Objective:To analyze the liver histological characteristics and clinically related factors in inactive hepatitis B surface antigen (HBsAg) carriers (IHC), and also explore whether antiviral treatment is necessary for IHC, as defined in the 2022 version of the hepatitis B prevention and treatment guidelines.Methods:A multicenter, retrospective cohort study was conducted. Two hundred and thirty-one IHC cases who underwent liver biopsy histopathological examination in nine medical institutions, including Beijing Youan Hospital affiliated with Capital Medical University, from January 2018 to December 2023 were included. General informative data, clinical serological markers, and transient elastography (TE) examination results were collected. Patients were divided into a positive (148 cases) and a negative group (83 cases) according to the results of hepatitis B virus (HBV) DNA detection. The differences in liver pathological inflammatory activity (G) and liver fibrosis stage (S) were analyzed between the two groups to explore the correlation between liver tissue conditions and clinically related factors. Comparsions of normally distributed continwous data, skeukd continuous data, and categorical data between groups are performed using t tests, Mann-Whitney U tests and χ2 tests, respectively. Results:The age of 231 IHC cases was 43 (38, 51) years old, with 95.2% (220/231) aged ≥30 years, and males accounted for 64.9% (150/231). HBsAg and HBV DNA levels were 131.9 (20.8, 400.9) IU/mL and 94.0 (0, 448.5) IU/mL, respectively, of which 35.9% (83/231) were HBV DNA negative (<20 IU/mL). The remarkable proportions of G≥2, S≥2, and liver injury (G≥2 and/or S≥2) in liver tissue were 16.5% (38/231), 29% (67/231), and 35.9% (83/231), respectively. The S≥2 proportion was significantly higher in the HBV DNA-negative group than the positive group (42.2% vs. 21.6%, P<0.001), and it mainly occurred in the population cohort over 30 years old (44.9% vs. 31.0%, P=0.04). The liver stiffness measurement (LSM), aspartate transaminase to platelet ratio index (APRI), and platelet (PLT) were significantly higher in the S≥2 group than the S<2 group ( P<0.05). Conclusion:Clinicians can comprehensively evaluate the degree of liver fibrosis in IHC based on clinical factors such as age, PLT, APRI, and LSM, even if the liver histological results are lacking. The China 2022 version guidelines define that nearly half of IHC has histological indications for antiviral therapy, and liver biopsy and prompt treatment can be recommended.

The anatomical structures of the perianal and perirectal regions are complex and prone to neoplastic and non-neoplastic lesions. Some non-neoplastic lesions may show morphological similarities with neoplastic lesions, potentially resulting in misdiagnosis and unnecessary treatment. This article focuses on the pathological diagnostic features of challenging non-neoplastic lesions in the anorectal region, including inflammatory cloacogenic polyp, solitary rectal ulcer syndrome, endometriosis of the intestinal mucosa and infectious proctitis.

The anatomical structures of the perianal and perirectal regions are complex and prone to neoplastic and non-neoplastic lesions. Some non-neoplastic lesions may show morphological similarities with neoplastic lesions, potentially resulting in misdiagnosis and unnecessary treatment. This article focuses on the pathological diagnostic features of challenging non-neoplastic lesions in the anorectal region, including inflammatory cloacogenic polyp, solitary rectal ulcer syndrome, endometriosis of the intestinal mucosa and infectious proctitis.

Objective:To analyze the liver histological characteristics and clinically related factors in inactive hepatitis B surface antigen (HBsAg) carriers (IHC), and also explore whether antiviral treatment is necessary for IHC, as defined in the 2022 version of the hepatitis B prevention and treatment guidelines.Methods:A multicenter, retrospective cohort study was conducted. Two hundred and thirty-one IHC cases who underwent liver biopsy histopathological examination in nine medical institutions, including Beijing Youan Hospital affiliated with Capital Medical University, from January 2018 to December 2023 were included. General informative data, clinical serological markers, and transient elastography (TE) examination results were collected. Patients were divided into a positive (148 cases) and a negative group (83 cases) according to the results of hepatitis B virus (HBV) DNA detection. The differences in liver pathological inflammatory activity (G) and liver fibrosis stage (S) were analyzed between the two groups to explore the correlation between liver tissue conditions and clinically related factors. Comparsions of normally distributed continwous data, skeukd continuous data, and categorical data between groups are performed using t tests, Mann-Whitney U tests and χ2 tests, respectively. Results:The age of 231 IHC cases was 43 (38, 51) years old, with 95.2% (220/231) aged ≥30 years, and males accounted for 64.9% (150/231). HBsAg and HBV DNA levels were 131.9 (20.8, 400.9) IU/mL and 94.0 (0, 448.5) IU/mL, respectively, of which 35.9% (83/231) were HBV DNA negative (<20 IU/mL). The remarkable proportions of G≥2, S≥2, and liver injury (G≥2 and/or S≥2) in liver tissue were 16.5% (38/231), 29% (67/231), and 35.9% (83/231), respectively. The S≥2 proportion was significantly higher in the HBV DNA-negative group than the positive group (42.2% vs. 21.6%, P<0.001), and it mainly occurred in the population cohort over 30 years old (44.9% vs. 31.0%, P=0.04). The liver stiffness measurement (LSM), aspartate transaminase to platelet ratio index (APRI), and platelet (PLT) were significantly higher in the S≥2 group than the S<2 group ( P<0.05). Conclusion:Clinicians can comprehensively evaluate the degree of liver fibrosis in IHC based on clinical factors such as age, PLT, APRI, and LSM, even if the liver histological results are lacking. The China 2022 version guidelines define that nearly half of IHC has histological indications for antiviral therapy, and liver biopsy and prompt treatment can be recommended.

Hyperkalemia is one of the common ion metabolism disorders in clinical practice. Hyperkalemia is defined as serum potassium higher than 5.0 mmol/L according to the guidelines at home and abroad. Acute severe hyperkalemia can cause serious consequences, such as flaccid paralysis, fatal arrhythmia, and even cardiac arrest. The use of renin-angiotensin- aldosterone system inhibitors, β-blockers and diuretics, low-sodium and high-potassium diets, and the presence of related comorbidities increase the occurrence of hyperkalemia. Hyperkalemia risk exist in all clinical departments, but there is a lack of a standardization in the management of multi- department cooperation in hospital. Therefore, a number of domestic nephrology and cardiology department experts have discussed a management model for multi-department cooperation in hyperkalemia, formulating the management standard on hospital evaluation, early warning, diagnosis and treatment, and process. This can promote each department to more effectively participate in nosocomial hyperkalemia diagnosis and treatment, as well as the long-term management of chronic hyperkalemia, improving the quality of hyperkalemia management in hospital.

Renal biopsy has been an essential part of the diagnosis and management of kidney disease. In recent years, the rapid development of artificial intelligence (AI) technology based on convolutional neural networks has significantly facilitated its utilization in nephrology. This article focuses on the research of AI in the recognition of tissue structure and pathological diagnosis of kidney biopsy. It elaborates on the identification and segmentation of kidney tissue structure and pathological features, as well as its auxiliary role in disease diagnosis across three dimensions: light microscopy, immunofluorescence, and electron microscopy. The aim is to provide a reference for the application of AI in renal pathology research and precision medicine.

Objective:The exact biological mechanism whereby exposure to ambient ozone(O3)may contribute to clinical onset of cardiovascular events remains unclear.In this study,we aim to examine the impacts of O3 exposure on cardiac arrhythmias and potential pathways involved through autonomic dysfunction and myocardial injury.Methods:Seventy-three non-smoking healthy adults were followed with 4 repeated measurements of 24-hour ambulatory arrhythmias,heart rate variability,ST-segment deviation,and blood pressure(BP)in Beijing,China,2014-2016.Generalized additive mixed models coupled with distributed lag nonlinear models were constructed to evaluate the associations and potential interlinks between O3 exposure and outcome measurements.Results:During the study period,24-hour average concentrations of ambient O3 were 47.4 μg/m3(ranging from 1.0 to 165.9 μg/m3).Increased risks of premature ventricular contraction and ventricular tachycardia were associated with interquartile range increases in O3 exposure during the last 5 days before each participant's clinic visit,with relative risks of 2.14(95％confidence interval[CI]:1.95 to 2.32)and 5.47(95％CI:3.51 to 7.43),respectively.Mediation analyses further showed that sympathetic activation,parasympathetic inhibition,and elevated BP levels,as well as heightened risks of ST-segment depression could mediate up to 47.74％of the risks of arrhythmias attributable to O3 exposure.Conclusion:Our results suggest that short-term exposure to ambient O3 could prompt the genesis of arrhythmias partially through worsening autonomic function and myocardial burden.

Objective:Evidence on potential cardiovascular benefits of personal-level intervention among the elderly exposed to high levels of particulate matter(PM)remains limited.We aimed to assess improvements in surrogate markers of cardiovascular injury in vulnerable populations at risks by using indoor air filtration units.Methods:We conducted a randomized crossover trial for 2 separate 2-week air filtration interventions in 20 households of patients with stable chronic obstructive pulmonary disease and their partners in the winter of 2013,with concurrent measurements of indoor PM.The changes in biomarkers indicative of cardiac injury,atherosclerosis progression and systemic inflammation following intervention were evaluated using linear mixed-effect models.Results:In the analysis,average levels of indoor PM with aerodynamic diameters＜2.5 μm(PM2.5)decreased significantly by 59.2％(from 59.6 to 24.3 μg/m3,P＜0.001)during the active air filtration.The reduction was accompanied by improvements in levels of high-sensitivity cardiac troponin I by-84.6％(95％confidence interval[CI]:-90.7 to-78.6),growth differentiation factor-15 by-48.1％(95％CI:-31.2 to-25.6),osteoprotegerin by-65.4％(95％CI:-56.5 to-18.7),interleukin-4 by-46.6％(95％CI:-62.3 to-31.0)and myeloperoxidase by-60.3％(95％CI:-83.7 to-3.0),respectively.Conclusion:Indoor air filtration intervention may provide potential cardiovascular benefits in vulnerable popu-lations at risks.

Esophageal squamous cell carcinoma (ESCC) is the main prevalent histological type of esophageal cancer worldwide, with a high mortality and poor prognosis due to advanced stage at diagnosis. Surgical resection after neoadjuvant therapy is the main treatment for ESCC. With the rise of immunotherapy, immunotherapy on ESCC has been shown to improve outcomes, especially the immune checkpoint inhibitors (ICIs). As the efficacy of immunotherapy for ESCC is limited, it is helpful to screen patients who may benefit from immunotherapy by looking for predictive biomarkers of efficacy of immunotherapy. In this paper, based on the current literature on immunotherapy and related biomarkers, we review the research progress on predictive markers of ICIs for ESCC, in hopes of providing assistances for the precise treatment and prognosis determination.

Objective:To explore the relative factors for best ovarian response in patients undergoing assisted reproductive technology with follicular phase long-acting long protocol, and to establish a Nomogram prediction model of ovarian response.Methods:This retrospective cohort study analyzed the clinical data of 1289 patients who received assisted reproductive treatment in the Center for Reproductive Medicine of Fujian Maternity and Child Health Hospital from July 1, 2018 to July 30, 2019. According to the number of oocytes retrieved, there were 164 cases in the low ovarian response group (≤5 oocytes retrieved), 891 cases in the normal ovarian response group (the number of retrieved oocytes was >5, and ≤18), and 234 cases in the high ovarian response group (>18 oocytes retrieved). Independent factors affecting ovarian reactivity were screened by logistic regression, which were the model entry variables, and a Nomogram prediction model was established based on the regression coefficients in the model.Results:There were statistically significant differences in age, anti-Müllerian hormone (AMH) level and antral follicle count (AFC) among the three groups [32.43±3.99, 31.48±3.89, 29.91±3.73; (2.53±1.90) μg/L, (3.79±2.20) μg/L, (5.94±3.12) μg/L; 10.24±3.10, 14.50±3.29, 19.81±3.44; all P<0.001]. There were no significant differences in body mass index (BMI), duration of infertility and causes of tubal infertility (all P>0.05). The initial dosage of gonadotropin (Gn) used for ovarian hyperstimulation among the three groups was statistically different [(182.62±53.96) U, (166.79±48.20) U, (159.13±43.92) U, P<0.001], while the duration of Gn used and clinical pregnancy rate had no significant differences (all P>0.05). Multifactorial stepwise aggression analysis showed that female age [0.93(0.90-0.96), P=0.007], AFC [1.07(1.03-1.09), P=0.001], AMH [1.29(1.20-1.39), P=0.001], basal follicle-stimulating hormone [0.79(0.73-0.86), P=0.001], luteinizing hormone value [1.11(1.06-1.23), P=0.010], initial dosage of Gn used [1.00(1.00-1.01), P=0.003], total dosage of Gn usd [1.00(0.99-1.00), P=0.001] and the presence or absence of diagnosis of endometriosis [0.63(0.47-0.86), P=0.001] and polycystic ovary syndrome [0.30(0.22-0.91), P=0.030] were independent factors for the occurrence of different ovarian responses during ovarian hyperstimulation. The prediction model of ovarian reactivity was constructed based on the above factors, and the accuracy of predicting the optimal ovarian response state was 95%. The above model was verified with 306 patients' data from August 1, 2019 to October 30, 2019 in this center, and the predicted ovarian response (number of oocytes obtained) of a total of 279 patients was consistent with the actual situation, with a coincidence degree of 91.2%. The consistency index of the model was 0.71. Conclusion:We screened out the relevant factors affecting ovarian response in patients undergoing assisted reproductive technology with follicular phase long-acting long protocol, and established a Nomogram prediction model of ovarian response, which could effectively, intuitively and visually predict ovarian reactivity in hyperstimulation.