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Botulinum Toxin Type A and Its Possible Mechanisms on Wound Healing

Modern Plastic Surgery 2020年第3期10卷 38-55页

作者： khushboo gurung Qian Tan Ye Xu Bingchen Duan Department of Burns Plastic and Reconstructive Surgery Nanjing Drum Tower Hospital Affiliated to Medical School of Southeast University Nanjing China Department of Burns Plastic and Reconstructive Surgery Nanjing Drum Tower Hospital Affiliated Hospital of Nanjing University Nanjing China Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University Nanjing China

Botulinum toxin type-A (BTX-A), a subtype from known seven types of botulinum neurotoxin (serotype A-G), is produced by a gram-positive bacterium, Clostridium botulinum. The toxin is now widely and efficiently used in treating a plethora of diverse symptoms and conditions. Recent evidence in the literature also shows that BTX-A exhibits a wide range of effects on non-neuronal cells. Its potential has markedly expanded to clinical applications other than the treatment of neurological and muscular conditions that are characterized by neuronal hyperactivity. A number of studies have shown BTX-A to improve the quality of scar outcome and prevent the formation of keloids and HTS. Although the mechanism of action of BTX-A on wound healing is still not clearly understood, lately there has been extensive research to grasp the underlying mechanisms of this multifunctional toxin. BTX-A seems to affect wound healing by a number of mechanisms that include action on tensile forces, inhibition of fibroblasts differentiation, downregulation of TGF-β1 and collagen expression. This review will explore the responses of Botulinum toxin type-A on wound healing and preventing pathological scars like HTS and keloids, and comprehend the overall effect BTX-A has on wound healing.

关键词： Wound Healing Botulinum Toxin Type-A Hypertrophic Scar Keloid Fibroblast Myofibroblasts Transforming Growth Factor β-1 Collagen Metalloproteinases Connective Tissue Growth Factor

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A型肉毒素治疗颈部切口瘢痕最佳时机 ——前瞻性，随机对照研究

A型肉毒素治疗颈部切口瘢痕最佳时机 ——前瞻性，随机对照研究

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作者： gurung khushboo(库思巴) 东南大学

学位级别：硕士

【背景】手术后瘢痕增生通常会引起患者康复期之后的生理及心理痛苦,严重者甚至引发心理疾病,因此,瘢痕治疗是近代心身医学发展的更高需求。尽管目前国内外学者有关瘢痕治疗的研究已经非常丰富,但对于增生性瘢痕的最佳治疗方案仍未达到... 详细信息

【背景】手术后瘢痕增生通常会引起患者康复期之后的生理及心理痛苦,严重者甚至引发心理疾病,因此,瘢痕治疗是近代心身医学发展的更高需求。尽管目前国内外学者有关瘢痕治疗的研究已经非常丰富,但对于增生性瘢痕的最佳治疗方案仍未达到普遍共识。现有研究认为,瘢痕增生的机制是主要是由于作用于伤口边缘的张力作用于正常愈合阶段所合成的未成熟胶原纤维而导致的异常修复结果。许多研究表明,早期切口周围注射A型肉毒素(BTXA)可导致暂时性肌肉麻痹,减少伤口边缘的张力,从而达到理想的伤口愈合结果。其中,A型肉毒素的注射时机是影响瘢痕愈合的重要因素。因此,为了研究极早期A型肉毒素不同的注射时机对切口瘢痕的影响,我们选择了术毕即刻和术后7天作为变量;同时,为完成较高的同质性研究,我们选择处于暴露区域的颈部切口(甲状腺手术切口)作为研究对象,以探讨A型肉毒素早期干预获得较好的疤痕结局的理想时机。【目的】一项前瞻性、双盲、随机对照试验,通过比较A型肉毒素注射技术对术后瘢痕康复的疗效,在术后即刻和术后7天注射A型肉毒素,评估在手术切口肉毒素A的较佳注射时机。本实验在南京鼓楼医院完成。【方法】34名接受甲状腺切除术的患者被纳入本研究,并随机分为两组,早期注射组(术毕注射组,D0)在皮肤闭合后立即接受毒素治疗,晚期注射组(D7)在术后7天接受毒素治疗。早期注射组16例,晚期注射组18例,均进行两次注射,一次注射A型肉毒素,一次注射0.9%NS。标准化照片对基线和90天随访时的瘢痕愈合结果由两名经验丰富的评估人员采用Stony Brook瘢痕评定量表(SBSES)、患者满意度(5分)量表以及Visual Analog Scale量表(VAS)进行评估。【结果】在90天的随访中,共对27名患者进行了评估。共有7例患者失访,早期注射组2例,晚期注射组5例。早期毒素组的改良SBSES有统计学显著改善,从基线到90天的随访平均增加0.86±1.41(p=0.040)。然而,在晚期注射组,从基线检查到90天的随访,改良的SBSES平均值下降了-1.27±1.48(p=0.009)。VAS评分中,早期注射组6.43(2.50,9.50),而晚期注射组4.85(3.00,9.00)。以上结果在统计学上是不同的,表明早期注射组的疤痕结果有显著改善(p=0.042)。在90天的随访中,早期注射组14例患者中,50%非常满意,14.29%满意,21.43%稍微满意,7.14%不满意,7.14%非常不满意,而晚期注射组13例患者中,23.08%非常满意,15.38%满意,7.69%稍微满意,30.77%不满意,23.08%非常不满意。【结论】注射A型肉毒素可以改善颈部瘢痕的预后情况。切口缝合后立即注射A型肉毒素对甲状腺切除术后瘢痕有明显的调节作用,是一种很值得推广的的瘢痕预防方法;同时,注射A型肉毒素的时机似乎是用A型肉毒素治疗瘢痕的一个非常重要的因素。

关键词： BTXA A型肉毒素瘢痕内注射伤口愈合增生性疤痕

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Donor-Site Morbidity Following Harvest of Autologous Costal Cartilage in Microtia Reconstruction

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Modern Plastic Surgery 2024年第4期14卷 57-73页

作者： Surendra Jung Basnet khushboo gurung Satya Raj Paudel Qingguo Zhang Plastic Surgery Hospital of Chinese Academy of Medical Science Peking Union Medical College Beijing China Nepal Plastic Cosmetic and Laser Center Kathmandu Nepal

Objectives: The objective of this study is to evaluate donor-site morbidity after costal cartilage harvest for microtia reconstruction. Methods: A total of 70 patients who underwent autologous costal cartilage harvest for microtia reconstruction from March 2008-March 2009 were included. Anterior chest wall deformity was evaluated with chest topography, and scar quality at baseline and at 6-months follow-up, and final outcomes analyzed with SPSS. Results: In 70 patients, 52 (74%) were male, 18 (26%) were female, and altogether 40 (57%) patients developed deformity. At 6-month follow-up, the incidence of anterior chest wall deformity was highest at 80% in Block-III, and least at 0% in Block-I. The 6 - 10 years age group was the largest group at 84% (21), and also with highest incidence of deformity in association to Block-IV harvest at 83%. The incidence of donor-site deformity was higher in female gender at 66%, and 54% in males. But in the sub-group, male had higher incidence of deformity at 75% in both Block-III, and Block-IV when compared to the respective females. The 120 - 135 cm height group had the highest deformity at 67% with Block-IV costal cartilages harvested. At the three measurement points: 1) xiphisternum, 2) intersecting points between PSL and LCM, and 3) intersecting points between MCL and LCM, significant differences (mean) were observed in chest circumference from baseline to 6-month follow-up, and between the left and right chest hemi-circumference (postoperatively). Acceptable donor-site scar was observed in all but 3% (2) developed hypertrophic scar. Conclusion: The development of chest wall deformity was observed when more than one costal cartilage was harvested, particularly the 6th (complete), 7th, 8th block. Therefore, to minimize the deformity, we recommend harvesting only the necessary amount of cartilage, and at the lowest level possible to avoid injury of costochondral junction. Additionally, age, height, gender and chest development are

关键词： Chest Wall Autologous Costal Cartilage Deformity Microtia

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A Comparative Study in the Outcome of Primary Asian Blepharoplasty with and without Fat Removal

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Modern Plastic Surgery 2023年第2期13卷 53-62页

作者： Surendra Jung Basnet Krishna Kumar Nagarkoti khushboo gurung Sudeep Amatya Srijana KC Department of Plastic Surgery Annapurna Neurological Institute and Allied Sciences Maitighar Kathmandu Nepal Nepal Plastic Cosmetic and Laser Centre Dhobighat-Ringroad Lalitpur Nepal

Background: Asian Blepharoplasty (AB) is one of the most commonly performed aesthetic procedures today. Despite the increasing demand for AB and advancements in surgical techniques, creating an optimal upper eyelid crease remains difficult. This study aimed to determine whether removing the preaponeurotic fat pad (PAF) had any effect on the revision surgery rates following primary Asian blepharoplasty. Methods: A retrospective comparative analysis was conducted on patients who underwent primary AB between January 2016 and December 2020. Patients were divided into PAF removed and PAF not removed groups. The outcomes in the groups were compared by the frequency of revision surgery following primary AB using the chi-square test (p Results: The study included 480 patients, 442 (92%) female and 38 (8%) male, and the final outcome was evaluated after 6 months postoperatively. 412 (86%) patients were observed to have PAF pads intraoperatively, while 68 (14%) had minimal/no PAF pads. In total, 115 (24%) patients underwent revision surgery, of whom 31 (27%) had PAF removed, 66 (57%) had PAF not removed, and 18 (16%) had minimal/no PAF noted. When compared to the PAF not removed group, the PAF removed group showed a significantly lower frequency of revision surgery between the two groups of patients (p = 0.0001). Conclusion: In the final outcome, not removing the PAF in primary AB indicated a strong association with an increase in revision surgery. The removal of PAF in primary AB showed a better overall outcome and patient satisfaction.

关键词： Asian Blepharoplasty Double Eyelid Preaponeurotic Fat Supra Tarsal Crease

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Diversity-accuracy assessment of multiple classifier systems for the land cover classification of the Khumbu region in the Himalayas

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Journal of Mountain Science 2022年第2期19卷 365-387页

作者： Charisse Camacho HANSON Lars BRABYN Sher Bahadur gurung Geography Programme University of WaikatoPrivate Bag 3105Hamilton 3240New Zealand Central Department of Geography Tribhuvan UniversityTU RdKirtipur 44618Nepal

Land cover classification of mountainous environments continues to be a challenging remote sensing problem,owing to landscape complexities exhibited by the *** study explored a multiple classifier system(MCS)approach to the classification of mountain land cover for the Khumbu region in the Himalayas using Sentinel-2 images and a cloud-based model *** relationship between classification accuracy and MCS diversity was investigated,and the effects of different diversification and combination methods on MCS classification performance were comparatively assessed for this *** present ten MCS models that implement a homogeneous ensemble approach,using the high performing Random Forest(RF)algorithm as the selected *** base classifiers of each MCS model were developed using different combinations of three diversity techniques:(1)distinct training sets,(2)Mean Decrease Accuracy feature selection,and(3)‘One-vs-All’problem *** base classifier predictions of each RFMCS model were combined using:(1)majority vote,(2)weighted argmax,and(3)a meta RF *** MCS models reported higher classification accuracies than the benchmark classifier(overall accuracy with 95% confidence interval:87.33%±0.97%),with the highest performing model reporting an overall accuracy(±95% confidence interval)of 90.95%±0.84%.Our key findings include:(1)MCS is effective in mountainous environments prone to noise from landscape complexities,(2)problem reduction is indicated as a stronger method over feature selection in improving the diversity of the MCS,(3)although the MCS diversity and accuracy have a positive correlation,our results suggest this is a weak relationship for mountainous classifications,and(4)the selected diversity methods improve the discriminability of MCS against vegetation and forest classes in mountainous land cover classifications and exhibit a cumulative effect on MCS diversity for this context.

关键词： Multiple classifier system Ensemble diversity Google Earth Engine Land Cover Classification Himalayas Random Forest

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How Himalayan communities are changing cultivation practices in the context of climate change

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Regional Sustainability 2023年第4期4卷 378-389页

作者： Ashma SUBEDI Nani RAUT Smriti gurung Department of Environmental Science and Engineering Kathmandu UniversityDhulikhelKavre45200Nepal

Climate change can have significant impacts on crop yields and food *** study assessed the linkages between climate change and crop yields to obtain a better understanding on the drivers of food *** study was conducted in Pasagaun village of Lamjung District in Nepal,where household surveys and focus group discussions(FGDs)were used to collect data including crop cultivation,irrigation facilities,and adaptation ***,climate data(temperature and precipitation)from 1992 to 2020 were collected from the Khudi Bazar meteorological station and crop yield data were obtained from the Agri-Business Promotion and Statistics *** analysis of temperature and precipitation was conducted using MannKendall trend test and Sen’s slope method,and the results showed an increase in the average temperature of approximately 0.02℃/a and a decrease in the annual precipitation of 9.84 mm/*** cultivation of traditional varieties of rice and foxtail millet(Kaguno)has ***,there was no significant impact of the maximum temperature on the yield of rice and maize,the regression analysis revealed that there are negative relationships between rice yield and annual minimum temperature(r=-0.44),between millet yield and annual precipitation(r=-0.30),and between maize yield and annual minimum temperature(r=-0.31),as well as positive relationship between rice yield and annual precipitation(r=0.16).Moreover,average rice yield and millet yield have decreased by 27.0% and 57.0% in 2000-2020,*** other reasons for the decrease in crop yield such as the lack of irrigation facilities,out-migration of farmer,and increased pest infestation,respondents have adopted adaptation strategies(for example,shifts in cultivation time and changes in crop types)to minimize the impacts of climate *** investigation and community-based farming education are needed to understand and alleviate the harmful impacts of climate change on crop yield,

关键词： Climate change Crop yield Adaptation strategies Farming practices Food security Nepal

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China’s Development Support to Nepal through the BRI:Prospects and Challenges

China’s Development Support to Nepal through the BRI:Prospe...

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作者： Apil gurung 四川大学

学位级别：硕士

尼泊尔作为一个内陆国家,也是一个发展中国家。其位于两个想成为世界大国的地区大国之间,但并未在社会与经济上把握住“发展浪潮”。尼泊尔经济严重依赖进口基本的必需品,比如原油、盐与机械。其地理特征为:北面的喜马拉雅山脉在中国与... 详细信息

尼泊尔作为一个内陆国家,也是一个发展中国家。其位于两个想成为世界大国的地区大国之间,但并未在社会与经济上把握住“发展浪潮”。尼泊尔经济严重依赖进口基本的必需品,比如原油、盐与机械。其地理特征为:北面的喜马拉雅山脉在中国与尼泊尔之间制造了天然屏障;而基于1950年双方协议,南面的平原则在印度与尼泊尔间制造了一条开放的通道。几十年来,尼泊尔严重依赖印度的支持与贸易。中国如今正在打通障碍,由于其拥有先进的工程技术,喜马拉雅山将无法再成为中尼联系的阻碍。最近这些年,中国已成为促进尼泊尔发展的最重要因素。众所周知,基础设施与公路、铁路互联互通是国家发展的关键。中国正在奋力做一些尼泊尔国内没人敢做的事情:建设穿过喜马拉雅山脉的基础设施。中国的“一带一路”倡议被支持者赞为经济增长、社会发展与区域合作的催化剂,其目标是提升全球的基础设施、工业化及通联度。尼泊尔看到了借助“一带一路”倡议通过陆地与世界进行连接的前景。尼泊尔想在2030年之前成为中等经济国家,“一带一路”倡议可能是实现这个目标的重要催化剂。但是尼泊尔的发展之路并不容易,现实条件使尼泊尔难以引入“一带一路”倡议的项目与投资。

关键词：发展一带一路倡议基础设施经济增长通联度尼泊尔与中国

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Effects of Compensation Management on Employee Performance:Evidence from Capital Hospital Kathmandu in Nepal

Effects of Compensation Management on Employee Performance:E...

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作者： Bandana gurung 湖南大学

学位级别：硕士

本文以尼泊尔加德满都首都医院为例,着重探讨补偿金管理对员工绩效的影响。基于员工的生产力大幅下降这一现象,研究者努力建立工作场所中员工绩效与激励之间的关系。这项研究旨在强调激励员工的重要性,以此鼓励他们提高生产力。使用数... 详细信息

本文以尼泊尔加德满都首都医院为例,着重探讨补偿金管理对员工绩效的影响。基于员工的生产力大幅下降这一现象,研究者努力建立工作场所中员工绩效与激励之间的关系。这项研究旨在强调激励员工的重要性,以此鼓励他们提高生产力。使用数据收集、访谈、管理问卷的主要和次要的来源来管理这个机制。采用SPSS软件进行描述性分析,并以此验证了研究结果。根据研究变量对研究结果进行分组,以获得所需的信息。然后根据研究结果和建议得出结论,因而能够预测员工福利和激励及其对生产力的影响。研究表明,补偿金对于提高员工的绩效和生产力具有积极的作用。人们认识到,尤其对大多数医疗保健专业人员(也包括其他员工)来说,当他们获得所在组织提供的某些补偿时,往往会更加努力地工作。然而,加德满都的大多数医疗机构并不赞成这种管理方案。首都医院就是一个例子,在这家医院里,对选定的少数人给予特别补偿。换句话说,在加德满都首都医院,员工补偿策略不是普遍的做法。因此,本文假设该医院的大多数员工由于普遍存在的选择性补偿而无法实现最佳工作状态。本研究旨在评估薪酬管理对员工绩效的影响,以加德满都首都医院为案例研究。这项研究是在尼泊尔与首都医院的工作人员进行的。Capital Hospital成立于公元2000年,是一家名为Lata诊所的诊所。它有六类工作人员完成实际和非实际工作人员。只有在患者入院时才会雇用护士和助手。由于缺乏机器,只做了一些小手术。在2001年,医院购买了一个感觉和病人的监控机器,并开始进行主要,次要和中间操作。自公元2003年以来,医院开始进行主要手术,全膝关节和髋关节置换以及脊柱外科手术。手术设定与获得的补偿之间存在着无数的关系。工人们抱怨已经工作了很多年,但却没有得到完美工作所需的补偿。士气低落导致低绩效。这家医院没有很多补偿技能。他们包括:a)基本工资/工资:这是每个昼夜,周或月结束时工人的最低工资。首都医院的工作人员抱怨说,尽管定期获得基本工资,但不会定期给予他们一些奖励。这导致了他们在医院工作的妖魔化。b)附带福利:这种好处可以提高员工的士气,并向他们灌输归属感,并促使他们为工作增添更多的精力。这是与雇主保持良好关系的结果。附带福利包括住房补贴,交通津贴,膳食和休假津贴,养老金和退休福利等。尽管在该医院工作了数年,但首都医院的工作人员抱怨没有获得这些福利。这导致了低动力,从而降低了员工的收益。雇主和雇员之间的关系必须是相互排斥的,这是一个不争的事实。雇主或企业组织的最大期望是合同雇员在实现规定的目标和目标方面最有效。这是通过制定监控员工流程和运营的良好策略来实现的。同样,雇员或雇用合同的企业组织将以不违反其原则的方式满足其需求和要求,这是雇员的期望。在大多数情况下,员工期望雇主努力促进他们的福祉和表现。这种促进员工福祉和绩效的行为只有在能够为员工提供有效工作机会的适当工具时才能实现。最重要的是,员工期望商业组织为他们提供良好的薪酬方案,使他们能够满足他们的动态需求和需求。毫无疑问,企业组织最大的主张是员工。他们可以是企业组织的进步或垮台。当他们获得适宜的工作环境以及良好的薪酬计划时,他们将努力确保业务组织的成长和成功。只有采用适当和良好的补偿方案,才能提高员工的生产力。这是让员工感到自己是公司的一部分的唯一方法。毫无疑问,许多商业组织都没有给予很多关注的补偿原则。他们并不了解这是技术人员被吸引和留在公司的唯一途径。正是由于这个原因,许多商业组织没有任何提高生产力。如果员工得到良好的补偿,员工只能尽力为公司服务。如果没有适当的补偿,员工的生产力就无法提高。换句话说,无论当时的情况如何,他们都无法向公司发挥最大作用。大多数员工都热衷于签约他们的商业组织是否会非常关注他们的需求,如退休福利,养老金,社会保障基金和带薪休假等。无可争辩的事实是,大多数员工对无法满足上述需求的商业组织不感兴趣。员工通过激励过程留在企业组织中。这种动机必须以满足员工标准,需求和利益的方式进行。动机的过程使员工对业务组织的趋势完全满意。这最终将有助于提高生产力在员工中间。但是,动机和薪酬计划必须符合组织的目标和目标。另一方面,必须理解员工的动机取决于他们如何致力于达到规定的目标。这意味着激励过程是由员工对实现组织目标的承诺而发起的。员工不能因为他们是员工而受到激励。他们只能被激励,因为他们正在为确保商业组织的成功做出贡献。因此,企业组织的管理必须采取监督员工绩效的战略措施。这将确保动力流向合适的员工。该研究解决了首都医院缺乏补偿的问题,以提高生产率。由于医院处理触及人类生活的关键服务,员工的生产力。该医院的工作人员应接受适当的补偿计划,这将使他们在向客户履行其专业授权的同时积极主动。该研究的主要目的是确定薪酬管理对员工绩效的最终产品。它将试图说明补偿计划在首都医院管理员工时所产生的影响。此外,该研

关键词： Compensation Descriptive Statistics Employees Performance Capital Hospital Kathmandu

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Overview of an early warning system for Glacial Lake outburst flood risk mitigation in Dudh-Koshi Basin, Nepal

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Research in Cold and Arid Regions 2021年第3期13卷 206-219页

作者： Sanjaya gurung Saroj Dhoj Joshi Binod Parajuli Real Time Solutions Pvt.Ltd. Lalitpur 44700Nepal Department of Hydrology and Meteorology Kathmandu 44600Nepal

Natural disasters inflict severe damage on almost the entire spectrum of social and natural habitats. This ranges from housing and shelter, water, food, health, sanitation to information and communication networks, supply of power and energy,transportation infrastructure, and others. Nepal is a risk prone country for Glacial Lake Outburst Flood(GLOF). GLOFs exist as major challenges as they repeatedly cause a heavy toll of life and property. During such a disaster, major challenges are indeed the protection of life, property and vital life-supporting infrastructure. Any delay or laxity in disaster relief can escalate the magnitude of distress for the victims. Thus, rather than trying to take curative measures, it is better to minimize the impacts of GLOF. These measures subsequently help in reducing the magnitude of death and casualties due to a GLOF event. This reduction of impact is often achieved by optimizing preventive measures. For applying necessary deterrent measures, it is essential to disseminate information about the danger beforehand. Early Warning System(EWS) is an important step for such information dissemination for GLOF disaster management and helps to anticipate the risk of disaster and disseminate information to lives at risk. It is impossible and impractical to reduce all GLOF risks, but it is possible to reduce several impacts of a GLOF through the implementation of the EWS. This paper presents the design and implementation of an EWS for monitoring potential outbursts of a glacier lake in the Dudh-Koshi Basin, Nepal.

关键词： glacier climate change early warning system glacial lake outburst flood

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Glycogen hepatopathy in type-1 diabetes mellitus: A case report

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World Journal of Hepatology 2022年第2期14卷 471-478页

作者： Yuvaraj Singh Susant gurung Maya Gogtay Internal Medicine Saint Vincent HospitalWorcesterMA 01604United States

BACKGROUND It has been studied that fluctuating glucose levels may superimpose glycated hemoglobin in determining the risk for diabetes mellitus(DM)*** non-alcoholic steatohepatitis(NASH)remains a predominant cause of elevated transaminases in Type 2 DM due to a strong underplay of metabolic syndrome,Type 1 DM can contrastingly affect the liver in a direct,benign,and reversible manner,causing Glycogen hepatopathy(GH)-with a good *** SUMMARY A 50-year-old female with history of poorly controlled type 1 DM,status post cholecystectomy several years ago,and obesity presented with nausea,vomiting,and abdominal *** vitals at the time of admission were *** physical examination,she had diffuse abdominal *** finger-stick glucose was 612 mg/dL with elevated ketones and low *** labs revealed abnormal liver studies:AST 1460 U/L,ALP:682 U/L,ALP:569 U/L,total bilirubin:0.3mg/dL,normal total protein,albumin,and prothrombin time/international normalized ratio(PT/INR).A magnetic resonance cholangiopancreatography(MRCP)demonstrated mild intra and extra-hepatic biliary ductal dilation without evidence of *** subsequently underwent a diagnostic ERCP which showed a moderately dilated CBD,for which a stent was *** for viral hepatitis,Wilson’s Disease,alpha-1-antitrypsin,and iron panel came back *** to waxing and waning transaminases during the hospital course,a liver biopsy was eventually done,revealing slightly enlarged hepatocytes that were PAS-positive,suggestive of glycogenic *** treatment of hyperglycemia and ensuing strict glycemic control,her transaminases improved,and she was *** With a negative hepatocellular and cholestatic work-up,our patient likely had GH,a close differential for NASH but a poorly recognized ***,first described in 1930 as a component of Mauriac syndrome,is believed to be due to glucose and insulin levels *** echo

关键词： Glycogen Mauriac Hepatic Steatosis Diabetes Type 1 Case report

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