[Clinical significance and mutation characteristics in the core promoter/pre-C region of different HBV genotypes in children].

Objective: To understand the clinical significance and mutation characteristics in the basic core promoters and pre-C region (BCP/PC) of different hepatitis B virus genotypes samples of infected children. Methods: A total of 294 children and 92 adults with CHB infection who were treated at four hospitals in Chongqing from 2011 to 2018 were collected. The BCP / PC region of HBV was amplified by PCR and sequenced directly to comparatively analyze the gene mutation conditions in this region. The two sample means were compared by the t-test, and the nonparametric data was compared by Wilcoxon-Mann-Whitney test. χ2 test or Fisher's exact test was used to compare the data rates of the two groups. Results: Children and adult patients were dominated by genotype B; accounting for 76.9% and 71.7%, respectively, and genotype C accounted for 23.1% and 28.3%, respectively. In the children group, the mutation rates of ten nucleotide sites containing nt 1679, 1721, 1753, 1757, 1758, 1762, 1764, 1775, 1856 and 1858 of the genotype C samples was significantly higher than that of genotype B samples. The mutation rates of G1721a, C1856t and T1858c of genotype C samples were 30.9%, 16.2% and 30.9%, respectively, while the mutation rates of genotype B samples were 0.4%, 0, 0, P < 0.001, respectively. In the adult group, the only three sites containing nt 1679, 1758, and 1775 of the genotype C sample had a higher mutation rate than the genotype B samples. The combined mutations pattern were only detected in children with genotype C samples, but not in children and adult with genotype B samples. Further analysis showed that the age of G1721A/A1775G/T1858C containing combined mutation group was significantly lower than that of the non-mutation group [(4.58 ± 2.53) years vs. (6.53 ± 4.02) years, P = 0.012]. Serum HBV DNA titer was significantly higher in combined mutation group than that of the non-mutation group [(7.57 ± 2.03) log10 copies / ml vs. (6.61 ± 2.11) log10 copies / ml, P = 0.045]. Conclusion: The frequencies of mutations in the BCP/PC region of HBV-infected children in genotype C samples were significantly higher than that of genotype B samples. Genotype-related combined site mutations were only found in children with genotype C samples, and were also associated with younger patients and high HBV-DNA titers.

[Therapeutic effect of different surgical methods for congenital small intestine atresia].

Objective: To compare and analyze the curative effect of three surgical methods in the treatment of small intestine atresia, and to provide evidence for individualized surgical treatment of children with small intestine atresia. Methods: The clinical diagnosis and treatment of 168 children with small intestine Ⅱ, Ⅲ, Ⅳ type atresia in our hospital from January 2008 to September 2017 were retrospectively analyzed and they were divided into different types according to the operation. The three groups were end-to-end anastomosis group (EEA, n=58), end oblique anastomosis group (EOA, n=68), and proximal end-end anastomosis group (PEA, n=42). The EEA group and the EOA group were further divided into group a (EEA-a/EOA-a) with a proximal intestinal tube diameter greater than 4.0 times the distal end and a group b ((EEA-b/EOA-b) with a diameter less than or equal to 4.0 times the distal intestinal tube diameter. The gender, gestational age, birth weight, type of atresia, and postoperative defecation time, postoperative feeding time, postoperative hospital stay and postoperative follow-up complications were compared. Results: There was no significant difference in gender, gestational age and birth weight between the groups (P>0.05). The PEA group was better than EEA-a group and EOA-a group in postoperative defecation time, postoperative feeding time, postoperative hospital stay and complications (P<0.05). The postoperative defecation time, postoperative feeding time, postoperative hospital stay and complications of the EOA-a group were better than those of the EEA-a group (P<0.05). There was no statistically significant difference in postoperative defecation time, postoperative feeding time, and complications between the EEA-b group and the EOA-b group (P>0.05), but the postoperative hospital stay in the EEA-b group was longer than that in the EOA-b group (P<0.05). Conclusion: PEA is recommended for children with a proximal intestinal canal diameter greater than 4.0 times greater than the distal end because of the rapid recovery and fewer complications; EOA is recommended for children with a proximal intestinal canal diameter of 4.0 or less because of its advantage of shorter hospital stay than EEA surgery. Congenital intestinal atresia has a better effect according to the specific conditions of the child.

[Correlation between serum uric acid and risk of new-onset nonalcoholic fatty liver disease: a 5-year observational cohort study].

Objective: To investigate the association between serum uric acid and the risk of new-onset nonalcoholic fatty liver disease(NAFLD). Methods: An observational cohort study was conducted in a hospital for five years. 856 patients without NAFLD who took physical examination in the hospital physical examination center in 2011 were selected as study subjects. According to the baseline level of serum uric acid, subjects were divided into 4 groups (F1, F2, F3, and F4). After 5-years of follow-up, the incidence of NAFLD in each group was observed in 2016.Serum alanine aminotransferase and aspartate aminotransferase, Total cholesterol, High-density lipoprotein cholesterol, Low-density lipoprotein cholesterol, Triglycerides, Fasting blood glucose and Imaging findings were examined. The cumulative incidence rate of NAFLD in each group was compared and the effect of baseline serum uric acid level on new-onset NAFLD was analyzed by Logistic regression. The receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of uric acid level in NAFLD. Results: The cumulative incidence rate of NAFLD was 19.16%, and the cumulative incidence increased with the increase of baseline uric acid. The incidence rates of F1, F2, F3 and F4 were 7.90%, 13.54%, 20.32% and 34.07% respectively. The difference was statistically significant (P < 0.05). The incidence rate of NAFLD in F2, F3 and F4 groups were 1.637 (0.856 ~ 3.344) times, 2.745 (1.345 ~ 5.211) times and 5.465 (2.977 ~ 9.843) times higher than those in F1 group (P < 0.05). The logistic regression analysis showed that the risk of NAFLD increased with the increase of serum uric acid level, and the serum uric acid level was an independent risk factor for NAFLD with a relative risks (RR) value of 1.654. The ROC curve analysis of serum uric acid levels had no diagnostic value for NAFLD. Conclusion: Our study demonstrates that increased serum uric acid level is an independent risk factor for the development of NAFLD and could be used as an investigative indicator to assess the risk.

Incidence, risk factors, and prognosis of acute kidney injury following transarterial chemoembolization in patients with hepatocellular carcinoma: a prospective cohort study.

BACKGROUND: Transcatheter arterial chemoembolization (TACE) is an effective first-line therapy for intermediate stage hepatocellular carcinoma (HCC). Acute renal injury may be induced after transarterial chemoembolization because of iodinated radiocontrast medium, but its incidence, risk factors, and prognosis remain unclear. PATIENTS AND METHODS: This prospective study enrolled 166 HCC patients with a total of 316 TACE treatments. The incidence, risk factors, and prognosis of acute kidney injury (AKI) were examined. RESULTS: The incidence of post-TACE AKI was 21.84% (69/316) according to Barrett and Parfrey criteria, whereas 7.59% (24/316) according to acute kidney injury network (AKIN) criteria. Multivariate logistic regression analysis showed that serum total bilirubin (TB) (>13.5 µmol/L; odds ratio [OR]: 1.871 95% confidence interval [CI]: 1.044-3.352; P = 0.035) and hemoglobin (HGB) level (<120 g/L; OR: 1.823, 95% CI: 1.019-3.264; P = 0.043) were associated with the development of AKI after TACE procedure in accordance to Barrett and Parfrey criteria. Meanwhile, age (>55 years; OR: 3.456, 95% CI: 1.107-10.790; P = 0.033), post-TACE AKI history (OR: 7.108, 95% CI: 1.387-36.434, P = 0.019), and serum aminotransferase level (>55 U/L; OR: 4.420, 95% CI: 1.792-10.906; P = 0.001) were associated with the development of AKI after TACE procedure in accordance to AKIN criteria. Total hospitalization cost was significantly higher (P = 0.034) in the patients with AKI after TACE procedure according to Barrett and Parfrey criteria. A post-TACE AKI diagnosis was associated with mortality in any definition used (P = 0.034 and P = 0.001 for Barrett and Parfrey and AKIN criteria, respectively). CONCLUSION: The present study showed that the incidence of post-TACE AKI was high in HCC patients (i.e., 7.59-21.84%) depending on criteria used. HGB (<120 g/L), serum TB (>13.5), and aminotransferase level (>55 U/L), age (>55 years) and post-TACE AKI history may be predictors of post-TACE AKI in HCC patients. The development of post-TACE AKI was associated with the risk of renal replacement treatment, prolonged renal insufficiency, or mortality according to AKIN criteria.

[Expression of human superoxide dismutase gene in rat vascular smooth muscle cells and its anti-oxidative effect].

A retroviral vector containing human superoxide dismutase (SOD) cDNA was constructed and transfected into rat vascular smooth muscle cells (VSMCs). The expression of exogenous hSOD1 in the VSMCs was analyzed with Northern and Southern blot. The protection of the transfected and/or non-transfected VSMCs from free radical produced by the xanthine/xanthine oxidase (X/XO) system was investigated. The results showed that the construction strategy of the vector was correctly performed and the expression of hSOD1 in the transfected cells was highly detectable. The cell damage of X/XO could be alleviated with expression of hSOD1 in the transfected cells, as compared to control. In addition, proliferation of the transfected VSMCs resulted from oxidative stress was suppressed. It is suggested that the expression of gene-transferred hSOD1 is able to prevent the formation of atherosclerosis, partially due to its cell protection and inhibition of the proliferative embolization.

Changes in cardiovascular function during inversion.

Although inversion therapy is used increasingly as a therapy for musculoskeletal back disorders, its effects on cardiovascular function have not been systematically determined. Heart rate, blood pressure and echocardiographic measurements were performed in 20 normal male volunteers before, during and after bent-knee inversion. Compared to control measurements in the supine position, inversion significantly increased heart rate, systolic and diastolic blood pressure, rate-pressure product, systemic vascular resistance and left ventricular (LV) wall stress. Inversion also resulted in a significant decrease in LV diastolic volume, cardiac output and ejection fraction. Thus inversion produces an increase in LV afterload and myocardial oxygen demand concomitantly with a decrease in LV preload and global systolic function, and may be contraindicated in patients with cardiovascular disease.

Changes in left ventricular wall stress during isometric and isotonic exercise in healthy men.

Changes in left ventricular (LV) meridional and circumferential end-systolic wall stress during isometric and isotonic exercises were determined noninvasively in 12 healthy subjects using echocardiography and cuff blood pressure measurements. Isometric exercise was performed at 20 and 40% of maximal voluntary contraction using a handgrip dynamometer, and isotonic exercise was done on a cycle ergometer at 150 kpm/min increments every 3 minutes to a maximum of 600 kpm/min. Although the increase in systolic blood pressure was similar in both forms of exercise, LV systolic stress in the circumferential and meridional planes increased markedly during isometric exercise but decreased slightly during higher intensity isotonic exercise. Isometric exercise also produced a significant decrease in fractional shortening, whereas isotonic exercise significantly increased fractional shortening. Wall stress and fractional shortening were linearly and inversely related, but isometric and isotonic exercise produced divergent and significantly different linear regressions. In normal subjects isometric exercise produces a significant increase in LV afterload that leads to a decrease in LV global function. In contrast, isotonic exercise causes an increase in LV global function, most likely from an unchanged or slight decrease in afterload associated with increased LV contractility from greater catecholamine release.