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Objective:To investigate the effect of withdrawal time on postpartum liver function in pregnant women receiving tenofovir disoproxil fumarate (TDF) therapy for blocking mother-to-child transmission of HBV.Methods:A prospective study was conducted in Hangzhou First People’s Hospital from June 2016 to August 2018. A total of 84 pregnant women with HBsAg and HBeAg positive were enrolled and divided into two groups according to simple randomized grouping method with 42 cases in each group. In group A TDF was withdrawn immediately after delivery and in group B TDF was withdrawn 12 weeks after delivery. Finally, 66 patients completed the follow-up for 24 weeks postpartum, 35 cases in group A and 31 cases in group B. All patients were administered TDF from week 24-28 of pregnancy. HBV DNA loads and ALT levels were regularly measured and compared. Multivariate logistic regression was used to explore the risk factors of postpartum ALT flare. SPSS 26.0 statistical software was used for statistical processing.Results:Compared with the baseline levels, the HBV DNA loads at 16 weeks postpartum had no significant changes in both groups( Z=-0.742 and -1.891, both P>0.05). Postpartum ALT flare was observed in 21 of the 66 patients, 9 cases (25.71%, 9/35) in group A, and 12 cases (38.71%, 12/31) in group B ( χ2=1.280, P>0.05); and there was no significant difference in the severity of postpartum ALT flare between the two groups ( χ2=0.527, P>0.05). Binary logistic regression analysis showed that increased ALT level during pregnancy was an independent risk factor of postpartum ALT flare ( OR=13.75, 95% CI 1.49-126.85, P<0.05). Conclusions:When TDF was used for preventing mother-to-child HBV transmission, withdrawal at different times after delivery had no effect on postpartum liver function. ALT flare during pregnancy is a risk factor for postpartum ALT flare, so TDF should be discontinued carefully and liver function should be closely monitored postpartum for such patients.
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Objective To evaluate the efficacy and safty of antiviral treatment for chronic hepatitis B ( CHB ) patients in second trimester of pregnancy.Methods Seventy-nine CHB patients in second trimester of pregnancy were collected from Hangzhou First People’ s Hospital and Xixi Hospital of Hangzhou during January 2010 to December 2013.Patients were divided into antiviral treatment group ( n=47) and the control group (n=32) according to their own wishes.Patients in antiviral treatment group were given lamivudine or telbivudine treatment plus hepatoprotective medication, while those in control group were only given hepatoprotective medication.All pregnant women were observed for 12 weeks after childbirth and the neonates were followed-up for 6 months after birth.The liver function, HBV DNA loads, HBV serological markers were measured;adverse effects during pregnancy, blocking rates of mother-to-child transmission and the growth of neonates were documented.t test or Chi-square test was used for statistical analysis.Results Alanine aminotransferase ( ALT) normalization rate and HBV DNA negative rate in antiviral treatment group before childbirth were 88.6%(39/44) and 84.1%(37/44) , while those in the control group were 60.0%(18/30) and 0 (χ2 =8.27 and 50.46, P0.05).No patient in antiviral treatment group terminated pregnancy due to abnormal liver function or adverse effect of drugs, while 2 out of 30 patients (6.7%) in the control group terminated the pregnancy, but the difference between two groups was not of statistical significance (χ2 =1.01, P >0.05).Mother-to-child transmission of HBV was successfully blocked in antiviral treatment group, while 3 cases (11.5%) in control group were failed (χ2 =5.19, P0.05).Conclusion Antiviral treatment can improve liver function, inhibit HBV replication and reduce the risk of mother-to-child transmission, and is safe for CHB patients in second trimester of pregnancy.
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Objective To evaluate the feasibility of CT subtraction angiography of the cerebral vessels with synchronous matched mask bone elimination (MMBE) technique, and to compare the imaging quality of MMBE with that of volume computed tomographic digital subtraction angiography (VCTDSA). Methods Vascular Vascular model was scanned with 64-slice spiral CT. Synchronous and asynchronous scans were independently performed for 10 times without contrast medium injection. ②Then with contrast medium injection, the same scans mentioned above were repeatedly performed each for 5 times. The imaging quality of MMBE was analyzed, which were reformatted and displayed with 3D volume rendering (VR) and maximum intensity projection (MIP). CT value of the overall view was measured on subtracted images (without contrast medium). Two sets of bone masks were extracted for subtraction and the imaging quality was evaluated (without contrast medium). Also the imaging quality of VCTDSA was compared with that of synchronous MMBE. Results With synchronous and asynchronous scan,imaging quality of MMBE was rated grade Ⅱ in 13 and grade Ⅲ in 2 times. There was no significant difference in the average CT value of subtracted images between the two methods(P>0.05). With synchronous scan, imaging quality of subtracted bone mask was rated gradeⅠ in 10 times. While with asynchronous scan, 1 time was grade Ⅰ, 8 were grade Ⅱ and 1 time was grade Ⅲ. The imaging quality of synchronous MMBE was rated grade Ⅱ in 13 times, grade Ⅲ in 2 times. For VCTDSA, the imaging quality was rated grade Ⅰ in 15 times. Conclusion Synchronous MMBE is a feasible imaging method for evaluation of cerebral vessels. The subtracted image quality is significantly improved with this technique. Imaging quality of VCTDSA is still superior to that of synchronous MMBE.
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Purpose To describe the normal appearances of skull on 3D-reconstruction of Multi-slice CT in adult.Materials and Methods 130 patient data of Volume CT digital subtraction angiography (VCTDSA) with cephalocervical and cephalic vessel that were checked at our hospital from May to July 2009 were analyzed.All of them were subjected to 3D reconstruction of the skull by volume render (VR) and maximum intensity projection (MIP).The anatomy of skull,vascular grooves,pacchionian impressions,the types and closure status of cranial sutures were observed.Results 27 pacchionian impressions (20.77%,27/130) and 51 vascular grooves (39.23%,51/130) were detected.There were three types of the general shapes of cranial sutures:Ⅰconventional type(86.15%,112/130),Ⅱfontanelle ossification type(5.38%,7/130) and Ⅲcranial suture within a cranium (8.46%,11/130).Furthermore,Status of each suture closure were divided into five types:typeⅠcomplete closure(3.0%,16/531);typeⅡgomphosis(78.3%,416/531);typeⅢ sutural bone (7.0%,37/531);typeⅣincomplete closure(3.6%,19/531),the average width of non-closed suture was 1.41mm±0.70mm;typeⅤmixed type (8.1%,43/531).Conclusion 3D reconstruction of multi-slice computed tomography is proved to be a reliable technique capable of defining anatomy of skull.Better than MIP to displays three-dimensional structure VR,but to display cranial sutures,vascular grooves,pacchionian impressions MIP is more definite and hypersensitive.Status of each suture closure may be divided into five types,and the general shapes of cranial sutures may be divided into three types.