Transient elastography technology role assessment during the diagnosis and treatment of patients with chronic hepatitis B virus infection / 中华肝脏病杂志

Objective: To explore the role of transient elastography technology in the assessment of disease staging and treatment in patients with chronic hepatitis B virus (HBV) infection. Methods: Patients who were clinically diagnosed with chronic HBV infection at Beijing Tsinghua Changgung Hospital from January 2018 to December 2021 was collected. Liver stiffness measurement (LSM) examination was performed more than once by transient elastography. The count data were expressed as cases (%) and the χ (2) test was made. Fisher's exact test was used with theoretical frequency less than 5. The measurement data between two groups was compared by t-test. Multiple groups were compared with an analysis of variance. Results: 1 055 patients were included in this study, including 669 (63.4%) males and 386 (36.6%) females. 757 (71.8%) patients were untreated. Among the untreated patients, the LSM value in the immune clearance (10.2 ± 3.8) kPa (187 cases, 40.4%), and the reactivation stages (9.1 ± 3.4) kPa (114 cases, 24.6%) was significantly higher than that in the immune tolerance (8.7 ± 3.6) kPa (78 cases, 16.8%) and immune control stages (8.4 ± 3.5) KPa (84 cases, 18.1%), and the difference between the four groups was statistically significant (F = 5.31 and P = 0.03). With ALT (male: 30 U/L, female: 19 U/L) as defined the normal value, the LSM value in the immune tolerance and the immune control stages were (5.8 ± 0.9) kPa and (7.1 ± 2.5) kPa, respectively, which were significantly lower than those of patients in the immune tolerance and immune control stages, and the difference was statistically significant (P < 0.01). There were 294 (38.8%) patients with uncertain period, excluding patients with fatty liver. Patients with uncertain periods were divided into four gray zone (GZ) groups: immune tolerance stage: LSM (5.1 ± 1.3) kPa was significantly lower than GZ-A (6.5 ± 2.4) kPa, t = 2.06, P = 0.03, and the difference was statistically significant; immune control stage: LSM was (5.6 ± 1.5) kPa, which was also lower than GZ-C (6.8 ± 1.3) kPa, t = 3.08, P = 0.02, and the difference was statistically significant; immune clearance stage: LSM > 8.0 kPa. LSM values showed a year-by-year reduction in patients with expanded indications who started antiviral treatment and were followed up for three years. Conclusion: The LSM value is significantly lower after the decrease of the defined high-normal ALT value in patients with the immune tolerance and immune control stages of chronic HBV infection. The LSM values of GZ-A and GZ-C in the uncertain periods of chronic HBV infection are higher than those of patients in the immune tolerance and immune control stages.

Case-control study on retaining articular capsule in the total hip replacement for old patients with unstable femoral neck fractures / 中国骨伤

<p><b>OBJECTIVE</b>To study the effect of reserving articular capsule and traditional total hip replacement for old patients with unstable femoral neck fractures.</p><p><b>METHODS</b>From January 2010 to January 2015, one hundred and twenty patients with femoral neck fracture were retrospective review. Among them, sixty patients were treated with total hip arthroplasty reserving articular capsule, the others were treated with traditional total hip arthroplasty without reserving articular capsule. The gender of reserving articular capsule group and traditional group were (male/female) 34/26, 31/29 respectively; the age were (73.4±4.4), (72.3±4.1) years old, respectively. All patients were followed up for six months, the operation time, blood loss, length of stay, incidence of postoperative complications, incidence of postoperative hip dislocation and hip Harris score of the two groups were observed.</p><p><b>RESULTS</b>The operative time of the reserving articular capsule group and traditional group were (95.68±6.90), (93.39±7.90) min (>0.05), and the blood loss were (998.78±15.20), (1 000.25±16.80) ml (>0.05). The time for hospital stay were (10.74±2.90), (13.25±2.20) days(<0.05). The Harris scores were 58.53±5.10, 49.38±4.90(<0.05) at 1 month after operation;91.08±7.50, 90.74±7.10(>0.05) at 6 months after operation.</p><p><b>CONCLUSIONS</b>The method of reserving auricular capsule can not increase the operative time and the blood loss. But it has a favorable effect on decreasing the hospital stay, complication, the rate of early dislocation of the hip joint, improving the function of hip joint.</p>