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Objective:To evaluate the safety of discontinuing nucleoside/nucleoside analogue (NAs) therapy in patients with compensated hepatitis B cirrhosis after HBsAg negative conversion.Methods:A total of 3 783 patients with hepatitis B cirrhosis in compensated stage were treated with NAs at Taizhou Hospital, Taizhou Municipal Hospital and Taizhou Enze Hospital from January 2008 to December 2020. The clinical data and laboratory tests results of 85 patients with HBsAg negative conversion were retrospectively analyzed, including 36 cases discontinued the drug, and 49 continued to use drug. Chi-square test and rank-sum test were used for data analysis.Results:During the 24 and 48 months of follow-up, the ALT levels were within the normal range in both groups. There were no significant differences in positive rates of anti-HBs and HBeAg ( χ2=0.75, 0.39 and 0.90, P=0.78 0.84 and 0.34; χ2=0.40, 0.00 and 0.00, P=0.84, 1.00 and 1.00) between two groups. After 48 months of follow-up, 2 cases of primary liver cancer occurred in the discontinuation group and no primary liver cancer occurred in the continuation group ( χ2=0.89, P=0.34). Throughout the follow-up, HBsAg remained negative and HBV DNA load was below the lower limit of detection in both groups. Conclusions:Discontinuation of NAs can be considered after the HBsAg negative conversion in patients with compensated hepatitis B cirrhosis.
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Objective To compare the clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and Quadrant minimally invasive system in treatment of lumbar disc herniation (LDH). Methods 59 single-level LDH patients were randomly divided into PTED group (n = 31) and Quadrant group (n = 28). Then compare the operative time, incision length, blood loss, length of hospital stay, and the return-to-work time between the two groups. In addition, visual analogue scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and modified MacNab criteria were used for surgical efficacy evaluation. Results In PTED group, compared with Quadrant group, we observed, shorter incision length, less blood loss, shorter hospital stay, and shorter time of returning to work (P 0.05). According to the improved MacNab criteria, there was no significant difference in excellent or good rate between the two groups (P > 0.05). Conclusion The clinical results of PTED and Quadrant minimally invasive system in treatment of lumbar disc herniation were satisfactory, and PTED were less traumatic method with rapid recovery.
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Objective To investigate the effect of long-term antiviral treatment on clinical outcome and liver histology in patients with hepatitis B virus ( HBV)-related compensated cirrhosis .Methods A total of 61 patients with HBV-related compensated cirrhosis receiving antiviral therapy were enrolled from Taizhou Hospital of Zhejiang Province during September 2010 and March 2015, including 26 HBeAg-positive cases and 35 HBeAg-negative cases .Thirty-nine patients were treated with entecavir ( ETV ) and 22 were treated with adefovir dipivoxil ( ADV ) .Biochemical , serological and virological markers were examined every 3 months during treatment, and Child-Turcotte-Pugh (CTP) scores were calculated.All the patients underwent liver biopsy before and 144 weeks after antiviral treatment .Metavir scoring system was used to evaluate the liver histological activity ( A) and fibrosis score ( F) .Wilcoxon rank sum test and paired t-test were used for the evaluation of liver histopathology and liver function before and after treatment , respectively.Results After 144 weeks of antiviral treatment , HBV DNA was reduced and below the lower limit of detection in 58 patients (95.1%), HBeAg disappeared in 14 patients (14/26, 53.8%), and HBeAg seroconversion was observed in 10 patients (10/26, 38.5%); alanine aminotransferase ( ALT), aspartate amino transaminase (AST), total bilirubin (TBil) and CTP score decreased (t=7.489, 8.259, 14.000 and 6.026, all P<0.01), prothrombin time (PT) was shortened (t=9.777, P<0.01), and serum albumin (Alb) increased (t=3.446, P<0.01).Improvements in both liver histologic activity and fibrosis score were observed (Z=5.716 and 6.657, all P<0.01).Liver histological activity decreased from A1 to A0 in 16 cases, from A2 to A0 in 9 cases, from A2 to A1 in 15 cases, from A3 to A0 in 1 case, from A3 to A1 in 5 cases, and from A3 to A2 in 5 cases.Fibrosis score at the baseline was F 4 for all patients, while after treatment, there were 7 patients with F1, 22 with F2, 20 with F3, and F4 remained in rest 12 patients.Conclusion Both clinical and histological improvements can be obtained after long-term antiviral treatment for patients with HBV-related compensated cirrhosis .
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Objective To investigate the clinical effect of the treatment of osteoporotic vertebral compression fractures in the elderly populationthrough different surgical approaches.Methods 98 cases with a single-level osteoporotic vertebral compression fracture in the elderly population were randomly divided into two groups from February 201 1 to June 2013.48 patients were performed by percutaneous vertebroplasty (PVP)through unipedicular approach and 50 patients through bipedicular approachs.The clinical data of patients were prospectively analyzed and the clinical efficacy were compared between two groups using VAS (visual analogue scale method)and ODI (Oswestry disability index)in preoperative,postoperative 1 day and 1 year postoperatively .The data of age, gender,injury to the patients with operation time,postoperative follow-up time,operation time,bone cement injection,bone cement leakage and other complications were observed.Cobb angle,vertebral compression ration were observed by imaging data.Results All the cases were followed-up.There was no statistical difference in preoperative clinical data between the two groups (P >0.05).In unilateral group (48 cases),the data of operation time,bone cement injection,bone cement leakage,Cobb angle improve,vertebral compression ration improve were (34.87±5.91)min,(6.20±0.66)mL,1 6 cases(33%),(10.1 9±2.12)%,(13.23°±1.58°)and adjacent vertebral fractures was 10 cases (20.9%).VAS score was respectively improved (4.05 ± 0.12 ),(5.42 ± 0.12 ) in postoperative 1 day and 1 year than preoperative.VAS score was improved (1.40 ±0.1 1 )in postoperative 1 year than 1 day.ODI score was respectively improved (35.46 ± 1.89)%,(47.88 ±2.21 )% in postoperative 1 day and 1 year than preoperative.ODI score was improved (1 1.42±0.24)% in postoperative 1 year than 1 day.In bilateral group (50 cases).The data of operation time,bone cement injection,bone cement leakage,Cobb angle improve, vertebral compression ration improve were (41.66±6.90)min,(4.88±0.52)mL,9 cases(18.0%),(10.48±1.43)%,(13.04°±2.03°)and adjacent vertebral fractures was 6 cases(12.0%).VAS score was respectively improved (4.06±0.1 1),(5.30±0.10)in postoperative 1 day and 1 year than preoperative.VAS score was improved (1.34± 0.08)in postoperative 1 year than 1 day.ODI score was respectively improved (36.08±2.13)%,(47.54±1.97)%in postoperative 1 day and 1 year than preoperative.ODI score was improved (1 1.26 ± 0.54)% in postoperative 1 year than 1 day.There was no obvious clinical problems after occurred leakage in two groups.there was statistical difference in cement injection,bone cement leakage and postoperative adjacent vertebral fractures after operation between the two groups.there was no statistical difference in Cobb angle improve,vertebral compression ration improve,VAS score and ODI score between the two groups.Conclusion Both approaches are effective in the treatment of osteoporotic vertebral compression fractures in the elderly population ,but there is advantage of decrease the incidence of bone cement leakage and postoperative adjacent vertebral fractures through bilateral approach.
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Objective To explore the correlationship between level of bFGF (basic fibroblast growth factor) in serum and synovia and X-ray severity (Kellgren-Lawrence Grading System) in patients with knee OA. Method 68 patients with knee OA were enrolled into this study. Knee OA grading was evaluated according to the Kellgren-Lawrence classification. bFGF levels in both serum and synovia were examined using enzyme-linked immunosorbent assay. Results The level of bFGF in serum and synovial fluid in patients with knee OA were positively correlated with radiographic severity (r = 0.619, P < 0.001 and r = 0.603, P < 0.001, respectively). Further analysis revealed that there was a positive correlation between the level of bFGF in serum and in synovia fluid (r = 0.688, P < 0.001). Conclusions Levels of bFGF in serum and synovial fluid were significantly increased in patients with OA, and levels of bFGF were positively correlated with radiographic severity. These findings indicate that bFGF levels may be a biomarker of disease severity and could play an crucial part in the pathophysiology of degenerative process in OA.
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Objective To investigate the result of local injection of growth differentiation factor-5 (GDF-5) and fibrin gel for treatment of lumbar disc injury in rabbits.Methods Lumbar puncture with a 20-gauge needle was performed at L3/4,L4/5,and L5/6 discs of 40 New Zealand white rabbits.After needle puncture,L3/4 discs were injected with GDF-5 and fibrin gel (compound group) ; L4/5 discs fibrin gel (fibrin gel group) ; L5/6 discs nothing (blank control group).Two weeks later,intervertebral disc degeneration in each group was observed via radiography,MRI and nucleus proteoglycan content detection and histological examination.Results At postoperative 2-,4-,8-,and 12-weeks,X-ray films revealed a gradual decrease in disc height index (DHI) among the three groups,but the decreasing velocity was lower in compound group than in other two groups (P ＜ 0.05).On MRI,the signal of intervebral discs among the three groups diminished progressively with time,but a relatively lower decreasing was observed in compound group (P ＜ 0.05).At postoperative 4-week,proteoglycan content of the nucleus pulposus was (6.3-± 0.4) in compound group,higher than (5.9-0.4) in blank control group and (5.8-± 0.3)in fibrin gel group (P ＜0.05).At postoperative 2-week,histological evaluation showed (5.28 ±0.41)points in compound group,lower than (7.54 ± 0.53) points in blank control group and (7.21 ± 0.44)points in fibrin gel group (P ＜ 0.05).Conclusion Local injection of GDF-5 and fibrin gel facilitates the restoration of the injured discs and delays further disc degeneration.
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[Objective]To study the degradation of nano-nacre powder and the biocompatibility of the composite artificial bone made from this nano-scale powder in vivo.[Method]The nano-nacre powder made through mechanical grinding and the artificial bones made from this powder and PDLLA(poly-D,L-lactide acid) were implanted into the femoral holes and the femoral muscle sacs of rats respectively.Normal micron-nacre powder and the artificial bones made from this powder and PDLLA were implanted as control group,and blank group was set up without implanting anything.X-ray photography was performed immediately and at 2,4 and 8 weeks after operation.The animals were injected with tetracycline for fluorescent mark before being killed.Then,the gross specimens,histological and SEM(scanning electron microscope) observations were performed.[Result]All the observations showed that nano-nacre powder degraded faster than micron-nacre powder,meanwhile,the bone defect recovery was the fastest in this group.Both of the composite artificial bones made from those two kinds of nacre powder had the good connection with the adjacent tissue.[Conclusion]The degradation of nano-nacre powder is faster than that of micron-nacre powder in vivo,and it can promote the growing of new bone.Nano-nacre composite artificial bone also has good biocompatibility.It is a kind of better bioactive degradable material.