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.

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.

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.

ObjectiveTo investigate the short-term knee function recovery of patients undergoing total knee arthroplasty (TKA) after discharge and analyze its related factors. MethodsFrom December, 2022 to April, 2023, 140 adult patients who underwent TKA in Nanjing Drum Tower Hospital and being about to be discharged were selected as the survey subjects using convenient sampling. Potential influencing factors were selected based on a literature review. They were investigated with general information questionnaire, Rehabilitation Exercise Compliance Scale, Self-Efficacy Scale for Rehabilitation Exercise (SER), Visual Analog Scale for pain (VAS), and joint range of motion measurements before discharge, and were investigated with the Hospital for Special Surgery Knee Score (HSS) one month after discharge. ResultsA total of 130 patients finished follow-up. One month after discharge, the HSS score ranged from 40 to 82, with an average of (70.89±6.26). Multiple linear regression analysis revealed that Body Mass Index (B = -0.423, 95%CI -0.622 to -0.224, P < 0.001), pre-discharge VAS (B = -1.016, 95%CI -1.198 to -0.113, P = 0.028), rehabilitation exercise compliance (B = 0.267, 95%CI 0.121 to 0.413, P < 0.001), SER (B = 0.478, 95%CI 0.315 to 0.642, P < 0.001), and knee joint flexion contracture angle (B = -0.251, 95%CI -0.414 to -0.088, P = 0.003) could influence HSS score one month after discharge (R² = 0.615, F =17.106, P < 0.001). ConclusionPatients after TKA have recovered well in short time after discharge, however, there is still significant room for improvement. Clinical healthcare providers should design and implement appropriate interventions based on related factors to improve the function.

BACKGROUND:The treatment of bone defects has always been a pressing clinical challenge for medical practitioners.The use of gelatin methacryloyl for three-dimensional extracellular cultivation offers a promising direction for the treatment of extensive bone defects. OBJECTIVE:To review the research progress of gelatin methacryloyl as a three-dimensional cell culture scaffold in bone tissue engineering,aiming to provide further references for clinical bone defect repair. METHODS:Computerized searches were conducted on the CNKI and PubMed databases for articles published from January 1986 to August 2023.The search terms in Chinese and English were"bone defect,bone tissue engineering,biomaterial scaffold,hydrogel,photocrosslinked hydrogel,gelatin methacryloyl,three-dimensional culture,cell culture"and"bone defect,bone tissue engineering,biomaterial scaffold,hydrogel,gelatin methacryloyl,three-dimensional culture,cell culture",respectively.Finally,68 articles were included for review and analysis. RESULTS AND CONCLUSION:(1)When compared to two-dimensional culture techniques,three-dimensional culture can construct a three-dimensional space under aseptic conditions,more effectively simulating the in vivo environment.It provides cells with the appropriate temperature,pH,and sufficient nutrients,allowing cells to grow and proliferate normally outside the body while maintaining their regular structure and function,offering unique advantages.(2)In the realm of bone tissue engineering,hydrogels stand out as the preferred choice for biomaterial scaffolds.Their excellent biocompatibility,degradability,and inherent three-dimensional network structure make them invaluable in bone regeneration studies.(3)The physical and biological properties of gelatin methacryloyl are influenced by factors such as concentration,light exposure duration,type of photoinitiator,and the overall reaction system.These properties can affect cell adhesion,growth,and proliferation,and even the morphology and function of cells.(4)Gelatin methacryloyl,recognized for its excellent biocompatibility,tunable physical properties,injectability,and photosensitivity,has been extensively used in three-dimensional cell encapsulation,three-dimensional bioprinting,and stereolithography techniques based on digital light processing in three-dimensional cell culture systems.(5)Utilizing a range of composite gelatin methacryloyl in three-dimensional cell culture can significantly promote vascularization and bone regeneration,paving the way for enhanced clinical solutions to bone defects.(6)At present,there is a noticeable gap in standardized guidelines concerning the sources,synthesis methods,and safety of gelatin methacryloyl.It is crucial to intensify research efforts to optimize gelatin methacryloyl's application in the three-dimensional cell culture field.

Objective To investigate the application efficiency and potential of CT radiomics in differentiating malignant and benign sub-centimeter solid pulmonary nodules. Methods A retrospective study was performed on the sub-centimeter ( ≤ 10 mm) solid pulmonary nodules detected by enhanced CT in our hospital from March 2020 to January 2023. Malignancy was confirmed by surgical pathology, and benignity was confirmed by surgical pathology or follow-up. Lesions were manually segmented and radiomic features were extracted. The feature dimension was reduced via feature correlation analysis and least absolute shrinkage and selection operator (LASSO). The 5-fold cross validation was used to validate the model. Support vector machine, logistic regression, linear classification support vector machine, gradient boosting, and random forest models were established for CT radiomics. Receiver operating characteristic curves were drawn. Delong test was used to compare the diagnostic performance of the five classifiers. The optimal model was selected and compared to radiologists with medium and high seniority. Results A total of 303 nodules, 136 of which were malignant, were examined. Radiomics models were established after feature extraction and selection. On test set, the areas under the receiver operating characteristic curves of support vector machine, logistic regression, linear classification support vector machine, random forest, and gradient boosting models were 0.922 (95%CI: 0.893, 0.950), 0.910 (95%CI: 0.878, 0.942), 0.905 (95%CI: 0.872, 0.938), 0.899 (95%CI: 0.865, 0.933), and 0.896 (95%CI: 0.862, 0.930), respectively. Delong test indicated no significant differences in the performance of the five radiomics models, and the support vector machine model showed the highest accuracy and F1 score. The support vector machine model showed significantly higher diagnostic accuracy as compared to radiologists (83.8% vs. 55.4%, P < 0.001). Conclusion The radiomics models achieved high diagnostic efficiency and may help to reduce the uncertainty in diagnosis of malignant and benign sub-centimeter solid nodules by radiologists.

Objective:To compare the clinical effects of the two design schemes of heart-shaped incision and "Mercedes-Benz incision" (three-leaf method) in umbilicoplasty.Methods:A retrospective analysis was performed for the clinical data of patients who underwent umbilicoplasty during abdominoplasty admitted to the Body Contouring & Fat Grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from November 2019 to September 2022. During the umbilicalplasty operation, different patients were treated with either a heart-shaped incision or a "Mercedes-Benz incision" three-flap method. The umbilical cord for infection, hematoma and other complications were observed after surgery; a 5-point Likert scale was used to evaluate the aesthetic effect of the new umbilicus 6 months after surgery(3-15 points, the higher the score, the better the aesthetic effect); the Vancouver scar scale (VSS) was used to score the scar condition 6 months after surgery (0-18 points, the higher the score, the better the scar condition). Postoperatively, patients were surveyed on umbilical shape satisfaction, which was divided into three levels: dissatisfied, relatively satisfied, and very satisfied. Normally distributed measurement data were expressed as Mean±SD, and independent samples t-test was used for comparison between two groups. P<0.05 was considered as a statistically significant difference. Results:A total of 35 patients were enrolled, all of whom were female. Among them, 19 cases underwent heart-shaped incision, and 16 cases underwent umbilicoplasty using "Mercedes-Benz incision". The ages of the two groups were (32.3±2.7) years old and (33.7±2.3) years old respectively. At the 6-month follow-up after surgery, the total aesthetic effect score of the umbilical cord in the heart-shaped incision group was higher than that in the "Mercedes-Benz incision" group [(13.3±0.7) points vs. (12.7±0.5) points, P<0.05]. The VSS score of the heart-shaped incision group was lower than that of the "Mercedes-Benz incision" group [(2.6±0.8) points vs. (3.4±0.9) points, P<0.05]. The results of the satisfaction survey after umbilicoplasty showed that in the heart-shaped incision group, 3 cases were relatively satisfied and 16 cases were very satisfied; in the "Mercedes-Benz incision" group, 2 cases were relatively satisfied and 14 cases were very satisfied. Conclusion:Compared with the classic "Mercedes-Benz incision", the heart-shaped incision design can obtain a better-shaped, more natural new umbilicus and a more invisible scar after umbilicoplasty.

Hemophilia encompasses a group of hereditary bleeding disorders characterized by impaired clotting factor activity,leading to prolonged clotting times.Patients display a tendency toward clotting issues following minor injuries,and severe cases may experience spontaneous bleeding.Acquired von Willebrand syndrome(AvWS)occurs due to the reduction of von Willebrand factor(vWF)levels,resulting in impaired platelet adhesion to endothelial cells,thereby compromising clotting function and leading to bleeding events.The increasing use of extracorporeal membrane oxygenation(ECMO)in clinical settings has brought attention to ECMO-related AvWS.During ECMO support,patients'blood exposure to high shear forces and non-physiological conditions can exacerbate the reduction of vWF levels,further impacting coagulation function.The precise mechanisms triggering AvWS during ECMO support are not conclusively defined,however,studies indicate that high shear forces and systemic inflammation response syndrome(SIRS)are key factors.Mechanical shear stress induced by ECMO damages endothelial cells,releasing factors associated with von Willebrand disease(vWD).Additionally,ECMO-induced SIRS may further compromise vWF functionality.Understanding these mechanisms is crucial for formulating effective preventive and treatment strategies.Diagnosing AvWS during ECMO support can be complex.Typically,assessing a patient's coagulation function and related factor levels is necessary,while cautious interpretation is vital due to potential ECMO interferences.Treatment strategies for managing AvWS during ECMO support are still under investigation.Some studies suggest that using plasma products may improve coagulation function.However,specific treatment approaches should be tailored to individual patient conditions and adjusted based on close monitoring.In summary,diagnosing and treating AvWS during ECMO support remains complex and challenging.Further research holds promise for better understanding the mechanisms involved and for developing more effective treatment strategies to enhance patient prognosis and quality of life.

Objective:To compare the clinical effects of the two design schemes of heart-shaped incision and "Mercedes-Benz incision" (three-leaf method) in umbilicoplasty.Methods:A retrospective analysis was performed for the clinical data of patients who underwent umbilicoplasty during abdominoplasty admitted to the Body Contouring & Fat Grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from November 2019 to September 2022. During the umbilicalplasty operation, different patients were treated with either a heart-shaped incision or a "Mercedes-Benz incision" three-flap method. The umbilical cord for infection, hematoma and other complications were observed after surgery; a 5-point Likert scale was used to evaluate the aesthetic effect of the new umbilicus 6 months after surgery(3-15 points, the higher the score, the better the aesthetic effect); the Vancouver scar scale (VSS) was used to score the scar condition 6 months after surgery (0-18 points, the higher the score, the better the scar condition). Postoperatively, patients were surveyed on umbilical shape satisfaction, which was divided into three levels: dissatisfied, relatively satisfied, and very satisfied. Normally distributed measurement data were expressed as Mean±SD, and independent samples t-test was used for comparison between two groups. P<0.05 was considered as a statistically significant difference. Results:A total of 35 patients were enrolled, all of whom were female. Among them, 19 cases underwent heart-shaped incision, and 16 cases underwent umbilicoplasty using "Mercedes-Benz incision". The ages of the two groups were (32.3±2.7) years old and (33.7±2.3) years old respectively. At the 6-month follow-up after surgery, the total aesthetic effect score of the umbilical cord in the heart-shaped incision group was higher than that in the "Mercedes-Benz incision" group [(13.3±0.7) points vs. (12.7±0.5) points, P<0.05]. The VSS score of the heart-shaped incision group was lower than that of the "Mercedes-Benz incision" group [(2.6±0.8) points vs. (3.4±0.9) points, P<0.05]. The results of the satisfaction survey after umbilicoplasty showed that in the heart-shaped incision group, 3 cases were relatively satisfied and 16 cases were very satisfied; in the "Mercedes-Benz incision" group, 2 cases were relatively satisfied and 14 cases were very satisfied. Conclusion:Compared with the classic "Mercedes-Benz incision", the heart-shaped incision design can obtain a better-shaped, more natural new umbilicus and a more invisible scar after umbilicoplasty.

OBJECTIVE: To describe negative conversion and rebound of patients with severe and critical acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection after treatment with Nirmatrelvir/Ritonavir, and to analyze related factors associating with failure of SARS-CoV-2 negative conversion and relapse and prognosis. METHODS: A single center retrospective cohort study was conducted. Patients aged ≥ 16 years old who were diagnosed with severe or critical SARS-CoV-2 infection and took Nirmatrelvir/Ritonavir for 5 days in Peking University First Hospital from December 7, 2022 to January 27, 2023, were included. General characteristics and clinical data were collected from electronic medical record system. The Kaplan-Meier curve of SARS-CoV-2 negative conversion was drawn. Factors with P < 0.10 were incorporated into multivariate Logistic regression model to analyze the relationship between the factors and persistent nucleic acid positive and rebound. RESULTS: A total of 31 severe and 37 critical SARS-CoV-2 infection patients were included. The median duration from initiation of Nirmatrelvir/Ritonavir to negative conversion of SARS-CoV-2 for both was 6.0 days, and the negative conversion rate on day 15 was 93.5% and 86.5%, respectively. SARS-CoV-2 rebound was observed in 7 patients (11.3%), among whom were 1 severe patient and 6 critical patients. The above 7 patients with SARS-CoV-2 rebound and 6 patients with failure of SARS-CoV-2 negative conversion were compared with 55 patients with persistent negative conversion. Factors with P < 0.10, including the lowest lymphocyte count (LYM), the highest D-dimer, the highest procalcitonin (PCT), the lowest Ct value, cardiovascular diseases other than hypertension and coronary heart disease, were incorporated into multivariate Logistic regression analysis. The decreased LYM [odds ratio (OR) = 0.146, 95% confidence interval (95%CI) was 0.031-0.689, P = 0.015] and the increased PCT (OR = 2.008, 95%CI was 1.042-3.868, P = 0.037) were revealed to be independent risk factors of the failure of SARS-CoV-2 negative conversion or rebound. The proportion of mechanical ventilation and invasive ventilation were significantly higher in patients with persistent SARS-CoV-2 infection or rebound than those in patients with SARS-CoV-2 negative conversion (84.6% vs. 38.2%, 69.2% vs. 25.5%, both P < 0.01), but no significant difference in mechanical ventilation and invasive ventilation duration was observed. Compared with the patients with SARS-CoV-2 negative conversion, more patients with persistent SARS-CoV-2 infection or rebound were admitted to intensive care unit (ICU, 76.9% vs. 50.9%), and length of ICU stay in patients with persistent SARS-CoV-2 infection or rebound tended to be longer [days: 13.0 (10.3, 24.3) vs. 11.0 (5.3, 23.0), P > 0.05]. CONCLUSIONS The decreased LYM and increased PCT are independent risk factors for the failure of SARS-CoV-2 negative conversion or rebound in patients with severe and critical SARS-CoV-2 infection. Attention should be paid to these patients for their poor prognosis.
Humans ; Adolescent ; COVID-19 ; SARS-CoV-2 ; Retrospective Studies ; Ritonavir/therapeutic use* ; Critical Illness ; COVID-19 Drug Treatment