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Background/Aims@#Existing hepatocellular carcinoma (HCC) prediction models are derived mainly from pretreatment or early on-treatment parameters. We reassessed the dynamic changes in the performance of 17 HCC models in patients with chronic hepatitis B (CHB) during long-term antiviral therapy (AVT). @*Methods@#Among 987 CHB patients administered long-term entecavir therapy, 660 patients had 8 years of follow-up data. Model scores were calculated using on-treatment values at 2.5, 3, 3.5, 4, 4.5, and 5 years of AVT to predict threeyear HCC occurrence. Model performance was assessed with the area under the receiver operating curve (AUROC). The original model cutoffs to distinguish different levels of HCC risk were evaluated by the log-rank test. @*Results@#The AUROCs of the 17 HCC models varied from 0.51 to 0.78 when using on-treatment scores from years 2.5 to 5. Models with a cirrhosis variable showed numerically higher AUROCs (pooled at 0.65–0.73 for treated, untreated, or mixed treatment models) than models without (treated or mixed models: 0.61–0.68; untreated models: 0.51–0.59). Stratification into low, intermediate, and high-risk levels using the original cutoff values could no longer reflect the true HCC incidence using scores after 3.5 years of AVT for models without cirrhosis and after 4 years of AVT for models with cirrhosis. @*Conclusions@#The performance of existing HCC prediction models, especially models without the cirrhosis variable, decreased in CHB patients on long-term AVT. The optimization of existing models or the development of novel models for better HCC prediction during long-term AVT is warranted.
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In order to achieve the global goal of eliminating viral hepatitis as a public health threat by 2030 proposed by the World Health Organization, it is of great importance to expand the treatment of chronic hepatitis B patients. Recent studies have shown that alanine aminotransferase (ALT) is associated with liver inflammation, fibrosis, hepatocellular carcinoma, and outcome events of liver disease. Besides, as a strategy for expanding antiviral therapy, reducing the treatment threshold of ALT can reduce the occurrence of liver cirrhosis, hepatocellular carcinoma, and liver-related death. In the Expert opinion on expanding antiviral therapy for chronic hepatitis B published in China in 2022, the treatment indication for chronic hepatitis B patients was updated to positive serum HBV DNA and ALT above the treatment threshold (30 U/L for male and 19 U/L for female), with the exclusion of other causes.
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Primary biliary cholangitis (PBC) is a chronic progressive cholestatic liver disease often observed in the middle-aged and elderly women and it can eventually lead to liver cirrhosis or liver failure. Osteoporosis is one of the common complications in PBC patients and is characterized by decreased bone mass and increased susceptibility to fractures. Osteoporosis and fractures caused by osteoporosis seriously affect the quality of life of PBC patients, and with the improvement of PBC treatment strategies and the increase in life expectancy, early diagnosis, prevention, and treatment of PBC with osteoporosis is of particular importance. This article briefly summarizes the epidemiology, pathogenesis, and diagnosis and treatment of patients with PBC and osteoporosis and proposes current challenges and future research directions.
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Primary biliary cholangitis (PBC) is a chronic progressive cholestatic liver disease often observed in the middle-aged and elderly women and it can eventually lead to liver cirrhosis or liver failure. Osteoporosis is one of the common complications in PBC patients and is characterized by decreased bone mass and increased susceptibility to fractures. Osteoporosis and fractures caused by osteoporosis seriously affect the quality of life of PBC patients, and with the improvement of PBC treatment strategies and the increase in life expectancy, early diagnosis, prevention, and treatment of PBC with osteoporosis is of particular importance. This article briefly summarizes the epidemiology, pathogenesis, and diagnosis and treatment of patients with PBC and osteoporosis and proposes current challenges and future research directions.
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Objective@#To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression.@*Methods@#Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment.@*Results@#A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness.@*Conclusion@#This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.
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Various chronic liver diseases may progress to liver fibrosis or liver cirrhosis. Assessment of the degree of liver fibrosis helps with clinical decision-making, prognosis prediction, and evaluation of therapeutic effect, and therefore, accurate diagnosis and evaluation of the degree of liver fibrosis is a research hotspot at present. The advances in the diagnosis of liver fibrosis in recent years include the publication of international consensuses and guidelines, evaluation of the outcome of liver fibrosis after antiviral therapy, development of the diagnosis of liver fibrosis in patients with non-viral hepatitis, and constant update of noninvasive diagnostic techniques.
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Objective:To explore the efficacy of group cognitive-behavioral therapy (GCBT) to generalized anxiety disorder (GAD).Methods:In this randomized controlled trial,the control group (n =23) and the intervention group (n =33) were included,all of the participants received duloxetine (30-120 mg/d) as pharmacotherapy.The intervention group received 8 group cognitive-behavioral therapy sessions weekly,90 minutes for each time.Assessments were conducted with the Hamilton Anxiety Scale (HAMA),Hamilton Depression Scale (HMAD) and Clinical Global Impression (CGI) at baseline,mid-treatmentand post-treatment.CGI included three factors,the severity of illness (SI),the globalimprovement (GI) and the efficacy index (EI).Results:The repeated measures analysis of variance of HAMA showed that,there were statistical significance on the HAMA for interaction between measure time and group processing (F =4.35,P ＜ 0.05).Compared with the control group,the intervention group got higher decreased scores of HAMA at the 4th week and 8th week,and higher prevalence of being cured and efficient at the 4th week.At the 8th week,the decreased scores of HMAD were higher in the intervention group than in the control group,and the scores of CGI-SI and the CGI-IE were lower in the intervention group.Conclusion:It suggests that group cognitive-behavioral therapy combined with pharmacotherapy could be earlier to be effective,and the symptoms of anxiety,depression and the state of illness could be improved more significantly compared with pharmacotherapy alone.
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Objective To investigate the prevalence of vitamin D deficiency in elderly patients in severe illness and its relationship with severity of disease and prognosis.Methods Totally 325 inpatients admitted to geriatric intensive care unit were included in this study.Serum 25-hydroxyvitamin D [25-(OH)D] was examined.Main laboratory findings,the incidence of multiple organ dysfunction syndrome (MODS),Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ) score and mortality rate of 30-day were compared among patients with different serum 25 (OH) D levels.Potential risk factors for mortality were analyzed by multivariate Logistic regression analysis.Results 25 (OH)D deficiency was identified in 113 (34.77％).Compared to 25(OH) D sufficiency group,25 (OH)D deficiency group has significantly higher plasma lactic acid,APACHE Ⅱ score,the incidence of MODS and mortality rate of 30-day,P ＜0.05.Analysis by multiple logistic regression suggested that 25 (OH) D deficiency was independent risk factor for mortality.Conclusions Vitamin D deficiency is highly prevalent among elderly patients with severe illness,and may be an independent risk factor for mortality.
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Objective To investigate the relationship between bone mineral density (BMD) and the changes of serum adiponectin (APN) level in elderly men.Methods A total of 240 elderly men was enrolled in this study.Measurement of BMD of lumbar spine with dual energy X-ray absorptiometry was performed.All subjects were divided into three groups (normal,osteopenia,and osteoporosis) according to the T value of BMD.Serum APN level was tested using enzyme-linked immunosorbent assay (ELISA),meanwhile were recorded as bone lurnover markers.Results (1) The level of serum APN in osteopenia group was lower than in normal group,the level of serum APN in osteoporosis group was significantly lower than in osteopenia group,while the level of serum APN in osteoporosis group was significantly lower than in normal group (all P ＜ 0.05).(2) Serum APN was positively correlated with T value of BMD (r =0.475,P ＜0.01).(3) The stepwise multiple linear regression analysis showed serum APN,25-hydroxyvitamin D,β-isomerized carboxyterminal propeptide (β-CTX),and osteocalcin could enter into the equation.Conclusions Serum APN might play an important role in pathogenesis of osteoporosis in elderly men.
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Objective To investigate the prevalence of vitamin D deficiency in patients in geriatric intensive care unit and the impact of vitamin D deficiency on the prognosis.Methods 213 hospitalized patients admitted into geriatric intensive care unit of Xinhua Hospital,Shanghai from June 2012 to December 2013 were included in the historical cohort study.Serum 25-hydroxyvitamin D [25 (OH)D] was examined in all the subjects.Main laboratory findings,the incidence of multiple organ dysfunction syndrome (MODS),Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score and mortality rate of 30-day kept in hospital were compared among patients with different serum 25-hydroxyvitamin D level.Potential risk factors for mortality were analyzed by multivariate logistic regression analysis.Results 25(OH)D deficiency was identified in 82 patients (38.5％),25(0H)D insufficiency in 90 patients (42.3％),and 25(OH)D sufficiency in 41 patients (19.2％).Compared with 25(0H)D sufficiency group,25(0H)D deficiency group showed the increased levels of APACHE Ⅱ score,plasma lactic acid,C reactive protein (CPR),the incidence of MODS and mortality rate (21.65±-8.89 vs.17.05±8.03,1.89±0.76 mmol/L vs.1.86±1.03 mmol/L,101.08±48.23 mg/L vs.92.48±38.56 mg/L,42.7％ vs.19.5％,30.5％ vs.9.8％,all P＜0.05).Multiple logistic regression analysis suggested that 25 (OH)D deficiency was an independent risk factor for mortality.25(OH)D levels were negatively correlated with length of stay in geriatric intensive care unit (r=0.18,P＜0.05).Conclusions Vitamin D deficiency is highly prevalent among patients admitted into geriatric intensive care unit.Vitamin D deficiency is associated with disease severity and may be an independent risk factor for mortality.
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Objective To study the relationship between serum osteocalcin and parameters of glucose and lipid metabolism in elderly men.Methods The bone metabolism index such as serum osteocalcin was measured by electrochemiluminescence immunoas -say in 206 old male patients , incluiding 69 patients with type 2 diabetes mellitus .The parameters of glucose and lipid metabolism were also measured and the correlation between the parameters and serum BGP were analyzed .Results Serum BGP and beta-CTx concen-trations were significantly lower in patients with type 2 diabetes than those in normal glucose tolerance group [ ( 9.57 ±4.74 )μg/L vs (13.22 ±10.35)μg/L, P <0.05;(0.25 ±0.19)μg/L vs (0.35 ±0.29)μg/L, P <0.05].Compared with the group in low level of BGP, fasting blood glucose and HbA1c were reduced in high-level-BGP group[(5.89 ±2.10)mmol/L vs (5.28 ±1.38)mmol/L, P<0.01;6.30%±1.03% vs 5.98%±0.61%, P <0.01].Triglyceride (TG) was positively correlated with serum BGP ( r =0.146, P =0.032).Stepwise multiple regression analysis showed that TG and HbA 1c were independently associated with serum BGP level(β=1.995, P <0.01;β=-1.483, P <0.05).Conclusions Serum TG and HbA1c are independent factors related to serum BGP in elderly men .
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Problem-based learning (PBL) is a student-centered pedagogy in which a subject is approached in the context of realistic problems.We have applied PBL into intemnal medicine of general medicine for up to three years.The results suggest that the PBL method could promote the clinical competencies and self-learning capacities of students.However there is still room for improvement.
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Objective Alterations in vascular structure and function and impairment of associated endothelial cells with aging are one of the independent risk factors in the process of atherosclerotic vascular diseases.The study of age-related endothelial dysfunction plays a critical role in preventing as well as treating heart and cerebral vascular diseases in the elderly.Methods The healthy male rats were divided into the young group (3-month-old),the adult group (9-month-old) and the middle-aged group (15-monthold).The indicators associated with vascular endothelial function,including plasma NO,eNOS,iNOS,ET-1 and aortic NO,eNOS,iNOS,were quantified to evaluate the endothelium-dependent and non-endothelium-dependent vasodilating function of isolated aortic rings.These morphological changes of rat aorta helped to find out the group in which endothelial function changed in the early stage.Results Plasma NO,eNOS,iNOS and aortic NOS activity in the young group,the adult group and the middle-aged group gradually decreased with increasing age (P ＜ 0.05).NO,eNOS and iNOS respectively displayed a negative correlation to age.ET-1 gradually increased with aging (P ＜ 0.05) and showed a predominantly positive correlation to age.Acetylcholine-induced greatest vasodilation of aortic rings lessened with increasing age (P ＜ 0.05).Vasodilation in each group reacted generally consistently with nitroprusside sodium (P ＞0.05).Aortic morphology,including intima media thickness (T),diameter (D) and intima media thickness / inner diameter (T / D),gradually enhanced with aging (P ＜ 0.05).T,D was positively correlated with age.NO,eNOS,iNOS,ET-1 of the adult group showed maximum slope (P ＜0.05 respectively) according to group regression analysis,suggesting that vascular endothelial function changed in this group.Meanwhile,T and D of the middle-aged group showed maximum slope (P ＜ 0.05 respectively),suggesting that age-related vascular structural changes predominantly occurred in this period and vascular function changed earlier than the structure.Conclusion Our study demonstrated vascular endothelial dysfunction with aging.Early evident changes of endothelial function occurred in the adult group,which impaired endothelium-dependent vasodilating function.Vascular function changed earlier than the structure.
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ObjectiveTo study the liver and kidney function and muscle effects of rosuvastatin in rats.MethodsIn this study,twenty healthy male rats (9-month-old) were randomly divided into two groups:normal control group and rosuvastatin treatment group.The first treated group was given conventional feed; The second treated group was given conventional feed and oral rosuvastatin [5mg/( kg · d)] of 12 weeks.The level of liver and kidney function and creatine kinase,histological changes of liver and muscle were examined before and after the treatment.ResultsOur findings demonstrate that the level of liver and kidney function and creatine kinase was no significant difference among the two experimental groups,also no difference before and after treatment( P ＞0.05).At the same time,liver and muscle showed no abnormal pathology.Conclusion These findings collectively indicate that rosuvastatin shows no significant side effects in the liver and kidney function and muscle pathology compared with control group.
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ObjectiveTo investigate the effects of atorvastatin on cardiomyocyte apoptosis and caspase-3 expression in acute myocardial infarction in rats.MethodsFifty SD rats were randomly divided into 3 group:sham group,control group( normal saline),atorvastatin pretreatment group ( 10mg/kg),The atorvastatin group were pretreated with atorvastatin ( 10mg/kg ) for 3 days,and those in the control group were pretreated with normal saline instead.All rats underwent coronary ligation of left anterior descending branch to establish AMI rat s model on the fourth day except the sham group,while sham group only received thoracotomy without coronary ligation.Then,The infarct size area at risk were defined by Evans blue and TTC staining,the caspase-3 mRNA expression of myocardium was measured with reverse-transcriptase polymerase chain reaction(RT-PCR) and the apoptosis index was analyzed by TUNEL staining.Results Compared with control group,the infarct size,the caspase-3 mRNA expression of myocardium,the apoptotic index were decreased significant in the atorvastatin group ( P ＜ 0.05 ).ConclusionPretreatment with atorvastatin has protective effect on the acute ischemic cardiomyocytes,which may probably be associated with the reduction of the expression of caspase-3 mRNA in the myocardium and the apoptotic index.
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Objective To compare the glucose levels and associated factors among the normal glucose tolerance subjects with different age.Methods Totally a community-based population of 2098 residences aged above 30 years Were tested with OGTT,and classified into normal glucose tolerance group(NGT),impaired glucose tolerance group(IGT),impaired fasting glucose group(IFG),both IGT and IFG group(ICT/IFC),anddiabetes group(DM) according to fasting and 2 hours glucose level(2 hPG).The subjects in NGT group were further divided into 5 groups according to different ages.The levels of blood glucose and HBCI in different groups and subgroups were measured and analyzed statistically. Results For patients in NGT,the FPG([5.17.±0.48]mmol/L vs.[5.09±0.44]mmol/L,P<0.05)and HbA1c([6.01±0.62]%vs.[5.95±0.66]%.P<0.05)in group aged 60-69 Were higher than that in group aged 50-59.The FPG in group aged 60-69 was also higher than those in group aged 40-49([5.17±0.48]mmol/L vs.[5.00±0.47]mmol/L,P<0.01),and the FPG in group aged 50-59 Was also higher than those in group aged 40-49([5.09±0.44]mmol/L vs..[5.00±0.47]mmol/L,P<0.01).There was no correlation between age and FINS,while a tendency of decreasing HBCI could be observed along with increasing of age(F=33.75,P<0.05).Conclusion In NGT subjects,the FPG and HbA1 C inereased along with age.
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Objective To explore the relationship between the level of morning blood pressure surge (MBPS) and High-sensitivity C-reactive protein( hs-CRP) in acute coronary events among old patients and to evaluate their clinical value. Methods One hundred and twenty - three patients with coronary disease were divided into two groups, each of which was old myocardial infarction(OMI, n = 55) and old myocardial infarction with acute cardiovascular syndrome (OMI + ACS, n =68). The control group includes the patients without coronary disease( n =50). The patients who have infection, malignant tumors, liver and kidney dysfunction, blood diseases, valvular heart diseases, congenital heart diseases, aortic dissection,secondary hypertension were not included. All groups were received 24 hours ambulatory blood pressure monitoring to calculate MBPS and the determination of hs-CRP in serum. Results Compared with each two groups, the levels of MBPS and hs-CRP in OMI group were significantly higher than those of the control group (0. 01 ＜ P ＜0. 05) , and had more significance in the other groups ( P ＜0.01). The levels of MBPS and hs-CRP had positive relationship in coronary events in the elderly ( r =0. 76, P ＜0. 01) . Conclusion The level of MBPS is positively correlated with serum hs-CRP which is one of key risk factors of inflammatory reactions by impairing vessels in body. The two factors both play important roles in the occurrence and the development of coronary events among old patients. They both have important clinical value in recurrent acute coronary events among old patients.
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Objective To investigate the prevalence of hyperuricemia and its relationship with hy-perlipaemia and hyperglycemia in the elderly .Methods We chose the elderly people whose age were over 60 years and who had routine physical examine during August and September in 2009 , the number of them is 1321.Hyperuricemia is defined as the level of serum uric acid (UA) >416 mmol/L.Hyperlipaemia is defined as the level of serum total cholesterol ( TC)≥5.18 mmol/L; triglyceride ( TG)≥1.70 mmol/L;high-density lipoprotein ( HDL) <1.04 mmol/L and low-density lipoprotein ( LDL)≥3.37 mmol/L.Hy-perglycemia is defined as the level of fasting blood glucose ( FBG)≥6.1 mmol/L.Results There were 344 patients with hyperuricemia accounting for 26.04%.With increasing age , the propotion of the patients with hyperuricemia and the mean levels of UA , TC, TG and LDL respectively showed gradually rising ( P<0.05 respectively).The incidence of hyperlipaemia and hyperglycemia was higher in the hyperuricemia group than those in the controls ( P <0.05 respectively ) .Hyperuricemia in the elderly displayed a positive correlation to TC, TG, LDL and FBG( r =0.9954,0.9805,0.9715,0.9682, P <0.05).Conclusion Hyperuricemia , related with hyperlipaemia as well as hyperglycemia , is common in the elderly and should be paid more attention .
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BACKGROUND:Bone mesenchymal stem cells(BMSCs) can accelerate vascularization of myocardial cell,relieve myocardial remodeling,and improve heart function.However,whether its paracrine action can facilitate the differentiation of CD117+ cardiac stem cells(CSCs) by effecting transforming growth factor-? Ⅲ(TGF-? Ⅲ) receptor expression is still unknown.OBJECTIVE:To study the influence of BMSCs on the expression of TGF-? Ⅲ receptor in the process of differentiation of CD117+ CSCs.DESIGN,TIME AND SETTING:In vitro cytology contract observation.The experiment was performed at the Xinhua Hospital from February 2008 to February 2009.MATERIALS:Neonatal rats,weighing 5-8 g,were used to prepare CSCs.Sprague Dawley rats,4 weeks old,weighing 200-250 g,were prepared for BMSCs.METHODS:CD117+CSCs were obtained from neonatal rats by explant cultures and magnetic bead cell sorting.Immunohistochemical experiment was performed to identify specificity of CSCs.CD117+CSCs suspension were synchronization without serum for 24 hours,washed by PBS for 3 times,and then cultured with DMEM/F12,followed by inoculation into 6-well plate.The cells were divided into the control and co-culture groups.In the control group,CSCs were induced differentiation by cardiac spheres,and Transwell chamber were used in the co-culture group.MAIN OUTCOME MEASURES:The growth of CSCs was observed by inverted microscope.The changes of cardiac Troponin T(cTnT),connexin43,TGF-? Ⅲ receptor,smad2 and phospho-smad2 expressions were detected by western blot at days 1,3,5 and 7 after culture.RESULTS:①CSCs isolated by explants cultures and MACS expressed CD117,which grew in disperse with smaller body.② The expression of cTnT and connexin43 were significantly higher in the co-culture group than that of the control group at days 5 and 7(P
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Objective To evaluate the clinical effects and complications of non - phacoemulsification small incision extracapsular cataract extraction(ECCE) and intraocular lens implantation to treat cataract. Methods Through 5.5 -7mm scleral tunnel incisions at 12:00, 212 cases (231 eyes) of cataracts were treated with intraocular lens implantation after continuous circular capsulorhexis and extraction of lens nucleus. Results One week postoperatively, the visual acuity was ≥0.5 in 184 eyes(79.65% ) ; one month postoperatively, the visual acuity was ≥0.5 in 202 eyes(87.45% ). The main complications were corneal edema, anterior chamber inflammation and posterior capsular rupture etc. Conclusion Nnon - phacoemulsification small incision ECCE and intraocular lens implantation is simple and has satisfied effects to treat cataract.