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Objective To investigate the epidemiological features and antiviral response of patients with genotype 6 chronic hepatitis C (CHC) in Guangxi, China. Methods A total of 97 patients with genotype 6 CHC who were admitted to The First Affiliated Hospital of Guangxi Medical University from December 2012 to December 2020 were enrolled, among whom 62 patients were given antiviral therapy. The 62 patients receiving antiviral therapy were divided into interferon group with 22 patients and direct-acting antiviral agent (DAA) group with 40 patients. Related data were collected, including general demographic data, HCV RNA, liver function, routine blood test results, and renal function. The chi-square test was used for comparison of categorical data between groups. Results Among the 97 patients, there were 69 male patients (71.1%) and 28 female patients (28.9%), with a mean age of 41.97±10.12 years, and the patients aged 30-40 years accounted for 47.4% (46/97). Of all 97 patients, 95 (97.9%) had genotype 6a, 1 had genotype 6e, and 1 had genotype 6xa. Among the 65 patients with a definite route of infection, 41 (63.1%) had intravenous drug use, 14 had medical-related operations, 9 had blood transfusion, and 4 had sexual contact as the route of infection. For the interferon group, the rapid virologic response (RVR) rate at week 4 was 81.8% (18/22), the rate of undetectable virus at the time of drug withdrawal (Epoint) was 86.4% (19/22), the rate of sustained virologic response at 12 weeks after drug withdrawal (SVR12) was 81.8%, and the rate of sustained virological response at 24 weeks after drug withdrawal (SVR24) was 81.8%; 1 patient in this group experienced recurrence. All 40 patients in the DAA group were previously untreated patients (33 patients without liver cirrhosis and 7 patients with compensated liver cirrhosis), with an overall RVR rate of 87.5%(35/40), an Epoint rate of 100%, and an SVR12 rate of 100%, and there was no treatment failure or recurrence. Although different DAA regimens had different RVR rates, they all had a SVR12 rate of 100%. The patients with compensated liver cirrhosis and other diseases had a SVR12 rate of 100%. Conclusion Intravenous drug addiction is the main route of infection for patients with genotype 6 CHC in Guangxi, and CHC is more common in men, with genotype 6a as the main subtype. DAA treatment has a higher virologic response rate than interferon treatment, with an SVR12 rate of 100%. There is no significant difference in SVR12 rate between the patients with compensated liver cirrhosis and those without liver cirrhosis.
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Objective To investigate the efficacy of entecavir (ETV) versus tenofovir disoproxil fumarate (TDF) and the treatment measures for poor response in previously untreated chronic hepatitis B (CHB) patients with high viral load. Methods A total of 165 CHB patients who received antiviral therapy and met the inclusion criteria in Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, from June 2016 to July 2021 were enrolled. The patients enrolled had a baseline HBV DNA level of > 6lg copies/ml and were previously untreated CHB patients who had used ETV or TDF for 48 weeks, and quantitative real-time PCR was used to measure HBV DNA. Virologic response rate was calculated after 48 weeks of treatment; a logistic regression analysis was used to investigate the influencing factors for the response of HBV DNA 40 U/L) at baseline, 89.2% (107/120) achieved an HBV DNA load of 30 years (77.8% vs 47.2%, 85.2% vs 66.7%). For the patients who did not achieve complete virologic response (HBV DNA ≥100 copies/mL) after 48 weeks of treatment, 87.9% (29/33) achieved complete virologic response after the original treatment regimen was prolonged for 48 weeks, and 100% (9/9) of the patients achieved complete virologic response after switching to or adding the first-line nucleos(t)ide analogues (NUCs) without cross-resistance sites with the original regimen for another 48 weeks. Conclusion The patients aged > 30 years should receive antiviral therapy as early as possible, regardless of viral load and ALT level, especially those with a family history of liver cirrhosis or hepatocellular carcinoma; the patients aged ≤30 years who have a normal ALT level and a high viral load should consider initiating antiviral therapy after providing informed consent. For the patients with poor response after 48 weeks of treatment, first-line NUCs without cross-resistance sites with the original regimen should be switched to or added in time.
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Objective:To introduce how to quickly set up a doctor team to achieve efficient treatment of batchs COVID-19 patients in Changchun GongTi shelter hospital.Methods:A cross-sectional study was conducted to analyze the basic situation of the doctors who supported the Changchun Gongti shelter hospital. The workload is the total number of patients from April 3 to 28, 2022. At the beginning of the task, the first week and the third week of the task, the five point scoring method was used to reflect the doctor's physical and mental state, stress state and rescue achievement. The time phased scheduling and disease grading management were fully implemented after 10 days of operation in the shelter. The doctors' ward round efficiency and self scoring changes before and after the implementation of the plan were compared, and the rescue results were summarized.Results:Total of 56 doctors (the Sichuan medical assistance team to Changchun), who undertook the work of Changchun Gongti shelter Hospital, came from 12 professional departments of 14 hospitals. By internal and external linkage-time phased scheduling and information-based patient zoning and grading management, the admission time of batch patients was shortened from (14.64±10.09) min to (6.80±5.10) min per person( P<0.05), the number of patients that each doctor can view per hour ranges from (28.50±12.26) to (68.43±19.95) ( P<0.01). A total of 1 293 patients were treated. There were no deaths, no accidents and no mild illness to severe illness in shelter hospital. 35 doctors completed a continuous survey. Before and after the implementation of those measures, the average physical state scores and the psychological state scores of doctors improved ( P=0.03), the self-score of stress feeling decreased ( P<0.01), and the self-score of professional achievement increased ( P<0.01). Conclusions:To adapt to the characteristics of emergency treatment for batch COVID-19 patients, the internal and external linkage-time phased scheduling and information-based patient zoning and grading management could help the temporarily convened doctors deal with a large number of patients efficiently, reduce work stress and exposure risk in shelter hospital.
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Objective:To compare the similarities and differences of clinical characteristics of human immunodeficiency virus (HIV)-negative and HIV-positive patients with talaromycosis marneffei (TSM).Methods:The clinical data of 175 inpatients diagnosed with TSM in First Affiliated Hospital of Guangxi Medical University from May 2012 to April 2019 were retrospectively analyzed. The patients were divided into HIV-positive group and HIV-negative group according to the results of HIV confirmation test. The clinical manifestations, laboratory examination indicators (white blood cell count, hemoglobin, albumin, CD4 + T lymphocyte count and C-reactive protein (CRP)) between the two groups were compared. Mann-Whitney U test and chi-square test were used for statistical analysis. Results:Among 175 TSM patients, 85 were HIV-positive and 90 were HIV-negative patients. The main clinical manifestations of fever and lymphadenopathy in the HIV-positive group and HIV-negative group were 71 (83.53%) cases and 73 (81.11%) cases, 50 (58.82%) cases and 47 (52.22%) cases, respectively, and there were both no statistical differences ( χ2=0.175 and 0.771, respectively, both P>0.05), while respiratory symptoms, weight loss and subcutaneous masses were 62 (72.94%) cases and 81 (90.00%) cases, 73 (85.88%) cases and 56 (62.22%) cases, one (1.18%) case and 16 (17.78%) cases, respectively, the differences were all statistically significant ( χ2=8.514, 12.630 and 13.737, respectively, all P<0.01). Hemoglobin in HIV-positive group and HIV-negative group were 90.50 (77.00, 113.95) g/L and 88.65 (72.85, 99.93) g/L, respectively. The difference was statistically significant ( Z=2.023, P=0.043). The ratios of albumin<30 g/L, CRP>10 mg/L in the two groups were 69.41%(59/85) and 60.00%(54/90), 94.37%(67/71) and 94.19%(81/86), respectively, and the differences were both not statistically significant ( χ2=1.693 and 0, respectively, both P>0.05). The ratios of cases with white blood cell counts >10×10 9/L and CD4 + T lymphocyte count<50/μL in the positive and negative groups were 3.53%(3/85) and 81.11%(73/90), 80.77%(63/78) and 1.75%(1/57), respectively, the differences were both statistically significant ( χ2=107.095 and 82.467, respectively, both P<0.01). Conclusions:In TSM patients, HIV-negative with subcutaneous masses, and increased white blood cell counts are common. Decreased body weight and CD4 + T lymphocyte count<50/μL in HIV-positive patients are more common than HIV-negative patients.
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ObjectiveTo investigate the incidence rate of resistance-associated variants (RAVs) in the non-structural protein 5B (NS5B) region in patients with hepatitis C virus (HCV) genotype 1b (GT1b) infection in Guangxi, China, as well as its difference between male and female patients. MethodsA total of 60 previously untreated patients with HCV GT1b infection who were admitted to The First Affiliated Hospital of Guangxi Medical University from April 2016 to September 2018 were enrolled. Their baseline serum samples were collected. The NS5B region fragments were amplified by nested PCR and gene sequencing was performed, and then the sequencing results were compared with standard strains in GeneBank. The t-test was used for comparison of age, HCV RNA, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) between male and female patients, and the Fisher′s exact test was used for comparison of mutation rate of drug-resistance sites. ResultsOf all 60 patients, 55 obtained the complete sequence information of the NS5B region, and the incidence rate of RAVs in the NS5B region was 96.3%. C316 (94.5%), A338 (70.9%), and T19 (74.5%) were the main mutation sites, and multisite mutations such as C316+T19 and C316+T19+A338 were observed. There was no significant difference in the incidence rate of RAVs between male patients and female patients ［95.8% (23/24) vs 96.8% (30/31), P=1.000］. ConclusionPatients with HCV GT1b infection in Guangxi have a high incidence rate of RAVs in the NS5B region, with both single-site and multisite mutations. There is no significant difference in the incidence rate of RAVs between male and female patients.
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Objective To observe the incidence of spontaneous clearance of hepatitis B virus (HBV) DNA in chronic hepatitis B (CHB) patients ,and to investigate the related factors of the spontaneous clearance of HBV DNA and to determine the time to start antiviral therapy .Methods Patients who met the inclusion criteria were recruited from the follow-up cohort of chronic HBV infection from January 2008 to August 2017 for observation .The liver function including alanine aminotransferase (ALT) levels ,HBV DNA load and serum markers of HBV were measured at baseline ,month 1 ,month 3 and month 6 of follow-up . Evaluation index included cumulative HBV DNA negative conversion rate and cumulative HBeAg negative conversion rate .Multivariable analysis was used to analyze the factors associated with the spontaneous clearance of HBV DNA .Results A total of 116 patients were recruited in this study .All the patients showed ALT level elevation at baseline .Without antiviral treatment ,the cumulative HBV DNA negative conversion rate was 12 .9％ after 6-month observation .HBeAg negative conversion rate was 22 .5％ .Multivariable analysis showed that patients without a family history of HBV infection ,baseline ALT level >3 times the upper limit of normal (ULN) and HBV DNA level <6 lg copies/mL had higher cumulative HBV DNA spontaneous clearance rate .HBV DNA negative conversion rate in patients whomet all the above three conditions was up to 75％ .Conclusions In CHB patients and ALT level elevation for the first time , some patients could achieve spontaneous clearance of HBV DNA without antiviral therapy .Patients without a family history of HBV infection ,baseline ALT level >3 ULN and HBV DNA level <6 lg copies/mL have higher rate of cumulative HBV DNA spontaneous clearance .
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Objective To investigate the dynamic change of pro‐and anti‐inflammatory eytokines of sepsis patients and its signif‐icance in clinical condition .Methods Forty‐three sepsis patients from 2010 to 2011 were divided into the survival group and the death group .Morning serum samples were collected on the first ,third ,firth and seventh day morning ;ELISA method was used to quantify the serum level of TNF‐α,IL‐1 ,IL‐4 and IL‐10 .The severity of patient′s condition was assessed according to the APACHEⅡsystem .Results In the early stage ,TNF‐α and IL‐1 in of both group increased and reached the peak on the third day ;then there was a gradual decline .Test in the same time point showed that the indexes of death group were all higher than that of survival group (P0 .05) .The APACHE Ⅱ of the survival group declined significantly while in death group it kept increasing and stay high .Conclusion Pro‐inflammatory eytokines(TNF‐α,IL‐1) ascended earlier than anti‐in‐flammatory eytokines(IL‐4 ,IL‐10) ,and the serum level of IL‐10 keep high level prompt the poor prognosis .
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Objective To investigate the epidemiological characteristics and therapeutic strategies of patients infected with hepatitis C virus (HCV)genotype 6 in Guangxi area.Methods Serum samples were collected from 150 patients with serologic HCV RNA positive in Guangxi, China. Reverse transcription nested polymerase chain reaction (PCR)was employed to amplify HCV NS5B fragments and the DNA products were sequenced.The sequences obtained were compared with the sequences deposited in GenBank to construct a phylogenetic tree.Among the patients who accomplished 48-week treatment of interferon plus ribavirin and 24-week follow-up after stopping medication,10 cases were infected with genotype 6a and 28 cases with genotype 1 HCV.The virological responses were evaluated at week 4,week 12,week 24 of treatment and week 24 after the end of the treatment.Results Among all recruited 150 cases,21 (14.0%)cases were HCV genotype 6 including two subtypes 6a (n = 20 )and 6d (n = 1 ). Genotype 6 HCV mainly affected intravenous drug users, especially with age of ≤ 40 years old. Phylogenetic tree showed that there was very close evolutionary distance between HCV 6 strains of Guangxi and Hongkong,China strains (Y12083,DQ 480515)and Vietnam strain (EU246930).All of 10 HCV genotype 6a patients who completed 48 weeks of antiviral therapy achieved sustained virological response (SVR).The rate of SVR was higher than that of genotype 1 patients,but without statistically different significance (10/10 vs 75 .0%,P >0.05).Conclusion HCV genotype 6 in Guangxi area mainly affects young intravenous drug users with age of ≤ 40 years old,which has high homology with Hongkong,China and Vietnam standard strains.Patients with HCV 6 genotype infection treated with interferon plus ribavirin for 48 weeks usually achieve favorable SVR.
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Objective To investigate the expression and resistant gene of integron in multidrug-resistant Acinetobacter baumannii (MDR-Ab).Methods 51 strains of MDR-Ab isolated from a hospital in August-October 2012 were collected, antimicrobial susceptibility testing was performed.Class I(Int I),II (Int II)and III (Int III)of integrase genes and inte-gron variable region gene cassettes were detected by polymerase chain reaction (PCR),and the homology of integron varia-ble region was analyzed by detection results of restriction fragment length polymorphism (RFLP)and DNA sequencing. Results Positive rate of integrase gene in MDR-Ab was 78.43%(40/51).All genes belonged to Int I,while IntⅡand IntⅢ were not found.Variable region cassettes were detected in 97.50% (n=39)of Int I,there were 5 types of integron gene cassettes:aacA4 in 14 strains,aacA4+catB8 in 22 strains,arr-3 +aacA4 in 1 strain,dfrA15 in 1 strain and arr-3 in 1 strain.Conclusion MDR-Ab isolated from this hospital may be related with Int I expression.Int I carried gene cassettes as follows:aacA4,aacA4+catB8,arr-3+aacA4,dfrA15 and arr-3.
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Objective To investigate the application of the central venous catheter (CVC) specialized for drainage intervention in severe acute pancreatitis (SAP) patients.Methods Sixty-two severe acute pancreatitis patients with seroperitoneum were randomly (random number) assigned into two groups:the drainage group (n =31) and the control group (n =31).All patients were treated with conventional internal medicine therapy.Patients of drainage group were treated with continuous peritoneal drainage by using the central venous catheter.The intra-abdominal pressure (IAP),lactic acid (LAC),and procalcitonin (PCT) were detected before and 12 h,24 h,48 h,72 h,5 days after intraperitoneal drainage.The symptoms of abdomen pain,abdomen distention,resume of bowel movement and the rate of MODS were observed.Results All patients with drainage got catheter successfully inserted.Compared with the control group,the IAP,LAC and PCT decreased significantly in the patients of drainage group.And the duration of abdomen pain,abdomen distention and resume of bowel movement function in the drainage group were shorter and the rate of MODS was lower.Conclusions Application of CVC specialized for intraperitoneal drainage is a safe and effective method for the treatment of pancreatitis with seroperitoneum.It is worthwhile to be widely used in clinic.
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Objective To evaluate the efficacy and drug resistance profiles of nucleosides (NA) retreatment in NA experienced chronic hepatitis B (CHB) patients. Methods Totally 104 NA experienced CHB subjects were enrolled in this study.All these subjects had received at least 3 months NA monotherapy and stopped the treatment,and then received NA retreatment for at least one year.The subjects were divided into three groups according to the following criteria:reached the therapy endpoint of China guideline when they stopped NA-naive treatment (group A,n =39); did not reach the therapy endpoint when they stopped NA-naive treatment but hepatitis B virus (HBV) DNA＜1.0× 103 copy/mL (group B,n=33); and with HBV DNA＞1.0× 103 copy/mL (group C,n=32).The efficacy and drug resistance profiles of retreatment were compared among three groups. The effects of baseline alanine aminotransferase (ALT) levels,HBV DNA levels and HBeAg titers on the retreatment efficacies were analyzed. The mutations of HBV P gene were detected by nested polymerase chain reaction (PCR) and direct sequencing.The data were analyzd by Wilcoxon test and x2 test.Results The time to ALT normalization in patients with baseline ALT＜ 1.3 × upper limit normal (ULN) was shorter than that in patients with ALT≥1.3×ULN (2 months vs 4 months; Z=2.281,P=0.023).The time to virological response in patients with baseline HBV DNA＜5 lg copy/mL was shorter than that in patients with HBV DNA≥5 lg copy/mL (1 month vs 2 months; Z=2.054,P =0.040). The time to virological response and ALT normalization in baseline HBeAg negative were both shorter than those in patients with baseline HBeAg positive patents ( 1 month vs 3 months and 2 months vs 4.5 months,respectively; Z=2.580 and 2.304,respectively; both P＜0.05). The subjects in group A achieved virological response and HBeAg seroconversion after retreatment earlier compared to previous NA-naive therapy ([1.61 ± 1.76] months vs [3.48±4.066]months and [3.38 ± 3.34] months vs [9.92-11.22] months,respectively; Z=-2.854 and-1.094,respectively; both P＜0.05).The cumulative HBeAg seroconversion rate in group A was higher compared to those in group B and group C (80.0％ vs 36.8％ and 37.5％,respectively; x2 =4.368 and 5.100,respectively; both P＜0.05).Thirteen patients developed clinical resistance and four of them developed genotypic resistance proved by PCR direct sequencing.Among the patients retreated with the same regimen as previous in the C group,the cumulative resistance rate was highest compared to group A and B (44％ vs 9％ and 0,respectively; x2 =5.019 and 6.588,respectively;both P＜0.05).No resistance was detected in the 14 patients retreated with combined NA treatment without cross resistance.Conclusions For NA experienced CHB patients who fulfill the indication of antiviral therapy,the retreatment should be started as earlier as possible. Retreatment with NA combination without cross resistance can prevent (reduce) the risk of developing drug resistance.
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Objective To explore the influence factors on hepatitis B virus (HBV) relapse after nucleos(t)ide analogues (NA) withdrawal in the chronic hepatitis B (CHB) patients who met NA cessation criteria. Methods Eighty-one consecutive CHB patients were treated with NA, 38 with lamivudine (LAM), 25 with adefovir dipivoxil (ADV), 12 with entecavir (ETV), 6 with LAM +ADV. Among recruited patients, 40 were hepatitis B virus e antigen (HBeAg) positive, 41 were HBeAg negative, 67 of them were initial treatment, 14 were retreatment due to resistance to NA at baseline. The treatment was discontinued after meeting China therapeutic end-point criteria. HBV DNA, HBV serological markers, alanine aminotransferase (ALT) were measured respectively at baseline, every month before virological response, every 3 months after virological response, every month within first 6 months and every 2 months over 6 months after drugs withdrawal. Twelve probable influence factors on relapse which were sex, age, HBV family history, baseline HBV DNA,baseline HBeAg status, baseline ALT, virological response time, total duration of treatment, duration of additional treatment, the level of hepatitis B virus surface antigen (HBsAg) at cessation therapy,initial treatment or retreatment, drug category were analyzed with univariate, multivariate Cox regression modle and stratified analysis. The cumulative relapse was calculated by the Kaplan-Meier method. Results A total of 36 patients (44. 4%) relapsed within 1 year. Initial treatment or retreatment, HBV family history, virological response time, the level of HBsAg at cessation therapy were independent risk factors. The relapse rate of retreatment was higher than that of initial treatment (78.6% vs 37. 3% , χ2 = 7. 983, P = 0. 005) , those of patients with HBV family history higher than without family history (64. 5% vs 15.0%, χ2 =12. 096,P = 0.002), those of patients obtained virological response within 3 months lower than after 3 months(34. 0% vs 64. 3% , χ2 =6. 823,P=0. 009) , those of patients with HBsAg≤150 μg/L at cessation therapy lower than >150 μg/L(27. 6% vs 53. 8%, χ2=5. 199,P=0. 023). Conclusions Retreatment, HBV family history, later virological response and higher HBsAg level at cessation therapy are risk factors of relapse after NA withdrawal. Such patients should be treated with prolonged duration after meeting end-point criteria to strengthen the efficacy.