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Objective:To evaluate the status of T, B and NK lymphocytes in peripheral blood of patients with chronic hepatitis B virus(HBV) infection and low-level viremia after nucleos(t)ide analogue (NA) treatment and to provide ideas for solving low-level viremia.Methods:This retrospective study involved 344 patients with chronic HBV infection who had been treated with NAs. They were divided into two groups: low-level viremia group (LLV group) and complete virological response group (CVR group). Clinical data including basic information, biochemistry and coagulation test results, HBV DNA, peripheral blood lymphocyte counts, PD1 and CD28 expression by T lymphocytes, and perforin and granzyme B expression by NK lymphocytes were collected and compared between the two groups. Propensity matching analysis was performed to verify the accuracy of the results.Results:Among the 344 cases, 162 were in the LLV group and 182 in the CVR group. There were no significant differences in disease diagnosis, alanine aminotransferase (ALT), aspartate aminotransferase (AST) or albumin (ALB) level between the two groups ( P>0.05), but the differences in gender and age were statistically significant ( P<0.05). The differences in the counts and percentages of peripheral blood CD3 +, CD4 + and CD8 + T lymphocyte and CD4 + /CD8 + ratios between the two groups were not statistically significant ( P>0.05), but the expression of PD1 and CD28 by peripheral blood CD3 +, CD4 + and CD8 + T lymphocytes was higher in the LLV group than in the CVR group ( P<0.05). The count of peripheral blood CD19 + B lymphocytes in the LLV group was higher than that in the CVR group ( P>0.05), and the percentage of peripheral blood CD19 + B lymphocytes was also higher in the LLV group ( P<0.05). The count of peripheral blood CD16 + CD56 + NK lymphocytes and the expression of perforin in the LLV group were lower than those in the CVR group ( P>0.05). The percentage of peripheral blood CD16 + CD56 + NK lymphocytes and the expression of granzyme B in the LLV group were lower than those in the CVR group ( P<0.05). After propensity score matching, 108 cases in the LLV group and 108 cases in the CVR group showed no significant differences in basic information ( P>0.05); the percentage of CD4 + T lymphocytes and CD4 + /CD8 + ratio in peripheral blood T lymphocyte subsets were higher in the LLV group than in the CVR group, while the percentage of CD8 + lymphocytes was lower in the LLV group ( P<0.05); the expression of PD1 and CD28 by CD3 +, CD4 + and CD8 + T lymphocytes remained higher in the LLV group ( P<0.05); the differences in the counts and percentages of peripheral blood CD19 + B lymphocytes as well as CD16 + CD56 + NK lymphocytes between the two groups were not statistically significant ( P>0.05); no significant difference in the expression of perforin by CD16 + CD56 + NK lymphocytes was found between the two groups ( P>0.05), and the expression of granzyme B remained lower in the LLV group ( P<0.05). Conclusions:Abnormal number and function of T lymphocytes and decreased function of NK lymphocytes might be related to the development of LLV in patients with chronic HBV infection after treatment. Therefore, in addition to adjusting NAs, targeting of T and NK lymphocytes might also be a feasible measure for future LLV treatment.
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Objective:To establish a predictive model and investigate its value in evaluating short-term prognosis of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF).Methods:Patients with HBV-ACLF admitted to Tianjin Second People's Hospital and Beijing Youan Hospital, Capital Medical University from May 2015 to October 2018 were enrolled. The data of gender, age, laboratory markers at admission, model for end-stage liver disease (MELD) score and clinical complications were collected for analysis. According to the prognosis on 12-week, patients were divided into survival group and death group. Univariate analysis and binary Logistic regression analysis were used to test the risk factors for short-term prognosis of the patients with HBV-ACLF, and a prediction model was established. The accuracy of each index and the established model were verified by the receiver operating characteristic (ROC) curve.Results:A total of 148 patients with HBV-ACLF were enrolled in the study, 91 cases survived while 57 cases died during the 12-week period. The age, total bilirubin (TBIL), neutrophil percentage (NEUT%), hepatitis B surface antigen (HBsAg), MELD score of death group were higher than those of survival group [age (years old): 50.00 (44.50, 55.00) vs. 43.00 (34.00, 53.00), TBIL (μmol/L): 310.30 (240.70, 405.70) vs. 266.40 (184.20, 360.20), NEUT%: (74.52±13.05)% vs. (66.64±12.35)%, lg HBsAg (kU/L): 3.72 (3.29, 3.92) vs. 2.97 (2.49, 3.78), MELD score: 24.27 (19.71, 27.40) vs. 21.88 (18.83, 24.38), all P < 0.05], while albumin (ALB), total cholesterol (CHO), prothrombin activity (PTA) and alpha-fetoprotein (AFP) were lower than those of survival group [ALB (g/L): 29.80 (27.05, 31.05) vs. 30.80 (28.00, 33.90), CHO (mmol/L): 1.98 (1.50, 2.38) vs. 2.49 (2.05, 3.01), PTA: (30.37±7.09)% vs. (32.94±6.03)%, AFP (μg/L): 21.54 (9.28, 51.54) vs. 66.16 (24.50, 152.80), all P < 0.05]. Logistic regression analysis showed that NEUT%, HBsAg and AFP were independent risk factors for short-term prognosis of patients with HBV-ACLF [odds ratio ( OR) was 77.843, 1.439, 0.995, respectively, all P < 0.05]. According to the results of regression analysis, the NHA-ACLF model (NEUT%+HBsAg+AFP) was established. The formula was logit (NHA-ACLF) = -5.441+5.688×NEUT%+0.430×lg HBsAg-0.005×AFP. The area under the ROC curve (AUC) of the NHA-ACLF model for pred HBV-ACLF patients was 0.790, which was better than NEUT% (AUC = 0.696), lg HBsAg (AUC = 0.670), AFP (AUC = 0.703) and MELD score (AUC = 0.640). When the cut-off value of NHA-ACLF model score was 0.459, the sensitivity was 73.7%, and the specificity was 79.1%. Conclusions:NEUT%, HBsAg and AFP are independent predictive indicator for short-term prognosis in patients with HBV-ACLF. Compared with MELD score, the risk assessment model NHA-ACLF has a greater value in predicting the short-term prognosis of patients with HBV-ACLF.
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This paper aimed at studying the physical and chemical properties, general examination and contents of someeffective components of Erratum Mongolia, and to provide scientific basis for the establishment of the quality standard ofvenerates Mongolia. The physical and chemical properties of venerates were identified by microscope and thin layerchromatography, and the general examination of venerates was studied with reference to the appendix of the 2010 editionof People's Republic of China Pharmacopoeia, and the main characteristic components and the active components inErratum were analyzed by HPLC. The content was analyzed and compared. The characters and microscopic identificationconfirmed that all the 7 batches of samples were venerates. The TLC identification was used as the control product ofhermitage, Erratum and restorative. The test products showed the same color spots in the corresponding position of thecontrol products. The spots were clear and the separation degree was good; the water and extracts of the different batch ofvenerates were examined by general terms. The content of ash in the Erratum collected from different regions was notsignificantly different (5.74-6.98％) . The content of the main active ingredients (hermitage) in Erratum from differentareas of the same plant is compared for the first time. The method is simple and reproducible. It provides a scientificbasis for improving the quality standard of Erratum Mongolia, the safe and rational application and the furtherdevelopment and production.
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Liver failure belongs to the category of jaundice and yellow plague in the traditional Chinese medicine. It has something in common with the etiology and pathogenesis of jaundice. In Synopsis of Prescriptions of the Golden Chamber, the theories, methods, prescriptions and drugs for jaundice are systemically explained, and the related therapeutic principles and methods are proposed, that have profound influence on the treatment of jaundice for later generations. From the point of view upon the treatment of jaundice in Synopsis of Prescriptions of the Golden Chamber, the treatment of liver failure is discussed in this article. The author thinks that the "dampness, heat and blood stasis" are the pathological bases of jaundice, but the heat phenomenon is more obvious in the course of the disease, and at later stage"deficiency" is significant; the basic principle of the treatment of liver failure should first comply with clearing away heat and promoting diuresis, using the drugs heavily for heat-clearing and detoxifying to block the disease as the main line especially at the beginning stage, drugs for activating blood circulation and removing blood stasis are applied from the beginning to the end of the treatment, and in the mean time, regulation of spleen and stomach and tonification of spleen and kidney should be paid attention to especially at the later stage. The application and skill of making Yinchenhao decoction for treatment of jaundice is also important.
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Liver failure belongs to the category of jaundice and yellow plague in the traditional Chinese medicine. It has something in common with the etiology and pathogenesis of jaundice. In Synopsis of Prescriptions of the Golden Chamber, the theories, methods, prescriptions and drugs for jaundice are systemically explained, and the related therapeutic principles and methods are proposed, that have profound influence on the treatment of jaundice for later generations. From the point of view upon the treatment of jaundice in Synopsis of Prescriptions of the Golden Chamber, the treatment of liver failure is discussed in this article. The author thinks that the "dampness, heat and blood stasis" are the pathological bases of jaundice, but the heat phenomenon is more obvious in the course of the disease, and at later stage"deficiency" is significant; the basic principle of the treatment of liver failure should first comply with clearing away heat and promoting diuresis, using the drugs heavily for heat-clearing and detoxifying to block the disease as the main line especially at the beginning stage, drugs for activating blood circulation and removing blood stasis are applied from the beginning to the end of the treatment, and in the mean time, regulation of spleen and stomach and tonification of spleen and kidney should be paid attention to especially at the later stage. The application and skill of making Yinchenhao decoction for treatment of jaundice is also important.
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Objective To evaluate the therapeutic value of alpha-fetoprotein (AFP) and cholinesterase (ChE) in patients with hepatitis B virus related acute onset chronic liver failure (HBV-ACLF). Methods A case-control observation was conducted. Sixty-seven patients with HBV-ACLF admitted to Tianjin Second People's Hospital from January 2009 to October 2015 were enrolled. According to the diagnostic criteria of ACLF, the patients were divided into early, middle, and late groups, and alternatively, according to the outcome, they were divided into survival group and death group. Serum samples were collected after 0, 2, 4, 8 weeks to determine the value of AFP and ChE and analyze the value of AFP and ChE in reflecting the changes during HBV-ACLF progression. The differences in AFP and ChE between the survival group and the death group were compared. The prognostic values of AFP and ChE for HBV-ACLF patients were evaluated. Results Among 67 patients, there were 24, 24, and 19 patients in the early, middle and late stage, respectively, and there were 0, 9, 18 deaths at 8 week. With the advance of HBV-ACLF, the levels of both AFP and ChE were decreased in the early, middle, and late stage, with the AFP value of 40.205 (14.663, 90.550), 23.445 (8.233, 64.213), 8.990 (6.120, 14.340) μg/L (F = 36.149, P = 0.000) and the ChE value of (4.217±1.408), (3.619±1.200), (2.503±1.248) kU/L, respectively (F = 19.575, P = 0.000). In the death group, the levels of serum AFP at 0, 2, 4, 8 weeks were significantly lower than those in survival group [μg/L: 21.540 (7.670, 50.470) vs. 60.680 (16.383, 146.100), 10.560 (6.170, 20.100) vs. 60.090 (27.662, 100.700), 8.750 (3.045, 10.105) vs. 51.875 (16.778, 88.833), 3.900 (2.120, 7.660) vs. 20.400 (12.950, 50.430), P < 0.05 or P < 0.01]. The levels of serum ChE at 2, 4, 8 weeks in the death group were significantly lower than those in the survival group (kU/L: 3.206±1.480 vs. 4.008±1.227, 2.893±1.478 vs. 4.140±1.236, 2.948±1.355 vs. 4.329±1.390, P < 0.05 or P < 0.01). The levels of AFP in 67 patients were 30.100 (10.100, 90.100) μg/L, and ChE was (3.685±1.382) kU/L at 2 weeks, and they showed no correlation between AFP and ChE according to the linear correlation analysis (r = 0.082, P = 0.508), suggesting that AFP and ChE could be used as two independent prognostic factors for HBV-ACLF patients. It was showed by receiver operating characteristic curve (ROC) analysis that the area under the curve of AFP (AUC) was 0.847 (P = 0.000), while the AUC of ChE was 0.681 (P = 0.012). The highest values of Youden index and the maximum effectiveness of testing were obtained when AFP and ChE reached 20.520 μg/L and 2.924 kU/L, respectively, with the sensitivity and the specificity of AFP being 85.0% and 77.8%, respectively, and of ChE being 77.5% and 59.3%, respectively. When using the value of AFP ≥ 20.520 μg/L combined with the value of ChE ≥ 2.924 kU/L, the sensitivity for predicting HBV-ACLF outcome was 65.9%, and its specificity was 91.0%. Conclusion Both AFP and ChE were helpful in providing accurate information for the progression and prognosis of HBV-ACLF patients due to the facts that their values were less interfered by the clinical treatment and that they have higher specificity.
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BACKGROUND:The cultivation of mammary gland stem cel s is of great significance for the development of mammary gland and breast cancer. OBJECTIVE:To seek an easy method to isolate and culture mammary gland stem cel in vitro, and verify the safety of cel s. METHODS:Mammary epithelial cel s were isolated from normal tissues surrounding breast cancer, and CD49f-and EPCAM-positive cel s were sorted using flow cytometry fol owed by surface marker analysis and cel colony formation ability analysis. Afterwards, real-time fluorescent quantitative PCR was used to detect C-erbB-2 and Maspin mRNA expression in mammary gland stem cel s, breast cancer tissues and normal tissues surrounding breast cancer. RESULTS AND CONCLUSION:Human mammary gland stem cel s were successful y cultured and highly expressed CD49f and EPCAM, with the presence of mixed colony, pleural epithelial cel colony, and myoepithelial cel colony. c-erbB-2 was lowly expressed while Maspin highly expressed in mammary gland stem cel s. Our experimental findings indicate that the mammary gland stem cel s derived from normal tissue surrounding breast cancer have biological safety.
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Objective To evaluate the diagnostic efficiency of fiberoptic ductoscope versus galactography for nipple discharge. Methods Literatures on comparing the diagnostic value of galactography with fiberoptic ductoseope (FDS) on the nipple discharge were searched from the Cochrane library, Evidence based medicine (EBM ),PubMed,China Vip database, and 8 studies were intaked. Then the data was analyzed by software Metadisc1.4 and Review Manager5.1. Results There are 1170 patients in the 8 studies. The pooled estimates for sensitivity of FDS and galactography was 82%, 78%, and the pooled estimates for specificity was 51%, 50%, respectively. The weighted AUC (area under curve) was 0.776, 0.705, Q*values was 0.715, 0.657, respectively. The sensitivities and specificity of the 2 methods were not significantly different. The overall diagnostic efficacy of FDS was better than that of galactography. Conclusion FDS is better than galaetography in the diagnostic value of nipple discharge.
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Objective:To compare the effects of different anesthesia methods on stress hormones and hemodynamic changes in the patients with gynecological laparoscopic surgery. Methods:Retrospective analysis was carried out. Totally 145 patients with gynecolog-ical laparoscopic surgery were divided into two groups according to the anesthesia method, the control group with 72 cases was given routine remifentanyl propofol intravenous anesthesia, and the observation group with 73 cases was given routine propofol isoflurane com-posite anesthesia. Such hemodynamic indices as SBP, DBP and HR, and plasma NE, E, cort and AT II levels at different time points in the two groups were studied and compared, and adverse drug reactions were also observed in the two groups. Results:The BP and HR at T2 and T3 time point in the two groups were significantly lower than those at T0 time point (P<0. 05), and those in the obser-vation group were lower than those in the control group at the same time point(P<0. 05). The levels of NE, E, cort and ATⅡat T2 and T3 time point in the two groups were significantly higher than those at T0 time point (P<0. 05), while the increase in the observa-tion group was lower than that in the control group (P<0. 05). The incidence of adverse drug reactions (ADR), such as respiratory depression, hypertension, bradycardia and so on, and the total incidence of ADR in the observation group were both lower than those in the control group (P<0. 05). Conclusion:Compared with remifentanyl propofol intravenous anesthesia, propofol isoflurane composite anesthesia can keep the hemodynamic stability more effectively and reduce the stress reaction with fewer ADR and promising safety, which is worthy of wider application in clinics.
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Objective To compare the efficacy of Graves disease animal models induced by thyroid stimulating hormone receptor (TSHR) plasmid DNA (pcDNA3.1-TSHR) and by TSHR A subunit recombinant adenovirus(Ad-TSHR289),and to investigate the influence of duration for preparing animal model induced by Ad-TSHR289 on Graves hyperthyroidism and its related indices.Methods The plasmid group and the adenovirus group were set up respectively.The plasmid group:21 female BALB/c mice were randomly divided into model group (n =12) and control group (n =9).The model group were injected intradermally with pcDNA3.1-TSHR 50 μg,once every 3 weeks,totally 3 times.Then 4 weeks after the last immunization,the mice were euthanized to obtain blood for testing TSHR antibody (TRAb),total T4,and thyroid tissue for histological examination.The controls were injected with the same dose of pcDNA3.1 in the same way.The adenovirus group:52 female BALB/c mice were divided into 10-week model group (n =8),14-week model group (n =10) and 18-week model group (n =8),and the respective controls (n =8,n =10,n =8) were set up.All model groups were injected intramuscularly with Ad-TSHR289,three times at three weekly intervals.Then the mice were euthanized at 4,8 and 12 weeks to test TRAb,total T4 level and to observe the change of thyroid histology.The controls were treated with the same dose of Ad-lacz in the same way.Another 8 mice were scheduled to test the dynamic variation of TRAb before and after the 3 times immunization.Results In the plasmid model group,only two of 12 mice developed weak antibody responses against TSHR,and no elevated total T4 level and no hyperplasia changes of thyroid were observed.In the 10-week model group,all mice had high level TRAb [(807.65 ± 136.33)U/L,Six-eighths mice had hyperthyroidism exhibited hyperplasia changes.In the 14-week model group,the TRAb level [(650.12 ± 192.88) U/L]and the incidence of hyperthyroidism (3/10) were lower than those in 10-week group.Histologically,the degree of thyroid hyperplasia lightened to a small extent,but its positive rate did not decline.In the 18-week model group,only 2 of 8 mice displayed slightly elevated TRAb level,and no mice showed increased total T4 level.Additionally,thyroid tissues of 2 mice were mildly abnormal.Compared with the model groups at different time,the change of antibody levels of the mice for TRAb dynamic observation exhibited the similar trend.Conclusions Being good at repeatability and high incidence of hyperthyroidism,the animal model of Graves disease induced by Ad-TSHR289 is still an ideal research tool presently.The duration of model ean be maintained 18 weeks,and 10 weeks is the best period to snstain characteristic of Graves disease.
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OBJECTIVE To find out relative risk factors of nosocomial infection in order to provide the evidence for taking measures to effectively control and reduce the infection rate.METHODS A retrospective survey was carried out on 19 535 cases of hospitalized patients during Jan and Dec of 2006.RESULTS In 2006,the nosocomial infection patients were 389,and the nosocomial infection rate of hospitalized patients was 1.99%;the sections with higher infection rates were respectively as follows: ICU,department of neurology,department of oncology,department of nephrology and department of pediatrics;the infected part of the body mainly occurred in respiratory tract,urinary tract,and gastrointestinal tract.In the nosocomial infection,132 strains were detected and its main pathogens were Gram-negative bacteria(52.27%).CONCLUSIONS The effective measures to control and prevent nosocomial infection rates should involve rational use of antibiotic drugs,increasing in the rate of delivering samples,shortening the period of hospitalization,decreasing in the aggressive operations and strengthening inspections of key departments.
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OBJECTIVE To investigate the current situation and rationality of clinical usage of antibacterial drugs in our hospital and to find out corresponding supervision measures. METHODS According to the same method and criterion,3343 medical records of discharged patients in 14 departments were investigated retrospectively by utilizing the designed questionnaire. RESULTS The total application rate of antibacterial drugs was 60%,and the rate of preventive usage took up 41% of the total application rate,the application rate of cephalosporins was the highest,and that of quinolones was the next.For the combined usage of drugs,1 150 patients were treated with one drug,730 were treated with two drugs,and 99 were treated with more than three drugs.The treatment period of 1 086 patients was less than 7 days. CONCLUSIONS The usage of antibacterial drugs should be supervised more intensively and the training for medical personnel be strengthened to improve their knowledge of using antibacterial drugs,in order to achieve the rational usage of antibacterial drugs.
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OBJECTIVE To investigate the clinical manifestation and the reasons of misdiagnosis of allergic rhinitis patients with postnasal drip. METHODS The clinical data of 3 patients with allergic rhinitis who had the symptom of postnasal dr ip and were mi sdiagnosed were s tudied. RESULTS The three patients to be misdiagnosed as chronic sinusitis treated by antibiotics drugs, post cold cough syndrome without any treatment, and chronic rhinitis treated with partial inferior turbinectomy. The 3 patients were diagnosed allergic rhinitis and cured with budesonide nasal spray. CONCLUSION The reasons of misdiagnosis are listed as follows. 1. The clinic doctors don't listen to the patient's complaint comprehensively and get incorrect information. 2. The symptoms of allergic rhinitis are not typical. 3. Postnasal drip is the main complaint and cause irritable cough, pharyngeal itching, globus. 4. The symptoms of allergic rhinitis are covered by other simultaneous diseases.
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OBJECTIVE To investigate the hand hygiene situation of medical staff in order to carry out supervising and monitoring on their hand hygiene pertinently.METHODS The hand hygiene monitoring data from Jan 2004 to Dec 2007 were retrospectively analyzed.RESULTS The total qualified rate of medical staff hand hygiene was 91.4%;the qualified rate of hand hygiene monitoring for doctors was 89.8%,and it was 96.7% for nurses;the qualified rate of medical staff working in the type-Ⅱenvironment was 93.6%,and the qualified rate of those working in the type-Ⅲ environment was 95.2%;for medical students and refresher doctors,it was 81.0 %.CONCLUSIONS The medical staff still lack the knowledge on hands' cleanliness and disinfection.The supervisors should strengthen monitoring on hand hygiene;some new regulations should be established and practiced,and the hand washing equipments should be updated;the medical staff's compliance of hand hygiene should be improved,and their conceptions of hand hygiene should be strengthened;all-sided originalities on hand hygiene should be carried out in order to reduce the occurring of hospital infections.
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Objective: To study the interaction anxiousness status of new recruits in Chinese People's Armed Police Force.Methods: 981 recruits were assessed with Interaction Anxiousness Scale(IAS).Results: The average score of IAS of recruits was 42.93?7.35.There was higher social anxiety level in the recruits who graduated from junior middle school than those who graduated from senior high school.There were respectively 37.5% and 39.3% of recruits feeling uneasy when they were in contacting with strangers and talking with supervisors.There were 85.5% of recruits lacking confidence.Conclusion: The level of interaction anxiousness of new recruits was relatively high,it embodied contacting with strangers,talking with supervisors and lacking confidence.