ObjectivesTo summarize the clinical and pathological features of patients with congenital liver fibrosis （CHF）， and to investigate the differences in clinical and pathological features between patients in different age groups. MethodsA retrospective analysis was performed for the clinicopathological data of 26 patients with pathologically confirmed CHF in China-Japan Friendship Hospital from August 2005 to June 2023， and the patients were stratified by age to investigate the clinical and pathological features of patients in different age groups. ResultsAmong the 26 patients， there were 12 male patients and 14 female patients， with an age of onset of 4 — 61 years. There were 19 patients with portal hypertension type （73.08%）， 2 patients with cholangitis type （7.69%）， 4 patients with mixed type （15.38%）， and 1 patient with occult type （3.85%）. Of all 26 patients， 4 had unknown clinical symptoms， and among the 22 patients with clear clinical symptoms， 10 （45.45%） attended the hospital due to upper gastrointestinal bleeding caused by portal hypertension. Pathological manifestations included roughly normal liver parenchyma separated by fibrous septa in the portal area， with the presence of abnormal reactive bile duct hyperplasia. Denser fibrous septa and a lack of portal veins with the corresponding caliber were observed in 4 pediatric patients with disease onset before the age of 10 years， with a significant reduction or even disappearance of compensatory thin-walled blood vessels. ConclusionPortal hypertension-type CHF is the most common type in clinical practice. Patients with an early age of onset have certain histopathological features of the liver， with the presence of serious complications associated with portal hypertension. Therefore， liver biopsy should be performed for patients suspected of CHF in clinical practice， and genetic testing should be performed when necessary. Early identification and diagnosis are of great importance for improving the prognosis of patients.

Objective:To evaluate the clinical efficacy of botulinum toxin type A (BTX-A) injection in enhancing chin aesthetics.Methods:A retrospective analysis was conducted on patients with suboptimal chin aesthetics who underwent dual-plane BTX-A injection at Plastic Surgery Hospital, Chinese Academy of Medical Sciences between August 2023 and March 2024. Prior to injection, patients were instructed to repeatedly pucker their lips forward and upward to identify the most prominent points of the mentalis muscle for injection. A 13 mm 30 G needle was inserted perpendicularly into the muscle layer, and BTX-A was administered at a concentration of 20 U/ml, with 3 U per injection point. For the patients exhibiting significant orange peel signs at rest, intradermal deep-layer BTX-A injection was concurrently performed at a concentration of 5 U/ml, with 0.5 U per linear track. Postoperative follow-up was conducted, and third-party physicians assessed pre- and post-treatment photographs using the global aesthetic improvement scale (GAIS) (scores ranging from 5 to 1, representing worse, no improvement, mild improvement, moderate improvement, and significant improvement, respectively). Patient satisfaction was also surveyed [categorized as very satisfied, satisfied, dissatisfied, or very dissatisfied; satisfaction rate = (very satisfied + satisfied) cases/total cases × 100%], along with their willingness to undergo repeated injections and recommend the procedure to others. Descriptive statistical analysis was performed using SPSS 24.0 software. Normally distributed continuous data were expressed as Mean±SD, and categorical data were expressed as counts (%).Results:A total of 120 patients were included, comprising 11 males and 109 females, aged 22-39 years (mean age of 33.3 years). Follow-up ranged from 1 to 5 months (mean of 1.3 months). Postoperatively, 102 patients reported subjective improvement in chin appearance, characterized by enhanced fullness and roundness of the chin. Thirty-one patients noted a slight elevation of the submental fat pad and improved definition of the cervicomental angle. The mean GAIS score was 1.61±0.78, with 76 cases scoring 1, 24 cases scoring 2, 10 cases scoring 3, and 10 cases scoring 4. Improvement (scores 1-3) was achieved in 91.7% (110/120) of patients. The subjective satisfaction rate was 85.0% (102/120), and 94 patients (78.3%) expressed willingness to undergo repeated injections and recommend the procedure to family or friends. Early postoperative complications included localized bruising in 17 cases, which was resolved within 10 d, and transient fine motor dysfunction of the lower jaw in 23 cases, with normal chewing, swallowing, and facial expressions, all of which were resolved completely within 6 weeks. No cases of mouth deviation, facial paralysis, allergic reactions, or other complications were observed.Conclusion:The application of BTX-A via intramuscular mentalis injection combined with intradermal deep-layer injection significantly improves both dynamic and static chin aesthetics. However, some common complications also ask for the further attention of practitioners.

Objective:To evaluate the clinical efficacy of botulinum toxin type A (BTX-A) injection in enhancing chin aesthetics.Methods:A retrospective analysis was conducted on patients with suboptimal chin aesthetics who underwent dual-plane BTX-A injection at Plastic Surgery Hospital, Chinese Academy of Medical Sciences between August 2023 and March 2024. Prior to injection, patients were instructed to repeatedly pucker their lips forward and upward to identify the most prominent points of the mentalis muscle for injection. A 13 mm 30 G needle was inserted perpendicularly into the muscle layer, and BTX-A was administered at a concentration of 20 U/ml, with 3 U per injection point. For the patients exhibiting significant orange peel signs at rest, intradermal deep-layer BTX-A injection was concurrently performed at a concentration of 5 U/ml, with 0.5 U per linear track. Postoperative follow-up was conducted, and third-party physicians assessed pre- and post-treatment photographs using the global aesthetic improvement scale (GAIS) (scores ranging from 5 to 1, representing worse, no improvement, mild improvement, moderate improvement, and significant improvement, respectively). Patient satisfaction was also surveyed [categorized as very satisfied, satisfied, dissatisfied, or very dissatisfied; satisfaction rate = (very satisfied + satisfied) cases/total cases × 100%], along with their willingness to undergo repeated injections and recommend the procedure to others. Descriptive statistical analysis was performed using SPSS 24.0 software. Normally distributed continuous data were expressed as Mean±SD, and categorical data were expressed as counts (%).Results:A total of 120 patients were included, comprising 11 males and 109 females, aged 22-39 years (mean age of 33.3 years). Follow-up ranged from 1 to 5 months (mean of 1.3 months). Postoperatively, 102 patients reported subjective improvement in chin appearance, characterized by enhanced fullness and roundness of the chin. Thirty-one patients noted a slight elevation of the submental fat pad and improved definition of the cervicomental angle. The mean GAIS score was 1.61±0.78, with 76 cases scoring 1, 24 cases scoring 2, 10 cases scoring 3, and 10 cases scoring 4. Improvement (scores 1-3) was achieved in 91.7% (110/120) of patients. The subjective satisfaction rate was 85.0% (102/120), and 94 patients (78.3%) expressed willingness to undergo repeated injections and recommend the procedure to family or friends. Early postoperative complications included localized bruising in 17 cases, which was resolved within 10 d, and transient fine motor dysfunction of the lower jaw in 23 cases, with normal chewing, swallowing, and facial expressions, all of which were resolved completely within 6 weeks. No cases of mouth deviation, facial paralysis, allergic reactions, or other complications were observed.Conclusion:The application of BTX-A via intramuscular mentalis injection combined with intradermal deep-layer injection significantly improves both dynamic and static chin aesthetics. However, some common complications also ask for the further attention of practitioners.

Objective:Our study aims to determine histological regression and clinical improvement after long-term antiviral therapy in hepatitis B virus-related cirrhosis patients.Methods:Treatment-na?ve chronic hepatitis B patients with histologically or clinically diagnosed liver cirrhosis were enrolled. Liver biopsies were performed after 5 years entecavir-based antiviral treatment. Patients were followed up every 6 months. Cirrhosis regression was evaluated based on Metavir system and P-I-R score. Clinical improvement was evaluated before and after the long-term treatment. Kruskal Wallis test and Wilcoxon signed-rank test were used for continuous variables, Fisher's exact test was used for categorical variables and multivariate analysis was performed using logistic regression analysis.Results:Totals of 73 patients with HBV-related liver cirrhosis were enrolled. Among them, 30 (41.1%) patients were biopsy proved liver cirrhosis and the remaining 43 (58.9%) cirrhotic patients were diagnosed by clinical features. Based on Metavir system and P-I-R score, 72.6% (53/73) patients attained histological regression. Furthermore, 30.1% (22/73) were defined as significant regression (Metavir decrease ≥2 stage), 42.5% (31/73) were mild regression (Metavir decrease 1 stage or predominantly regressive by P-I-R system if still cirrhosis after treatment) and 27.4% (20/73) were the non-regression. Compared to levels of clinical characteristics at baseline, HBV DNA, ALT, AST, liver stiffness(decreased from 12.7 to 6.4 kPa in significant regression, from 18.1 to 7.3 kPa in mild regression and from 21.4 to 11.2 kPa in non-regression)and Ishak-HAI score significantly decreased after 5 years of anti-HBV treatment, while serum levels of platelets and albumin improved remarkably ( P<0.05). In multivariate analysis, only the pre-treatment liver stiffness level was associated with significant regression ( OR=0.887, 95% CI: 0.802-0.981, P=0.020). Conclusions:After long-term antiviral therapy, patients with HBV-related cirrhosis are easily to attain improvements in clinical parameters, while a certain percentage of these patients still cannot achieve histological reversal.

A liver biopsy has an important suggestive role in the diagnosis of inherited metabolic liver disease (IMLD). This article introduces the IMLD pathological diagnosis considerations, five types of classification of liver biopsy based on the morphological characteristics (basic normal liver tissue morphology, steatosis, cholestatic disease, storage/deposition, and hepatitis), and a summary of the pathological characteristics of different injury patterns and common diseases in order to provide clues for the correct diagnosis.

ObjectiveTo investigate the association of common clinical indices and noninvasive liver fibrosis scores with hepatic-type Wilson’s disease (WD) in Chinese patients and their ability to identify advanced liver fibrosis. MethodsA retrospective analysis was performed for the clinical data of 236 Chinese patients with WD who were diagnosed and treated in Beijing YouAn Hospital and China-Japan Friendship Hospital from May 1996 to April 2020. A total of 26 patients with hepatic-type WD who underwent liver pathological examination and had complete clinical data were enrolled; the METAVIR score was used to determine liver fibrosis stage, and the patients were divided into advanced liver fibrosis (F3 and F4 stages) group and non-advanced liver fibrosis (F0, F1, and F2 stages) groups. Three noninvasive liver fibrosis scores ［Sheth index, aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) index］ were calculated for both groups, and the above indices and related clinical indices were compared between the two groups. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the Fisher’s exact test was used for comparison of categorical data between two groups. The Spearman rank correlation test was used for further analysis of indices with statistical significance, and the clinical indices and scoring criteria correlated with liver fibrosis degree were screened out; the receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was calculated. ResultsMost of the patients in this study developed the disease in childhood and adolescence, and among these patients, 10 (38.5%) had positive K-F ring and 17 (65%) were in the stage of advanced liver fibrosis. There were significant differences between the advanced liver fibrosis group and the non-advanced liver fibrosis group in white blood cell count (WBC) (Z=-2.102, P=0.036), hemoglobin (Hb) (t=-2.860, P=0009), platelet count (PLT) (t=-4.053, P＜0.001), direct bilirubin (DBil) (Z=-2.130, P=0.033), albumin (Alb) (t=-2.875, P=0.008), and Sheth index (Z=-3.369, P=0.001). WBC, Hb, PLT, and Alb were negatively correlated with liver fibrosis degree in WD patients (r=-0.587, -0.610, -0.656, and -0.411, all P＜0.05), and DBil and Sheth index were positively correlated with liver fibrosis degree (r=0.486 and 0.711, both P＜0.05). The ROC curve analysis showed that WBC, DBil, Sheth index, Hb, PLT, and Alb had an AUC of ＞0.7, among which Sheth index had the largest AUC of 0.908, with a sensitivity of 70.6%, a specificity of 100.0%, a positive predictive value of 100.0%, and a negative predictive value of 64.3%. ConclusionSheth index has a better diagnostic efficiency than the other clinical indices alone and can well identify advanced liver fibrosis in Chinese patients with hepatic-type WD.

The epicanthal fold is a common phenomenon among East Asians. Epicanthoplasty technique is currently the most effective method to improve the epicanthal fold. However, complications still occur, such as scar hyperplasia and recurrence, unnatural appearance, etc. Based on classic techniques, various improved techniques and new techniques have emerged. This article has extensively reviewed recent advances in surgical methods of epicanthoplasty and restoration of epicanthoplasty in recent years.

The epicanthal fold is a common phenomenon among East Asians. Epicanthoplasty technique is currently the most effective method to improve the epicanthal fold. However, complications still occur, such as scar hyperplasia and recurrence, unnatural appearance, etc. Based on classic techniques, various improved techniques and new techniques have emerged. This article has extensively reviewed recent advances in surgical methods of epicanthoplasty and restoration of epicanthoplasty in recent years.

OBJECTIVE: To explore the correlation between endothelial microparticles(EMPs) and subacute 1,2-dichloroethane(1,2-DCE) toxic encephalopathy. METHODS: A total of 24 patients with subacute 1,2-DCE toxic encephalopathy were selected as the case group, and 24 healthy individuals were selected as the control group using a convenient sampling method. Blood plasma was collected from the fasting venous blood of patients in these two groups, and the level of EMPs in the plasma was detected by flow cytometry. RESULTS: The levels of plasma EMPs of patients in the control group and the case group were(692.0±174.4) ×10~3/L and(839.8±155.8) ×10~3/L respectively. The levels of plasma EMPs in patients with mild, moderate and severe case subgroups were(691.6±101.9) ×10~3/L,(900.6±46.6) ×10~3/L and(1 026.8±69.8)×10~3/L respectively. The EMPs level of patients in the case group was higher than that of the control group(P<0.01). The level of EMPs in the moderate and severe case subgroups was higher than that of the control group and mild case subgroup(P<0.01). CONCLUSION: Endothelial injury was found in patients with subacute 1,2-DCE toxic encephalopathy and endothelial injury is related to the severity of poisoning.

Objective: To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression. Methods: Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment. Results: A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness. Conclusion This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.