Interpretation of the important update of the Guideline for the prevention and treatment of hepatitis C (2022 edition) / 中华肝脏病杂志

In the past 20 years, Chinese Medical Association had issued several versions of hepatitis C prevention and treatment guidelines. In the latest guidelines published in 2022, the Chinese Society of Hepatology and the Society of Infectious Diseases for the Chinese Medical Association organized experts to update their recommendations for hepatitis C screening and treatment. The updated key points on prevention, diagnosis, and treatment proposed in the guidelines are now interpreted, aiming to provide reference for more effective clinical application of the guidelines.

Study on infusion misdirection syndrome during phacoemulsification cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

Infusion misdirection syndrome(IMS)is a rare and troublesome intraoperative complication during phacoemulsification cataract surgery, which usually occurs in hydrodissection, phacoemulsification or irrigation/aspiration(I/A). Under the factors of lax zonular fibers, lens dislocation, posterior capsular rupture, the anterior segment crowding, high perfusion pressure, the infusion fluid accumulates in the vitreous cavity or behind the vitreous, leading to intraocular hypertension, shallowness or even disappearance of the anterior chamber and eventually causing the suspension of surgery. It needs to be differentiated from suprachoroidal hemorrhage(SCH), capsular block syndrome(CBS), etc. After intraoperative emergency treatments, such as rest combined with intravenous drip of mannitol, pars plana needle aspiration or vitrectomy, a favorable prognosis can be obtained. This review discusses the pathogenesis, diagnosis, emergency management, prevention and prognosis of IMS during phacoemulsification cataract surgery, with the aim of providing clinical guidance for ophthalmologists.

Influencing factors of Toric intraocular lens postoperative rotation and its principles of treatment / 国际眼科杂志(Guoji Yanke Zazhi)

Correcting astigmatism safely and effectively has become a crucial part of modern cataract surgery due to the transformation of the surgery into a refractive procedure. The increased predictability and enhanced safety of Toric intraocular lens(IOL)implantation has made it the preferred method of correcting corneal regular astigmatism above 0.75D in cataract surgery. Toric IOL needs to be implanted in a precise axis position to achieve good astigmatism correction. A major cause of toric misalignment is postoperative rotation, which typically occurs soon after surgery. However, large axis misalignment will eliminate the astigmatism corrective effect of Toric IOL, even cause astigmatism in a new axis position. The factors responsible for IOL postoperative rotation are diverse. As a result, profound understanding of the factors is crucial for clinicians to minimize the rotation. Repositioning procedure is generally selected in case of significant rotation and the timing of the procedure is vital. This paper reviewed the influencing factors of IOL rotation postoperatively and its principle of treatment.

New advances of artificial intelligence in the diagnosis of non-alcoholic fatty liver disease / 中华肝脏病杂志

Artificial intelligence (AI) refers to the use of computer programs to simulate and extend human intelligence, and has application prospects in the diagnosis and treatment of diseases. This review focuses on the research status of the screening and diagnosis of NAFLD and nonalcoholic steatohepatitis using artificial intelligence technology, electronic health record data, multi-omics prediction models, image recognition technology based on liver imaging and pathological biopsy, and new drugs research and development, with a view to provide new ideas for the diagnosis and treatment.

Impact of hepatitis C virus genotype 3 on liver disease progression in a Chinese national cohort / 中华医学杂志(英文版)

BACKGROUND@#Hepatitis C virus (HCV) genotype 3, particularly subtype 3b, is increasing in prevalence and distribution in China. This study evaluated the prevalence, regional distribution, clinical characteristics, host factors, treatment outcomes, and disease progression of patients with HCV genotype 3 in China.@*METHODS@#A 5-year follow-up was preceded by a cross-sectional study. Treatment choices were at the discretion of treating physicians. Estimated infection time to overall-disease-progression (defined by ≥1 of: newly diagnosed cirrhosis; cirrhosis at baseline, Child-Turcotte-Pugh score increased 2 points or more; progression from compensated cirrhosis to decompensated cirrhosis; hepatocellular carcinoma; liver transplantation; or death) was calculated using the Kaplan-Meier method. Cox regression analyses were conducted to evaluate the risk factors for disease progression.@*RESULTS@#The cross-sectional study enrolled 997 patients, including 91 with HCV genotype 3 infection. Among them, subtype 3b (57.1%) was more dominant than subtype 3a (38.5%). Five hundred and twelve patients were included into the follow-up phase. Among patients analyzed for estimated infection time to overall-disease-progression, 52/304 (17.1%) patients with HCV genotype 1 and 4/41 (9.8%) with HCV genotype 3 (4/26 with genotype 3b, 0/13 with genotype 3a, and 0/2 with undefined subtype of genotype 3) experienced overall-disease-progression. Patients with HCV genotype 3 were younger than those with genotype 1 (mean age: 39.5 ± 8.7 vs. 46.9 ± 13.6 years) and demonstrated more rapid disease progression (mean estimated infection time to overall-disease-progression 27.1 vs. 35.6 years).@*CONCLUSIONS@#HCV genotype 3, specifically subtype 3b, is associated with more rapid progression of liver disease. Further analysis to compare HCV subtype 3a and 3b is needed in high prevalence regions.@*TRIAL REGISTRATION@#NCT01293279, https://clinicaltrials.gov/ct2/show/NCT01293279; NCT01594554, https://clinicaltrials.gov/ct2/show/NCT01594554.

Experimental Research on Liver Pathological Characteristics of Autoimmune Hepatitis C57BL/6 Mice / 昆明医科大学学报

Objective To observe liver pathological characteristics of the autoimmune hepatitis (AIH) C57BL/6 mice.Methods We established AIH C57BL/6 mice model with mixed adjuvants of allogenic liver antigens and complete freund's adjuvant by intraperitoneal injection.Then we determined and compared the body weight,alanine aminotransferase (ALT),aspartate aminotransferase (AST) between the normal control group (N group) and AIH model group (M group).And we compared the pathological characteristics of liver,spleen,heart,lung,kidney between two groups.Results We successfully established AIH C57BL/6 mice model.Compared with N group,we found that the average weight increase of mice in M group was decreased,ALT and AST of mice in M group were boosted.In M group,liver of mice presented typical interface of hepatitis,lymphocytic infiltration,even severe hepatitis,and showed spotty necrosis,multi-acinar necrosis.Some showed early sign of liver fibrosis by aprearing fibrous tissue hyperplasia.M group mouse's spleens were enlarged significantly.The spleen had darker color,not neat,and not smooth.Meanwhile,results were analyzed with statistics to confirm whether there was a significant difference between two groups (P＜0.05).About lungs,hearts and kidneys of mice in two groups,the pathological features were not found,and there was no statistic difference (P＞0.05).Conclusions The liver pathological characteristics of AIH C57BL/6 mice are similar to AIH patients.The results provide the pathological basis for the experimental research of autoimmune hepatitis.

Drug resistance situation in 2 271 tuberculous patients and epidemiological characteristics analysis / 重庆医学

Objective To investigate the drug resistance situation and the epidemiological characteristicin the tuberculoupatientin ordeto provide the reference foeffective prevention and treatmenof T.MethodTotally 2 271 patientwith posi-tive sputum smeapulmonary tuberculosi(TB) in the Jiangbei Branch Hospital of Chongqing Zhongshan Hospital from January 2009 to Decembe2013 were performed the drug resistance detection of 10 kindof anti-Tdrugs(isoniazid ,streptomycin ,rifampi-cin ,ethambutol ,para-aminosailcyliacid ,kanamycin ,pasiniazid ,protionamide ,capreomycin ,and ofloxacin) .ResultOf all 2 271 ca-seof positive sputum culture pulmonary T,the total drug resistance rate and total multi-drug resistance rate were 61 .91% and 26 .29% ,respectively ;the total drug resistance ratein initial treatmenand retreatmenpatientwere 52 .85% and 78 .06% respec-tively ,and the multi-drug resistance ratewere 16 .70% and 43 .38% ,respectively ;the top five in the average drug resistance ratefrom high to low were streptomycin(39 .45% ) ,isoniazid(33 .20% ) ,rifampicin(32 .94% ) ,para-aminosailcyliacid(31 .40% ) and pasiniazid(21 .53% );the anti-Ttreatmenhistory ,gende,age and occupation were significantly associated with the drug resist-ance occurrence (P＜0 .05) .Conclusion The drug resistance situation of the Tpatientin the local areof Chongqing iseriouin the recen5 year.The standardized managemenand treatmenon the Tpatientwith drug resistance should be strengthened .

Direct-acting Antiviral Agents Resistance-associated Polymorphisms in Chinese Treatment-naïve Patients Infected with Genotype 1b Hepatitis C Virus / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It has been reported that several baseline polymorphisms of direct-acting antivirals (DAAs) agents resistance-associated variants (RAVs) would affect the treatment outcomes of patients chronically infected with hepatitis C virus (CHC). The aim of this study is to investigate the prevalence of DAAs RAVs in treatment-naÏve GT1b CHC patients.</p><p><b>METHODS</b>Direct sequencing and ultra-deep sequencing of the HCV NS3, NS5A, and NS5B gene were performed in baseline serum samples of treatment-naÏve patients infected with genotype 1b hepatitis C virus (HCVs).</p><p><b>RESULTS</b>One hundred and sixty CHC patients were studied. Complete sequence information was obtained for 145 patients (NS3), 148 patients (NS5A), and 137 patients (NS5B). Treatment-failure associated variants of DAAs were detected: 56.6% (82/145) of the patients presented S122G for simeprevir (NS3 protease inhibitor); 10.1% (14/148) of the patients presented Y93H for daclatasvir and ledipasvir (NS5A protein inhibitors); 94.2% (129/137) of the patients presented C316N for sofosbuvir (NS5B polymerase inhibitor). Nearly, all of the DAAs RAVs detected by ultra-deep sequencing could be detected by direct sequencing.</p><p><b>CONCLUSIONS</b>The majority of genotype 1b CHC patients in China present a virus population carrying HCV DAAs RAVs. Pretreatment sequencing of HCV genome might need to be performed when patients infected with GT1b HCV receiving DAAs-containing regimens in China. Population sequencing would be quite quantified for the work.</p>

Effect of rehabilitation training on rat with spinal cord injuries:a Meta-analysis / 局解手术学杂志

Objective To evaluate the effect of rehabilitation training on rats with spinal cord injuries by Meta-analysis. Methods Ar-ticles were searched from PubMed( ~2013),CNKI(1989~2013), WanFang Data( ~2013),VIP(1989~2013),quality of included article was assessed with Jadad scale,and available data was analyzed with RevMan 5. 0 software. Results 287 related articles were identified,but only 11 eligible articles were included. The Meta-analysis of BBB score indicated that the rehabilitation training groups were better than con-trol groups. The BBB score[weighted mean difference(WMD) =1. 87,95%CI(1. 50,2. 33),Z=10. 02,P<0. 01]. There was significant diffence between two groups. Conclusion Rehabilitation training can improve the recover of hindlimb function.

Investigation on the interaction of young teachers' classroom teaching at medical colleges and universities / 中华医学教育探索杂志

Objective To analyze the interactions in lectures conducted by young teachers in medical institutions and investigate the way of improving their ability. Methods We analyzed the teaching plans and the actual performance of 31 teachers who enter the final of the 16th competition of young teacher's basic skills, 2011 and observed the lectures of another 15 randomly selected teach-ers, focusing on the interactions and the effects in the lectures. Results Among the 31 teachers, 19 (which is 61.29% of the total) teachers designed and implemented interactive teaching; 6 (which is 40.00% of the total) teachers adopted interactive teaching in daily teaching. Among the 40 young teachers included in the research , 27 ( which is 54 . 35% of the total ) teachers employ interactive teaching. The way of performing interactive teaching in all above situations is answering questions. Conclusions Interactive teaching is commonly used in lectures by young teachers in medical insti-tutions. However, the method is simple and the quality needs to be improved.

Etiological features of cirrhosis inpatients in Beijing, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The etiological spectrum of cirrhosis has changed over the years, but our knowledge of it is limited. The present study aimed to investigate the etiological features of cirrhosis inpatients and their variation in the past 18 years in Beijing.</p><p><b>METHODS</b>A retrospective analysis was performed on all patients with cirrhosis diagnosed for the first time in Peking University People's Hospital from January 1, 1993, to October 25, 2010. Data were analyzed using SPSS 20.0.</p><p><b>RESULTS</b>A total of 2119 cirrhosis inpatients were included in this study: 1412 (66.6%) male and 707 (33.4%) female. Chronic hepatitis B accounted for 58.7%; chronic hepatitis C for 7.6%; chronic hepatitis B and hepatitis C virus co-infection for 0.8% (16 cases); alcoholic liver disease for 9.4% (200 cases); and autoimmune diseases for 9.4% (199 cases). In the past 18 years, the percentage of chronic hepatitis B has decreased from 75.2% to 48.7%; alcoholic liver disease has increased from 5.1% to 10.6%; and autoimmune disease has increased from 2.2% to 12.9%. The percentages of chronic hepatitis B and alcoholic liver disease were higher among men, whereas the percentages of chronic hepatitis C, autoimmune diseases and cryptogenic cirrhosis were higher among women.</p><p><b>CONCLUSIONS</b>Chronic hepatitis B was still the most common etiology of cirrhosis in China, but the percentage has been decreasing. The percentages of alcoholic liver disease and autoimmune diseases have been increasing. The etiological spectrum of cirrhosis inpatients differed significantly according to sex.</p>

Effect of antiviral therapy on the prognosis of patients with chronic hepatitis B-related cirrhosis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To conduct a meta-analysis to study the effect of antiviral therapy on the prognosis of patients with chronic hepatitis B (CHB)-related cirrhosis.</p><p><b>METHODS</b>PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Biomedical Database, Chinese Journals Full-text Database, and Wan Fang Digital Journal Full-text Database were searched for studies on nucleoside analogues antiviral treatment outcome of patients with CHB-related cirrhosis (vs. controls without antiviral therapy) published between January 1998 and March 2012. Data extraction and quality assessment was performed by two independent investigators. Heterogeneity was assessed by the I2 index. In the case of homogeneity the random-effects model was applied, and in the case of heterogeneity the fixed-effects model was applied. The odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.</p><p><b>RESULTS</b>Seven studies were included in the meta-analysis: one high-quality randomized-controlled trial (RCT) study, four prospective cohort studies, and two case-control studies. Compared to the control group, the group treated with antiviral therapy showed a significantly lower incidence of hepatocellular carcinoma (11.2%, 76/680 vs. 6.7%, 75/1116; OR = 0.56, 95% CI: 0.40 to 0.79, P = 0.001) and lower mortality (23.6%, 78/331 vs. 10.8%, 43/398; OR = 0.36, 95% CI: 0.23 to 0.55, P = 0.000).</p><p><b>CONCLUSION</b>Antiviral therapy with nucleoside analogues significantly reduces the incidence of hepatocellular carcinoma and mortality in patients with CHB-related cirrhosis.</p>

Effects of Electrical Stimulation on the Expression of Glial Fibrillary Acidic Protein and Interleukin-1 Alpha in Adult Rats with Spinal Cord Injury / 中国康复理论与实践

@#Objective To investigate the effects of electrical stimulation on the expression of glial fibrillary acidic protein (GFAP) andinterleukin-1 alpha (IL-1α) in adult rats with spinal cord injury. Methods 72 adult SD rats were randomly divided into damage group (n=24), electrical stimulation group (n=24) and normal group (n=24). The spinal cord incomplete injury model on T9 was made with Allen'smethod in the former 2 groups. The rats in electrical stimulation group accepted electrical stimulation for 7 d. All the rats were evaluatedwith the Basso, Beattie & Bresnahan locomotor rating scale (BBB scale), and the expression of GFAP and IL-1α were determined with immunohistochemistry.Results The BBB scores in both the damage group and electrical stimulation group were significantly less than that inthe normal group (P<0.05), and it was more in the electrical stimulation group than in the damage group 5 and 7 d after injury. The expressionsof the GFAP significantly increased after injury to the peak on 5th day, while it was less in the electrical stimulation group than in thedamage group 5 and 7 d after injury (P<0.05). The expressions of the IL-1α increased continually after injury, while it was less in the electricalstimulation group than in the damage group 5 and 7 d after injury (P<0.05). Conclusion Electrical stimulation can inhibit the expressionof GFAP and IL-1α, that reduce inflammation and glial scar formation.

Effects of transcutaneous electrical stimulation on the expression of neurotrophin-3 and tumor necrosis factor-α in the ventral horn after spinal cord injury / 中华物理医学与康复杂志

Objective To research the effects of transcutaneous electrical stimulation (TES) on the expression of neurotrophin-3 (NT-3) and tumor necrosis factor-α (TNF-a) in the ventral horn of rats' spinal cords and in the injured region after spinal cord injury (SCI),and to explore the effects of TES on neuron reconstruction and functional recovery and their mechanisms. Methods Forty-eight Wistar rats were selected and divided using stochastic methods into a model group and a TES group.Using Allen's method,a complete SCI model was created at T9.Rats of the TES group were given TES treatment.Basso-Beattie-Brasnahan ( BBB ) ratings were used to evaluate locomotor function.Both groups were sampled at 1,3,5 and 7 days after the operation.Immunohistochemical techniques were used to detect the expression of NT-3 and TNF-α in the rats' spinal cords at the different time points. Results The post-operative BBB ratings of both groups showed an increasing trend.In the TES group the improvement was significantly better at 5 and 7 days than in the model group.The expression of NT-3 immuno-positive cells increased in both groups,peaking at 5 days post-operation,then declining at day 7.The expression of NT-3 positive cells at days 5 and 7 had increased significantly more in the TES group than in the model group.TNF-α immuno-positive expression increased with time in both groups,but in the TES group the expression increased substantially less than in the model group.At days 5 and 7 post-operation,the expression was significantly lower than in the model group. Conclusions TES can promote NT-3 expression in rats with SCI,inhibit the increase in TNF-α expression,and aid repair and reconstruction of neurons and related functional recovery.

The effects of endothelial progenitor cell transplantation in carbon tetrachloride induced hepatic fibrosis rats / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To study the effects of rat endothelial progenitor cell (EPC) transplantation on hepatic fibrosis in carbon tetrachloride (CCl4) induced hepatic fibrosis rats.</p><p><b>METHODS</b>Hepatic fibrosis was developed in 24 healthy female SD rats by feeding them 25% CCl4/olive oil for 8 weeks. Eight of them were sacrificed at the end of the 8 weeks. The rats were subdivided into a EPCs transplanting group (n=8) and a saline control group (n=8). After the EPCs were isolated and cultured for 9 days, the cells were injected into the portal veins of the rats in the EPCs transplanting group. Four weeks later all of the rats were sacrificed. The blood biochemical parameters from the serum were examined. The degree of liver fibrosis was evaluated by reading Masson staining liver slides and by detecting the expression of a-SMA and collagen III.</p><p><b>RESULTS</b>Compared with the saline control group, hepatic activity index (HAI), levels of ALT, AST and TBil in the serum were all lower in the EPCs transplanting group, but the level of Alb was higher and the expression of a-SMA and collagen III were lower. Compared with the 8 week hepatic fibrosis group, the levels of ALT, AST and TBil in the serum of the EPCs transplanting group were all lower. In the saline control group, the serum levels of ALT, AST and TBil were higher, the level of Alb was lower, and the expressions of a-SMA and Collagen III were higher.</p><p><b>CONCLUSION</b>In hepatic fibrosis rats, transplantation of rat EPCs could minimize the hepatic fibrosis process and the injuries.</p>

Effect of glia maturation factor beta on the activation of hepatic stellate cells and on liver fibrosis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To further study the mechanism of the inhibitory effect of interferon beta-1a (IFN beta-1a) on the activation of human hepatic stellate cell (HSC) LX-2, and to analyze the differences on the protein expression in LX-2 induced by I IFN beta-1a.</p><p><b>METHODS</b>Cultured LX-2 cells were treated with 2000 U/ml IFN beta-1a for 48 h. Two-dimensional gel electrophoresis (2-DE) was performed to compare protein patterns of the control (untreated) and IFN beta-1a treated LX-2 and for quantitative and qualitative analyses of protein expression. A rat liver fibrosis model was established and the rats were sacrificed and their various tissues were obtained for the same analyses. Western blotting and RT-PCR were used to validate the expression of the changed proteins after treatment of IFN beta-1a in LX-2 cells and of various tissues of the rats.</p><p><b>RESULTS</b>708 +/- 25 spots were detected in control LX-2 cells and 804 +/- 32 spots in IFN beta-1a-treated LX-2 cells. A match rate of 73%-82% was achieved. The results also showed that 31 protein spots displayed quantitative changes in expression after IFN beta-1a treatment. Of the 31 spots, 21 proteins were identified, of which, one was newly found, two were enhanced in abundance and 18 showed lower expressions. The newly found protein was glia maturation factor beta (GMF beta). The treatment of LX-2 with IFN beta-1a increased the production of GMF beta(GMF beta) protein in comparison with the untreated cells (t=1.81, P < 0.01). The expression of GMF beta protein (1.81 vs 0.10) and mRNA (0.85 vs 0.12) were more in the normal liver tissues than in the cirrhotic liver tissues (t=2.53, 2.13 respectively, P < 0.01). The expressions of GMF beta protein and mRNA were weak in rat heart and lung tissues, however, they were strong in rat liver, kidney, spleen and brain tissues (t=1.91, 1.94 respectively, P < 0.01).</p><p><b>CONCLUSION</b>There is a significant difference of protein expression levels between IFN beta-1a untreated and treated LX-2 cells. These proteins, especially GMF beta, may be involved in an inhibition process of IFN beta-1a on activation and apoptosis of LX-2 cells. This proteome study may be useful in further studies of the relationship of IFN beta-1a treatment and human liver diseases.</p>

Analysis of prognosis of patients with decompensated liver cirrhosis using the criterion of the Model of End-Stage Liver Disease / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the relationship between the Model for End-Stage Liver Disease (MELD) with Child-Pugh scoring, and the prognosis of patients with decompensated liver cirrhosis.</p><p><b>METHODS</b>110 patients with decompensated liver cirrhosis were graded with MELD formula and with Child-Pugh. The death rate was observed within three months.</p><p><b>RESULTS</b>31 patients died within 3-months. The mortality of patients whose MELD scores were between 10 approximately 19, 20 approximately 29, and > or = 30 was higher than those with MELD < or = 9 (The mortality of those with MELD less than 9, 10 approximately 19, 20 approximately 29, or > or = 30 was 11.76%, 38.18%, 64.71%, 75.00% respectively). The mortality of patients whose MELD scores were > or = 18 was higher than those with MELD < 18 (The mortality of those with MELD < 18, MELD > or = 18 was 26.58%, 58.06% respectively. chi2 = 9.643). The mortality of Child A, B, C was 14.89%, 42.55%, 75% respectively.</p><p><b>CONCLUSION</b>Both MELD and Child-Pugh scores can accurately predict the short-term prognosis of patients with decompensated liver cirrhosis.</p>

The serum proteomic analysis of the adefovir dipivoxil response in the chronic hepatitis B patients / 中华检验医学杂志

Objective To compare the difference of the protein about the patient of hepatitis B who received adefovir dipivoxil(ADV)therapy,and seek the useful biomarker of effective therapy.Methods We used the two-dimensional gel electrophoresis technology to examine HBV infected serum samples aiming at searching protein's alteration after ADV therapy.Results After 1 year's treatment,haptoglobin, haptoglobin 2-alpha raised and alpha-l-antitrypsin precursor,Factor B,Chain B,transthyretin,glutathione peroxidase,alpha-2-HS-glycoprotein,retina]binding protein,retinol-binding protein precursor, apolipoprotein,apolipoprotein A-I precursor fell in viral response patients.Transthyretin raised and leucine- rich alpha-2-glyeoprotein,haptoglobin,alpha-2-actin,apolipoprotein A-I precursor fell in none viral response patients.To compare two groups:apolipoprotein A-I have the same change and haptoglobin, transthyretin have the opposite change.Conclusion Proteomics study can find the alteration of protein during the ADV treatment,and is helpful to searching the predictable biomarker to ADV.