Internal Synergy Effects of Internal Auditting and Management Accounting in Public Hospitals from the Perspective of Value Added / 中国卫生经济

According to the synergy effect theory based on value-added perspective,it analyzed the synergistic effect between internal audit and management accounting on internal control,risk management,value creation,management concept and so on.The common goal of internal audit and management accounting were to improve the level of hospital management and realize the value added.

Clinical value of serum cystatin C measurements in patients with HBV related acute-on-chronic liver failure / 中华实验和临床病毒学杂志

Objective@#To study the clinical value of serum cystatin C, neutrophil gelatinase-associated lipocalin (NGAL) and matrix metalloproteinase (MMP)-9/NGAL-1 measurements for early diagnosis of acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF).@*Methods@#This study included 102 patients with hepatitis B virus related ACLF and 31 patients with chronic hepatitis B (CHB) were enrolled as controls. Biomarkers including serum cystatin C, NGAL and MMP-9/NGAL-1 were measured twice in the patients with ACLF at admission and at the time progressed to AKI and once in the controls.@*Results@#In patients with ACLF, serum cystatin C levels was higher than that of the CHB control (t=3.609, P=0.000), whereas NGAL and MMP-9/NGAL-1 levels were lower in patients with ACLF than that of CHB controls (t=3.016, P=0.003; t=7.514, P=0.000, respectively). Thirty-three patients (32.4%) progressed to AKI during hospitalization period. In AKI group of the patients serum cystatin C levels was higher than that of non-AKI group of the patents (t=4.543, P=0.000). MMP-9/ NGAL-1 and NGAL levels were not different in patients with and without AKI (t=0.905, P=0.368; t=0.061, P=0.952). Serum cystatin C in patients with mild AKI (serum creatinine<1.5 mg/dl) and AKI serum creatinine>1.5 mg/dl were 33.59± 9.19 ng/ml and 43.32±9.02 ng/ml respectively. That was higher than that of non-AKI patients (27.94±7.93 ng/ml, P=0.022, 0.000, respectively). Serum cystatin C was the independent risk factors associated with development of AKI by a multivariate logistic regression in patients with ACLF.@*Conclusions@#Serum cystatin C measurement may contribute to more earlier diagnosis of AKI even in patients with S. creatinine<1.5 mg/dl. NGAL and MMP-9/NGAL-1 may be the biomarker of progress for ACLF.

Long-term outcomes and prognostic risk factors in patients recovered from hepatitis B virus related acute-on-chronic liver failure / 中华实验和临床病毒学杂志

Objective@#To study the long-term prognosis of the convalescent patients with hepatitis B virus (HBV) associated acute-on-chronic liver failure (HBV-ACLF).@*Methods@#A 72-month follow-up study of HBV-ACLF recovery patients recruited between January 2005 and December 2009 was performed in our hospital. According to the results of imaging examination at the first visit, the enrolled patients were divided into two groups, the liver cirrhosis ACLF (Lc-ACLF) group and chronic hepatitis B related ACLF (CHB-ACLF) group. In both groups, the occurrence of cirrhosis, decompensated cirrhosis or ACLF and hepatocellular carcinoma (HCC) were observed.@*Results@#The media time of cirrhosis formation, decompensated cirrhosis and HCC occurrence in CHB-ACLF group were 12.5, 23 and 43 months, respectively. However, the median time of LC-ACLF patients developing to decompensated cirrhosis and HCC were 7 and 14 months, which was significantly shorter than that in CHB-ACLF group (P=0.009, 0.040, with statistical significance). Furthermore, the blood chemical parameters including serum albumin (ALB), cholinesterase (CHE) and total cholesterol (TC), triglyceride (TG), as well as platelet count (PLT), the anti-viral treatment compliance and the virus mutation were significantly related to the clinical endpoint events, respectively (P<0.05). Moreover, results from the logistic regression model demonstrated that the patient age, with or without liver cirrhosis, HBV mutation and the anti-viral treatment compliance were the independent risk factors for the long-term prognosis of patients with hepatitis B associated liver failure (OR=1.035, 0.510, 2.462, respectively. P< 0.05). The cumulative risk of Lc-ACLF patients progressed to decompensate cirrhosis, acute-on-chronic liver failure or HCC was significantly higher than that of CHB-ACLF patients (χ2=21.603, 4.423, P=0.000, 0.035, respectively).@*Conclusions@#Considering the importance of patients with or without liver cirrhosis, HBV mutation and the anti-viral treatment compliance in the long-term prognosis of HBV-ACLF patients, it is necessary and important to monitor the virus mutation and anti-viral treatment compliance of HBV- ACLF patients during antiviral therapy and those processes would benefit the improvement of long term prognosis of the patients with ACLF.

Diagnosis and treatment of invasive fungal diseases in patients with severe liver diseases / 临床肝胆病杂志

Invasive fungal diseases (IFDs) are an important factor affecting the prognosis of patients with severe liver diseases, and their early diagnosis remains a challenge for clinicians. The four most commonly seen IFDs are candidiasis, aspergillosis, cryptococcosis, and pneumocystis pneumonia. We should pay attention to the risk of developing IFDs in patients with severe liver diseases during clinical management. Particularly, early diagnosis and proper treatment of IFDs are important in high-risk patients. These are vital to improving the prognosis of patients with severe liver diseases.

Clinical efficacy of direct-acting antiviral agents in treatment of patients with hepatitis C recurrence after liver transplantation / 临床肝胆病杂志

ObjectiveTo observe the clinical effect and safety of direct-acting antiviral agents (DAAs) in patients with hepatitis C recurrence after liver transplantation. MethodsFifteen patients who received liver transplantation in 302 Hospital of PLA from December 2014 to May 2015 were selected, and after treatment, the HCV RNA-positive patients were treated with DAAs. The patients with genotype 1b were treated with Harvoni (sofosbuvir 400 mg/d + ledipasvir 90 mg/d) or sofosbuvir 400 mg/d + daclatasvir 60 mg/d, and those with genotype 2a were treated with sofosbuvir 400 mg/d + ribavirin 900mg/d. The course of treatment was 12 weeks. The changes in clinical symptoms and signs and laboratory markers including routine blood test, liver function, and HCV RNA quantification were observed regularly. ResultsAmong the 15 patients with hepatitis C recurrence after liver transplantation, 14 achieved HCV RNA clearance within 1-4 weeks, and the shortest time to clearance was 5 days; one patient had a HCV RNA level of 5.6×10 IU/ml at week 4. At month 12 of treatment, all the patients achieved HCV RNA clearance, and at the end of treatment, all the patients achieved virologic response. At present, 14 patients had achieved sustained virologic response for 12 weeks, and the other patients were still in the follow-up stage; at present, 3 patients had achieved sustained virologic response for 24 weeks, and the other 12 patients were still in the follow-up stage. Side effects of the treatment were mainly headache (1 case), weakness (5 cases), and arthralgia (1 case). ConclusionDAAs can be used in the treatment of patients with hepatitis C recurrence after liver transplantation with minor side effects, tolerance, and definite curative effect. Long-term sustained virologic response requires further observation.

Clinical characteristics of 4132 patients with alcoholic liver disease / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics of patients with alcoholic liver disease (ALD).</p><p><b>METHODS</b>The records of the 302 Hospital of People's Liberation Army (Beijing, China) were searched to identify patients diagnosed with liver disease for retrospective analysis of ALD. Measurement data was summarized as mean +/- standard deviation and intergroup comparisons were made using ANOVA; count data was assessed using the chi-square test.</p><p><b>RESULTS</b>Among the total 4132 ALD cases, 97.68% were male and 2.32% were female; ages ranged from 18 to 95 years-old,with the average age being 48.11+/-10.58 years and the range of 40 to 60 years-old being the most frequently represented.Considering all patients with liver disease from 2003 to 2012,ALD cases increased over time (from 2.00% in 2003 to 5.05% in 2012). The overall ALD cases were represented by alcoholic cirrhosis (70.35%), alcoholic hepatitis (19.26%), alcoholic fatty liver (6.29%), and alcoholic liver failure (4.09%). Among the ALD patients between 40 and 60 years of age, 73.81% had cirrhosis,compared to 50.42% of ALD patients less than 40 years-old (P less than 0.001). Comparison of ALD cases in 5-year increments showed increasing trends in rates of alcoholic cirrhosis and alcoholic hepatic failure;moreover, there was an increasing annual trend in the percentage of alcoholic liver failure cases among the total cases of liver failure in our hospital.</p><p><b>CONCLUSION</b>From 2003 to 2012,our hospital admissions increased for patients with alcoholic liver disease, and the patients were primarily in the age range of 40-60 years-old. In general, incidences of alcoholic liver failure and cirrhosis increased in recent years, and cirrhosis has been common among the elderly patients with ALD.</p>

Establishment of a real-time quantitative RT-PCR assay for rapid detection of hepatitis E virus in serum / 国际检验医学杂志

Objective To establish a method for the rapid detection of hepatitis E virus (HEV)from serum samples based on fluorescence quantitative PCR.Methods (1 )One-hundred HEV sequences including our country popular three major genotypes were obtained from the GeneBank with the Vector NTI software.The proper sequence was selected to design and synthesize the primers of the fluorescence quantitation and the Taqman probe.(2)The amplification region PCR fragment was transcribed in vitro to synthesize cRNA standard,at the same time the trace serum virus lysate was introduced into a universal real-time TaqMan PCR assay.(3)10 clinical serum samples were collected from the patients with clinical hepatitis E and detected by using the established method for further verifying this method.Results This detection technique could effectively detect the serum samples in the pa-tients with genotype I and genotype IV hepatitis E positive,while the serum detection in the patients with other virus infectious dis-eases had the negative results,which verified that this RT-PCR detection technique had higher specificity and good reliability.The detection results from 10 clinical serum samples further verified that this method was rapid,convenient and sensitive with good re-peatability.Conclusion A fluorescence quantitative RT-PCR detection technique suitable for detecting main genotypes of HEV in China population is established,which can meet the demand of early and rapid diagnosis for HEV.

Epstein-Barr virus infection and expression of latent membrane protein 2A in Hodgkin's lymphoma of Uygur patients / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate Epstein-Barr virus(EBV) infection in Hodgkin's lymphoma (HL) of Uygur patients and related clinicopathological characteristics.</p><p><b>METHODS</b>EBV-encoded small RNA (EBER) was detected in 40 cases of HL and 20 cases of lymphoid reactive hyperplasia by in-situ hybridization. Expression of LMP2A in HL was investigated by immunohistochemistry.</p><p><b>RESULTS</b>EBV was detected in 26/40 (65.0%) of HL and 5/20 of lymphoid reactive hyperplasia (P < 0.05). The expression level of EBER showed significant difference among various histological subtypes of HL (P < 0.05) and between patients with and without B symptom (P = 0.02). However, no difference was found in relation to gender, clinical stage and tumor burden. The expression of LMP2A in the mixed cellularity and nodular sclerosis classical HL associated with EBV infection was 57.7% (15/26). Expression of LMP2A was not detected in lymphoid reactive hyperplasia cases.</p><p><b>CONCLUSION</b>Uyghur patients with Hodgkin's lymphoma have a high infection rate of EBV and distinct clinicopathologic characteristics.</p>

Clinical and pathological analysis of 566 patients with cryptogenic liver diseases / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the etiology, pathology, and clinical characteristics of cryptogenic liver diseases in order to develop a pathogenic profile for clinical diagnosis and therapeutic design.</p><p><b>METHODS</b>The data of the 566 patients diagnosed with abnormal liver function and who had undergone liver biopsy at our institute between January 2006 to March 2010 were retrospectively analyzed. The Chi-squared (x²) test was used to assess disease correlation with sex and the rank sum test was used to assess disease correlation with continuous data since all data had asymmetric distribution.</p><p><b>RESULTS</b>Among the 566 patients, abnormal liver function was attributed to alcoholic liver disease (n=175; 30.92%), drug-induced or environmentally-induced liver disease (n=101; 17.84%), hereditary and metabolic disease (n=93; 16.43%), infectious hepatitis disease (n=84; 14.84%), fatty liver disease (n=53; 9.36%), and autoimmune liver disease (n=30; 53.00%). Thirty patients had unknown etiology, despite liver biopsy analysis. Among these disease subgroups, there were distinct correlations with sex, age, and levels of alanine transaminase (ALT) and gamma-glutamyltransferase (GGT). The autoimmune liver disease group was correlated with sex (q=9.14, 7.435, 5.071, 9.529, and 12.5, respectively; P less than or equal to 0.01). The alcoholic liver disease group and autoimmune liver disease group were correlated with age (vs. genetic metabolic disease group: q=17.254 and 10.302; infectious hepatitis group: q=17.523 and 10.697); drug/environmentally-induced liver damage group: q=9.170 and 5.266); fatty liver group: q=7.118 and 4.661) (P less than or equal to 0.01). In addition, the alcoholic and autoimmune liver disease groups were correlated with GGT levels (vs. genetic metabolic disease group: q=8.003; infectious hepatitis group: q=4.793; drug/environmentally-induced liver damage group: q=4.404) (P less than or equal to 0.01).</p><p><b>CONCLUSION</b>Liver pathology is important for the diagnosis of cryptogenic liver diseases. Patient age, sex, and biochemistry index may facilitate diagnosis and treatment in the absence of pathology.</p>

Expression of CAS in hepatocellular carcinoma tissues and its relationship with HBV infection / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To explore whether the cellular apoptosis susceptibility (CAS) protein could serve as a pathologic marker for HCC diagnosis and the roles of CAS expression in HBV infection associated HCC.</p><p><b>METHODS</b>The expression of CAS protein in HCC and its paracarcinoma tissues, non-tumor liver cirrhosis and hepatitis tissues were detected by immunohistochemistry. Meanwhile, HBsAg, HBcAg and HBV DNA in HCC tissues with HBV infection were examined by immunohistochemistry and in situ hybridization respectively.</p><p><b>RESULTS</b>The expression of CAS protein was significantly higher in HCC than in its paracarcinomas tissues (P < 0.01), and higher in paracarcinomas tissues than in non-tumor liver cirrhosis and hepatitis tissues (P < 0.01). Poorly differentiated tumors immunochemically stained stronger than moderately or well differentiated (P < 0.01). CAS protein expression was significantly higher in HBV-infected HCC tissues than that of in non-HBV infection (P < 0.01). Meanwhile, in HBV-infected HCC tissues, the staining intensity score of CAS protein in HBV DNA positive HCC tissues was significantly higher than HBV DNA negative tissues (P < 0.05).</p><p><b>CONCLUSIONS</b>Higher expression of CAS protein is found in HCC tissues,and the intensity of CAS protein expression is related closely to tumor differentiation. We suggested that CAS protein might serve as a marker for HCC diagnosis and differentiation estimation, and deduced that CAS might play an important role in the initiation of HBV infection associated HCC through upregulating expression of CAS.</p>

Clinical analysis of 134 cases of HEV-related liver failure / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To study the clinical features of hepatitis E virus-related liver failure.</p><p><b>METHODS</b>134 patients with HEV-related liver failure were analyzed retrospectively.</p><p><b>RESULTS</b>HEV-related liver failure accounted for 8.45 percent of the total number of hepatitis E patients in the hospital. Of the 134 patients, 68 were infected with simple HEV, 66 had the superinfection with HBV. The average age of simple HEV-related liver failure patients (56.12 +/- 14.29) was higher than that of HBV superinfectiong liver failure patients (P < 0.05). The ratio of elderly patients (> or = 60 years) in simple HEV-related liver failure patients (45.59%) was significantly higher than that of the other group (13.64%, P < 0.05). The ratio of direct bilirubin/total bilirubing (0.72 +/- 0.07, 0.69 +/- 0.08), and serum alanine aminotransferase [(1250.90 +/- 1593.97) U/L, (616.26 +/- 797.62) U/L] were significantly higher in simple HEV-related liver failure patients than in HBV superinfectiong liver failure patients (P < 0.05), but the total bilirubing had no significant difference (P > 0.05). The disease outcome and stage were no-significant difference in the two groups (P > 0.05). CONCLUSION; Simple HEV-related liver failure patients may have older age, higher aminotransferase, higher ratio of direct bilirubin/total bilirubin, but disease outcome and stage were no-significant difference in the two groups.</p>

Clinical characteristics of hepatitis B virus-related acute-on-chronic liver failure patients with familial aggregation / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics of hepatitis B virus-related acute-on-chronic liver failure patients with familial aggregation.</p><p><b>METHODS</b>275 patients with hepatitis B virus--related acute-on-chronic liver failure were investigated. The patients were divided into familial aggregation and non-familial aggregation group basis on their epidemiological features. Clinical data and biochemical indicators between the two groups were analyzed statistically.</p><p><b>RESULTS</b>93 of 275 patients (33.82%) case were family aggregation. There was no significant difference compared with chronic hepatitis B patients (38.3%). The mean age of the two groups was 45.98 and 43.61 years old, respectively (P > 0.05). The rates of liver cirrhosis in family aggregation group were significant higher than non-familial aggregation group (73.91% vs 58.24%, p < 0.05). Serum total (TBil) and prothrombin activities (PTA) were no significant difference between the two groups, but ALT level in familial aggregation group was much higher (407.80 U/L vs 256.45 U/L, P 0.05).</p><p><b>CONCLUSION</b>Familial aggregation were not related to acute-on-chronic liver failure in chronic HBV hepatitis patients. But the rate of liver cirrhosis were higher in patients with familial aggregation.</p>

Analysis the relationship of HBV BCP A1762T/G1764A double mutation with HBV related acute on chronic liver failure / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To analysis the relationship between HBV BCP A1762T/G1764A double mutation with acute on chronic liver failure (ACLF).</p><p><b>METHODS</b>HBV BCP A1762T/G1764A double mutation was detected in 166 HBV chronic infection patients by nested PCR and direct DNA sequencing. The mutation rate was compared among the patients with different disease course.</p><p><b>RESULTS</b>Among 166 patients, 45 patients, 45 patients, 49 patients and 27 patients were diagnosed as chronic hepatitis B (CHB), liver cirrhosis (LC), ACLF and hepatocellular carcinoma (HCC), respectively. A1762T/G1764A double mutation rate was 40.0% (18/45), 84.4% (38/45), 73.5% (36/49) and 92.6% (25/27) respectively in different groups. However, A1762T/G1764A double mutation rate has no difference between ACLF based on CHB and LC (P = 0.502) and between patients with HBeAg positive and negative (P = 0.735). HBV DNA level (log) of patients with A1762T/G1764A double mutation was 5.68 +/- 1.36, lower than but having no significant statistic difference compared to patients without the double mutation (6.14 +/- 1.81, P = 0.075).</p><p><b>CONCLUSION</b>A1762T/G1764A double mutation has a close relationship with the progress of HBV-infection diseases, but is not specific to patients with ACLF. And patients with BCP double mutation have similar HBV DNA levels and HBeAg status with patients without the double mutation.</p>

Association between the serum HBV DNA loads normalized to hepatic parenchyma cell volume and the liver histopathologic inflammation gradings in the immune clearance phase / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the relationship between the serum HBV DNA loads normalized to hepatic parenchyma cell volume and the liver histopathologic inflammation gradings in the immune clearance phase during the natural history of hepatitis B.</p><p><b>METHODS</b>Serum HBV DNA loads were detected by fluorescence polymerase chain reaction and normalized to hepatic parenchyma cell volume. The association between normalized HBV DNA loads and liver inflammation histopathologic grade were analyzed.</p><p><b>RESULTS</b>The serum HBV DNA loads in patients with liver inflammation histopathologic grading 1, 2, 3 and 4 were 8.20*10(5)+/-9.11*10, 1.36*10(6)+/-5.96*10, 8.12*10(5)+/-8.01*10 and 2.08*10(6)+/-3.69*10 copies/ml, respectively (P more than 0.05). But the serum HBV DNA loads normalized to hepatic parenchyma cell volume in their located fibrosis stage were 9.24*10(8)+/-935, 5.33*10(9)+/-756, 1.06*10(10)+/-1770 and 3.31*10(11)+/-518 copies/ml, respectively (P less than 0.05).</p><p><b>CONCLUSION</b>The serum HBV DNA load normalized to hepatic parenchyma cell volume in patients with different fibrosis stages is associated with liver histopathologic inflammation gradings.</p>

Studies on RNase H of hepatitis B virus DNA polymerase to up-regulate the expression of cellular apoptosis susceptibility gene / 解放军医学杂志

Objective To study the activation effect of HBV RNase H protein on the transcription of cellular apoptosis susceptibility gene (CAS). Methods The promoter of DNA sequence of CAS gene was identified in GenBank by bioinformatics and amplified from HepG2 genome by PCR using sense (5′-GGTACCCGATTACATGTTGTACATGAAGG-3′) and antisence (5′-CTCGAGGCTGAGTTCCATTGCTATAG-3′) primers. As these primers contained Kpn I and Xho I recognition sites on their respective 5′-ends, the amplified DNA fragments were tested by sequencing and then subcloned into Kpn I/Xho I sites of pCAT3-Basic reporter vector by routine molecular biological methods. The reconstructed plasmid named pCAT3-CASp was identified by enzyme digestion of Kpn I/Xho I, in which the expression of chloramphenical acetyltransferase (CAT) was under the control of the promoter of CAS. The HepG2 cells were transfected by pCAT3-CASp, and then co-transfected by pCAT3-CASp and pcDNA3.1(-)-RH plasmids. At the same time, the empty pCAT3-basic and pCAT3-TXNRD1p were transfected (self-contructed by the authors) as controls. After 24h culturing, cells were collected and the expression of CAT activity was detected by ELISA according to the manufacturer′s protocol. Results The optical density of expression of CAT of pCAT3-CASp was 0.043 by ELISA, in contrast, the optical density of expression of pCAT3-Basic was 0.024. The expression of CAT in co-transfection of pCAT3-CASp and pcDNA3.1(-)-RH(0.065) was 1.5 times as higher as pCAT3-CASp plasmid (0.043), and 2.7 times as higher as pCAT3-Basic. Conclusions The CAS gene promoter identified in present study has transcription activity and HBV RNase H protein may activate the expression of CAS gene.