As new evidence emerges, treatment strategies toward the functional cure of chronic hepatitis B are evolving. In 2019, a panel of national hepatologists published a Consensus Statement on the functional cure of chronic hepatitis B. Currently, an international group of hepatologists has been assembled to evaluate research since the publication of the original consensus, and to collaboratively develop the updated statements. The 2.0 Consensus was aimed to update the original consensus with the latest available studies, and provide a comprehensive overview of the current relevant scientific literatures regarding functional cure of hepatitis B, with a particular focus on issues that are not yet fully clarified. These cover the definition of functional cure of hepatitis B, its mechanisms and barriers, the effective strategies and treatment roadmap to achieve this endpoint, in particular new surrogate biomarkers used to measure efficacy or to predict response, and the appropriate approach to pursuing a functional cure in special populations, the development of emerging antivirals and immunomodulators with potential for curing hepatitis B. The statements are primarily intended to offer international guidance for clinicians in their practice to enhance the functional cure rate of chronic hepatitis B.

Enhanced recovery after surgery (ERAS) is a series of perioperative optimization measures based on evidence-based medicine aimed at achieving rapid recovery. Existing studies have shown that ERAS can effectively reduce surgical stress, decrease the incidence of complications, shorten hospital stays, save medical costs, and improve patient satisfaction. Although lung transplantation techniques have become increasingly mature, lung transplant recipients still have a high incidence of complications during perioperative period. To further improve the perioperative survival rate of lung transplant recipients, introducing ERAS concept into the perioperative management strategy of lung transplantation is of great significance for reducing incidence of perioperative complications, promoting rapid recovery and long-term survival of lung transplant recipients. This article discusses the advances in application of ERAS concept in the perioperative management of lung transplantation, aiming to provide references for optimizing the perioperative management of lung transplant recipients and reducing perioperative complications.

Objective To investigate the correlations of serum levels of soluble vascular cell ad-hesion molecule-1(sVCAM-1),homocysteine(Hcy)and D-dimer(D-D)with inner ear microcircu-lation disorders in patients with sudden sensorineural hearing loss.Methods Eighty-four patients with sudden deafness were selected as subjects.Patients were divided into mild(17 cases),moderate(31 cases)and severe(36 cases)groups based on the degree of hearing loss.According to the types of audiogram maps,they were divided into low-frequency group(22 cases),high-frequency group(33 cases)and full-frequency group(29 cases).Forty-two healthy individuals undergoing physical examination during the same period served as healthy group.The levels of sVCAM-1,Hcy as well as D-D and inner ear microcirculation arterial diameters were compared among different audiogram types and degrees of hearing loss.Pearson correlation analysis and linear regression analysis were em-ployed to verify the correlations between the aforementioned serum indicators and arterial diameters in inner ear microcirculation of affected patients.Results Compared with the healthy group,the diameters of the internal auditory artery,basilar artery,and anterior inferior cerebellar artery in the inner ear microcirculation were significantly reduced in the low-frequency type,high-frequency type and full-frequency type groups,with the high-frequency and full-frequency types being significantly smaller than the low-frequency type,and the full-frequency type being significantly smaller than the high-frequency type(P＜0.05).Serum levels of sVCAM-1,Hcy and D-D were significantly higher in the low-frequency type,high-frequency type and full-frequency type groups compared with the healthy group,with the full-frequency type being significantly higher than the low-frequency and high-frequency types(P＜0.05).Serum levels of sVCAM-1,Hcy and D-D were significantly high-er in the mild,moderate and severe groups compared with the healthy group,with the severe group being significantly higher than the mild and moderate groups(P＜0.05).The diameters of the in-ternal auditory artery,basilar artery and anterior inferior cerebellar artery in the inner ear microcir-culation were significantly smaller in the mild,moderate and severe groups compared with the healthy group(P＜0.05).Compared with the mild group,the diameters of the internal auditory ar-tery,basilar artery and anterior inferior cerebellar artery were significantly reduced in the moderate and severe groups,with the severe group being significantly smaller than the moderate group(P＜0.05).Serum levels of sVCAM-1,Hcy and D-D showed negative correlation with the diameters of the internal auditory artery,basilar artery and anterior inferior cerebellar artery(P＜0.05).Arterial di-ameters of the internal auditory artery,basilar artery and anterior inferior cerebellar artery were inde-pendently correlated with serum levels of sVCAM-1,Hcy and D-D(P＜0.05).Conclusion Serum levels of sVCAM-1,Hcy and D-D are closely related to inner ear microcirculation disorders in pa-tients with sudden deafness.As serum levels of sVCAM-1,Hcy and D-D increase,the severity of hearing loss and inner ear microcirculation disorder intensifies.

Objective To compare the clinical efficacy of narrow band imaging(NBI)-guided microscopic CO2 laser surgery and conventional microscopic CO2 laser surgery in treatment of patients with vocal cord atypical hyperplasia.Methods A total of 90 patients with vocal cord atypical hyper-plasia were enrolled as study subjects.Based on different surgical approaches,they were divided into conventional group(43 cases,undergoing conventional microscopic CO2 laser surgery)and NBI-guided group(47 cases,undergoing NBI-guided microscopic CO2 laser surgery).The negative mar-gin rate,complication rate,recurrence rate,and the levels of voice-related parameters(jitter,shim-mer,noise-to-harmonic ratio)and inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6)]before and after surgery were compared between the two groups.Results The negative mar-gin rate of the first-time biopsy after laser surgery in the NBI-guided group was 97.87％,which was higher than 86.05％in the conventional group,with a statistically significant difference(P＜0.05).After surgery,the jitter,shimmer and noise-to-harmonic ratio in both groups were lower than those before surgery,with statistically significant differences(P＜0.05),but there was no statistically sig-nificant difference between the two groups(P＞0.05).After surgery,the levels of CRP and IL-6 in both groups were lower than those before surgery,with statistically significant differences(P＜0.05),but there was no statistically significant difference between the two groups(P＞0.05).The compli-cation rate was 4.26％in the NBI-guided group,and 9.30％in the conventional group,with no statistically significant between-group difference(P＞0.05).During a follow-up of 6 months to 2 years,the recurrence rate in the NBI-guided group was 2.13％and 6.98％in the conventional group,with no statistically significant between-group difference(P＞0.05).Conclusion Com-pared with conventional microscopic CO2 laser surgery,NBI-guided microscopic CO2 laser surgery can more precisely determine the range of the lesion and the surrounding mucosal margins and re-duce the number of intraoperative biopsies in the treatment of vocal cord atypical hyperplasia.How-ever,the two surgical methods have similar impacts on postoperative voice-related parameters,in-flammatory factors,complications and recurrence rates.

Objective To identify potential ergonomic risk factors of works and quickly assess their risks of developing work-related musculoskeletal disorders (WMSDs) in the medical staff. Methods A total of 188 medical staff were selected as the research objects using a two-stage random sampling method. The method for the identification of musculoskeletal stress factors (PLIBEL) was used to analyze the adverse ergonomic factors in the work process, and the rapid entire body assessment (REBA) was used to quickly assess the whole-body posture load. Results The PLIBEL assessment results showed that various adverse ergonomic factors affected different parts of the body during the work process of medical staff. Specifically, 18 adverse ergonomic factors were identified in the neck, shoulders, and upper back, while 10 adverse ergonomic factors were identified in the elbow, forearm, hand, and lower back. Rehabilitation therapists and nurses engaged in patient handling in general wards and medication preparation and blood collection were exposed to ≥35 adverse ergonomic factors. The REBA assessment showed that the REBA score was 3-12 points for medical staff during their work process. Rehabilitation therapists were classified as having an extremely high ergonomic risk. High-risk occupations included ward housekeeping nurses, surgery assistant nurses, operating-room instrument nurses, and surgeons. Medium-risk occupations included general ward nurses (medication preparation and blood collection, venipuncture/infusion, and patient handling), intensive care unit (ICU) nurses, internal medicine residents, and dentists. Low-risk occupations included administrative front-desk nurses, outpatient internal medicine physicians, and technicians/physicians in ultrasonography, laboratory medicine, physical examination, and occupational health departments. Conclusion Adverse ergonomic factors of medical staff predominantly affect the neck, shoulders, upper back, elbows, forearms, hands, and the lower back during the work process. Rehabilitation therapists, ward housekeeping nurses, ICU nurses, operating-room instrument nurses, and surgeons are high-risk groups for WMSDs. Attention should be paid to the management and control of adverse ergonomic factors for medical staff to prevent the occurrence of WMSDs.

Objective To investigate the prevalence and risk factors of work-related musculoskeletal disorders (WMSDs) among construction workers. Methods A total of 5 783 workers were selected as participants from 12 construction companies in Guangdong Province, Guangxi Zhuang Autonomous Region and Zhejiang Province using a convenient sampling method. The revised Musculoskeletal Disorders Questionnaire was used to investigate the prevalence and influencing factors of WMSDs. Results The prevalence of WMSDs was 27.4% among the construction workers. The prevalence of WMSDs in shoulder, neck, waist/lower back and hand/wrist was 10.6%, 9.5%, 9.5% and 9.4% respectively, which was higher than that in other body parts. Bianry logistic regression analysis showed that the risk of WMSDs in construction workers with junior high school education and below was higher than that of high school/ college and above (P<0.05). The risk of WMSDs was higher in drinkers than that in non-drinkers (P<0.01). The worse the health status of construction workers, the higher the risk of WMSDs (P<0.01). The risk of WMSDs in those who exercised once or twice a month was lower than that in those who did not exercise (P<0.05). The risk of WMSDs was higher in construction workers with longer working hours in uncomfortable postures and greater back bending amplitude at work (all P<0.01). The risk of WMSDs in construction workers with hands holding above the shoulder was higher than that with hands below the shoulder (P<0.05). Construction workers who repeated the same work daily, involved in high-temperature work, often worked overtime, had insufficient rest time, and had a shortage of department personnel had a relatively high risk of WMSDs (all P<0.01). Conclusion The prevalence of WMSDs among the construction workers was relatively high, and the most common WMSDs occurred in shoulder, neck, waist/lower back and hand/wrist. Individual characteristic, work type, work posture and work organization are the influencing factors of WMSDs. Comprehensive measures, especially ergonomic measures based on personal and occupational characteristics should be taken to reduce the risk of WMSDs among construction workers.

Insulin is an important protein hormone that participates in multiple metabolic pathways.Biosynthetic insulin has been widely used in the treatment of type 1 and type 2 diabetes.Currently,the number of reported cases of insulin overdose both at home and abroad is gradually increasing,and insulin homicide is no longer a means of"committing murder without leaving a trace".At present,there are no systematic protocols for the identification of insulin overdose in the field of forensic medi-cine in China.This article introduces the causes,toxicological characteristics,forensic examination,labo-ratory testing methods and indicator reference of insulin overdose.Based on the identification practice and research results and referring to relevant studies on insulin overdose at home and abroad,this pa-per aims to provide recommendations and references for the formulation of forensic identification guide-lines for insulin overdose cases.

Integrins are transmembrane receptors that can coordinate signal transduction between cells and extracellular matrix or between cells.The abnormal function of integrins is one of the recognized mechanisms of tumor development.As an important regulatory mode,post-translational modification can change the conformation and physicochemical properties of proteins,thus affecting their activities,stability and functions.After the modification of the integrin,such as glycosylation and methylation,the corresponding signal transduction pathway changes,and then affects cell adhesion,migration,differentiation and other life activities,involving in diverse physiology and pathological processes.Post-translational modifications of integrins are abundant in tumor progression and play a key role in regulating the growth,metastasis and drug resistance of different tumor cells.In this review,the structure and function,post-translational modification of integrins,and their relationship with occurrence and development of tumors will be discussed,in order to provide more explorable targets for the treatment of cancer.

Andrographolide sulfonate (AS) is a sulfonated derivative of andrographolide extracted from Andrographis paniculata (Burm.f.) Nees, and has been approved for several decades in China. The present study aimed to investigate the novel therapeutic application and possible mechanisms of AS in the treatment of rheumatoid arthritis. Results indicated that administration of AS by injection or gavage significantly reduced the paw swelling, improved body weights, and attenuated pathological changes in joints of rats with adjuvant-induced arthritis. Additionally, the levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and IL-1β in the serum and ankle joints were reduced. Bioinformatics analysis, along with the spleen index and measurements of IL-17 and IL-10 levels, suggested a potential relationship between AS and Th17 cells under arthritic conditions. In vitro, AS was shown to block Th17 cell differentiation, as evidenced by the reduced percentages of CD4⁺ IL-17A⁺ T cells and decreased expression levels of RORγt, IL-17A, IL-17F, IL-21, and IL-22, without affecting the cell viability and apoptosis. This effect was attributed to the limited glycolysis, as indicated by metabolomics analysis, reduced glucose uptake, and pH measurements. Further investigation revealed that AS might bind to hexokinase2 (HK2) to down-regulate the protein levels of HK2 but not glyceraldehyde-3-phosphate dehydrogenase (GAPDH) or pyruvate kinase M2 (PKM2), and overexpression of HK2 reversed the inhibition of AS on Th17 cell differentiation. Furthermore, AS impaired the activation of phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signals in vivo and in vitro, which was abolished by the addition of lactate. In conclusion, AS significantly improved adjuvant-induced arthritis (AIA) in rats by inhibiting glycolysis-mediated activation of PI3K/AKT to restrain Th17 cell differentiation.
Animals ; Th17 Cells/immunology* ; Diterpenes/pharmacology* ; Arthritis, Rheumatoid/metabolism* ; Proto-Oncogene Proteins c-akt/immunology* ; Glycolysis/drug effects* ; Cell Differentiation/drug effects* ; Phosphatidylinositol 3-Kinases/genetics* ; Rats ; Male ; Rats, Sprague-Dawley ; Humans ; Andrographis paniculata/chemistry* ; Arthritis, Experimental/drug therapy* ; Interleukin-17/immunology* ; Signal Transduction/drug effects*