[Analysis of clinical features of 380 cases of special portal hypertension-Abernethy malformation]

Objective: To summarize the clinical features of special portal hypertension-Abernethy malformation reported at home and abroad. Methods: The relevant literature on Abernethy malformation published at home and abroad from January 1989 to August 2021 was collected. Patients'clinical features, imaging and laboratory test results, diagnosis, treatment, and prognosis were analyzed. Results: A total of 380 cases were included from 60 and 202 domestic and foreign literatures. Among them, there were 200 cases of type I, with 86 males and 114 females, and the average age was (17.08±19.42) years, while there were 180 cases of type II, with 106 males and 74 females, and the average was (14.85±19.60) years. The most common reason for the first visit of an Abernethy malformation patient's was gastrointestinal system symptoms such as hematemesis and hematochezia caused by portal hypertension (70.56%). Multiple malformations were present in 45.00% of type Ⅰ and 37.80% of type Ⅱ patients. The most prevalent condition was congenital heart disease (62.22%, and 73.53%). Complications related to Abernethy malformation was occurred in 127 and 105 cases with type I and type II, respectively, with liver lesions in 74.02% (94/127) and 39.05% (42/105) and hepatopulmonary syndrome of 33.07% (42/127) and 39.05% (41/105), respectively. The imaging diagnosis of type I and type II Abernethy malformations were mainly based on abdominal computed tomography (59.00%, and 76.11%). Liver pathology was performed in 27.10% of patients. Blood ammonia increased by 89.06% and 87.50%, and AFP increased by 29.63% and 40.00% in laboratory findings. 9.76% (8/82) and 6.92% (9/130) died, while 84.15% (61/82) and 88.46% (115/130) had improved conditions after medical conservative, or surgical treatment. Conclusion: Abernethy malformation is a rare disease in which congenital portal vein development abnormalities lead to significant portal hypertension and portasystemtic shunt. Patients often seek medical treatment for gastrointestinal bleeding and abdominal pain. Type Ⅰ is more common in women, often associated with multiple malformations, and prone to secondary intrahepatic tumors. Liver transplantation is the main treatment method. Type Ⅱ is more prevalent in males, and shunt vessel occlusion is the first treatment choice. Overall, type Ⅱ has a better therapeutic impact than type Ⅰ.

[Current epidemiology and pathogenesis of non-alcoholic fatty liver disease-associated liver cancer]

Liver cancer is a common malignant tumor. Although the overall incidence and mortality rates of liver cancer has been decreasing in recent years, the incidence of nonalcoholic fatty liver disease (NAFLD)-associated liver cancer tends to increase. The health and social issues brought by NAFLD-associated liver cancer have attracted more and more attention, and its epidemiology, pathogenesis, and diagnosis and treatment await further research. This article summarizes the current epidemiology and pathogenesis of NAFLD-associated liver cancer.

Cytomegalovirus infection in pregnancy

OBJECTIVES

To investigate the effects of intrauterine human cytomegalovirus (HCMV) infection on pregnancy outcomes and infant development.

METHODS

The study group consisted of the HCMV-IgM-positive offspring of 75 pregnant women, and a control group of the non-infected offspring of 73 pregnant women. Chorionic villi, amnionic fluid, and umbilical blood were obtained to detect HCMV-late mRNA with a reverse transcriptase-polymerase chain reaction (RT-PCR) assay. The pregnancy outcomes were followed up. For all offspring, neurological development was evaluated with neurosonography, audiologic development with the brainstem auditory evoked potential (BAEP), and psychomotor development with the Beyley Scale of Infant Development (BSID).

RESULTS

In the study group the positive rate of late mRNA was 50% in the chorionic villi and 67.65% in the amnionic fluid and the umbilical blood; the incidence of abnormal pregnancy outcomes (abortion, preterm delivery, stillbirth, etc.) was much higher than in the control group (40% vs. 6.57%; chi(2)=24.06; P=0.001); the abnormal rate of neurosonography results at birth and 3 months after birth was higher in the study group than in the control group (P<0.05), as were BAEP values 4 months after birth (chi(2)=8.960; P=0.003). Scores for the Infant Mental Development Index (MDI) were apparently lower than in the control group. When congenitally infected children were tested at the age of 5.5-6.5 years with the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), their rate of mental retardation was still found to be approximately 20%.

CONCLUSIONS

Intrauterine HCMV infection is closely related to abnormal pregnancy outcomes, infant neurological damage, mental retardation, and hearing loss.

The utero-placental circulation, eugenics and the prevention and treatment of high risk pregnancies

Through systematic experimental and clinical studies, the physiological regulation of utero-placental circulation and the relation of the disturbance in this acirculation to pathogenic mechanisms of high risk pregnancies-Intrauterine Growth Retardation (IUGR) and Pregnancy-induced hypertension (PIH) were explored. The pharmacological effects and mechanism of a Chinese herbal medicine-Qingxintong in improving, the utero-placental circulation and the therapeutic efficacy in treatment of IUGR and PIH, both accompanied by disturbance of utero-placental circulation, were investigated as well.

[Clinical pathologic analysis of congenital malformations in 411 perinates: with 80 autopsy materials]

411 cases of malformed babies in 1960-1985 were analyzed, giving an incidence of 6.8%. The clinical data and autopsy materials showed that the order of occurrence of malformation in various systems was: nervous system, face and neck, muscle, bone and digestive system. Autopsy rate was 37.4% in this series. The ratio of malformed male babies to female was 1.3 to 1. 46.5% of the mothers with malformed baby were at age of 25-29 years and 66.2% delivered at 37 to 41 weeks of gestation. 69.3% of mothers with malformed baby had gestational complications 11 times as high as those delivering normal neonate in the same period (P less than 0.01). Of them hydramnion, premature rupture of membranes, oligoamnios, neonatal asphyxia were obviously higher than those pregnancies with normal baby (P less than 0.01). There is mainly discussed the clinical value of autopsy and the preventive measures in decreasing birth of malformed babies.