the epidemic of the Omicron variant.Methods:A retrospective analysis was performed on the strategies and management experience of precise prevention and control of novel coronavirus infection in PICU at Pediatric Hospital of Fudan University from March 1 to May 10, 2022.Results:According to the national and Shanghai novel coronavirus infection prevention and control standards, the PICU in our hospital, in accordance with the specialty characteristics of PICU, cooperated with the hospital′s department of infection and medical department to jointly construct a precise ward management strategy for the outbreak of the omicron mutants infection.Precise prevention and control management strategies were formulated from four aspects: the admission process of critically ill children, the division of PICU ward areas and nosocomial infection protection, the reception management system for children′s family members, and the " bubble management" system for PICU staff, and run them for 3 months.During the epidemic, there was no nosocomial infection of novel coronavirus infection in children or medical staff.During the period, a total of 140 critically ill children were admitted, including 87 cases transferred from the general ward in the hospital, 48 cases from the emergency department(non-febrile, 3 cases transferred by the transfer team), four cases from fever clinic, and one case from control ward.Four of the critically ill children had no emergency nucleic acid test report when they were admitted to the PICU.Among the 140 critically ill children, 54 patients received mechanical ventilation, 18 patients received blood purification, and two patients were monitored after liver transplantation.Seventy-eight (55.7%) children had underlying diseases.Conclusion:During the current round of novel coronavirus epidemic in Shanghai, PICU in our hospital formulated the admission and ward management procedures for critically ill children, which ensured the prevention and control of nosocomial infection of novel coronavirus, and at the same time ensured the treatment of critically ill children to the greatest extent.

P2X7 receptor is an ion channel receptor with adenosine triphosphate (ATP) as its ligand, which is widely expressed in various immune cells and tissues. Activated P2X7 receptor is involved in a variety of physiological and pathological processes. P2X7 receptor is abnormally expressed in colon cancer, and plays a duel role of cancer-promoting and cancer-suppressing in colon cancer progression. When P2X7 receptor is activated by extracellular ATP, it can effectively inhibit proliferation and induce apoptosis of colon cancer cells through various mechanisms. In addition, P2X7 receptor can also promote the growth, invasion and metastasis of colon cancer. Understanding the activation of P2X7 receptor and its effect mechanism is of great significance for the treatment of colon cancer.