[ABSTRACT]OBJECTIVETo evaluate the diagnostic value and curative effect of keyhole neurovascular decompression with local anesthesia for vestibular paroxysmia.METHODSOf 40 patients with trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia, 8 of them combined with vestibular paroxysmia underwent keyhole neurovascular decompression under local anesthesia to explore the vascular compression of acoustic nerve root and have the neurovascular decompression. The evaluation of the vertigo after operation was performed with symptom report card. The patients were followed-up for 36 to 61 months. RESULTSThe vessels compressing the root zone of the vestibular nerve were found in 8 patients with vestibular paroxysmia, of whom 7 patients had the vascular compression vertigo induced during operation and the vertigo was disappeared after operation, moreover, one patient had no vascular compression vertigo induced during operation and the vertigo was not changed after operation. With the average follow-up of 57 months, of 8 patients with vestibular paroxysmia, 7 patients had no recurrence of the vertigo, and the effective control rate was 87.5%.CONCLUSION Local anesthesia keyhole neurovascular decompression was not only an effective way for treating vestibular paroxysmia and controlling the vertigo, but also had certain clinical significance in the diagnosis of vestibular paroxysmia.

Objective To investigate the effects of ligustrazine (TMP) combined with salvia miltiorrhiza on the progression of chronic allograft nephropathy (CAN) in rats and the action mechanism.Methods Fischer 344 rats and Lewis rats were used as renal transplant recipients and donors for ortlotopic kidney transplantation. The CAN model was established.By using random number table,the kidney transplant recipients were divided into five groups:cyclosporine A (CsA) group (A),TMP + CsA group (B),Salvia + CsA group (C),TMP + Salvia + CsA group (D) and blank control group (E,receiving no treatment).At 2nd,4th,6th,8th and 12th week after operation,5 mice in each group were sacrificed,and the transplanted kidney was removed for examination of renal histopathological changes. The immunohistochemistry was used to detect the expression of transforming growth factor β1 (TGF-β1) in the renal allograts,and by using fluorescent quantitative polymerase chain reaction,TGF-β1 mRNA expression in the renal allograts assayed.Results In blank control group,the survival time was no more than two weeks.In group A,the CAN pathological changes occurred at 4th week postoperation,those in group B and group C occurred later than in group A,and latest in group D with mild pathological lesions.In all groups after operation,Banff scores showed an upward trend,and at the same time point,those in group A were significantly higher than groups B,C and D ( P＜0.05 and P＜0.01 ).and those in group D was significantly lower than in group B and group C (P＜0.05),but no significant difference was found between group B and group C (P＞0.05).With time over,the TGF-β1 expression intensity showed an increasing trend.At the same time point,TGF-β1 expression intensity in group A was strongest among groups A,B,C and D (P＜0.05 and P＜0.01 ),and that in group D was significantly lower than in group B and group C (P＜0.05),but no significant difference was found between group B and group C (P＞00.05).The changes of TGF-β1mRNA expression pattem in each group showed the same trends as TGF-β1 protein expression.Conclusion TMP or salvia miltiorrhiza can delay the progression of CAN in kidney transplant rats by down-regulating the TGF-β1 expression,and the combined use of them exerts synergic effects.

ObjectiveTo investigate the effects of the imbalance between regulatory T cells (Treg) and T helper 17 cells (Th17) in patients with chronic hepatitis B virus (HBV) infection.MethodsThe serum concentration of Treg/Th17 differentiation-related cytokines in 34 patients with chronic hepatitis B (CHB),20 patients with HBV related acute on chronic liver failure (ACHBLF),and 20 healthy controls (NC) were measured by enzyme-linked immunosorbent assay (ELISA) and proportion of peripheral Th17 and Treg cells were analyzed by flow cytometry.Numeration data was analyzed by Fisher's exact propability method and measurement data was tested by one-factor analysis of variance or Turkey multiple comparison.Results The levels of Th17 differentiation-related cytokines,II-1β (3.97±2.85) pg/mL,IL-6 (12.75±-8.87) pg/mL,and IL-21 (360.0±335.7) pg/ mL in patients with ACHBLF were significantly increased than those in NC,which were (1.87 ±0.94) pg/mL(q=4.559,P＜0.01),(5.28±0.72) pg/mL(q=7.309,P＜0.01) and (46.68±20.17) pg/mL(q=6.946,P＜0.01 ),respectively.The proportion of Th17 increased markedly in patients with ACHBLF than that in NC(q=3.972,P＜0.05).However,compared to NC and patients with ACHBLF,the Treg differentiation-related cytokine,TGF-β,in patients with CHB,increased significantly (q=4.536 and 5.323,respectively; both P＜0.01).And the population of Treg also increased markedly in CHB patients.The level of IL-17A which was the characteristic effector cytokine of Th17 was the highest in patients with ACHBLF.The peripheral Th17 cell proportion was positively correlated with the level of serum total bilirubin in patients with ACHBLF (γ=0.74,P＜0.01).Conclusions Th17 and Treg imbalance including cytokine profiles and cell numbers exists in patients with chronic HBV infection.The Th17 are active in patients with ACHBLF and Treg are active in patients with CHB.

Objective To investigate the efficacy and safety of different optimal therapy strategies for hepatits B e antigen (HBeAg) positive chronic hepatitis B (CHB) patients with suboptimal response to peginterferon-α-2a (peg-IFN-α-2a) at 24 weeks.Methods This open-label,single-center and prospective clinical observational study was conducted in Department of Infectious Diseases at Shanghai Changhai Hospital between January 2009 and December 2011.The cases of HBeAg-positive CHB with suboptimal response to peg-IFN-α-2a at week 24 were enrolled.Based on virological markers and patient preference,patients were treated with either peg-IFN-α-2a add-on adefovir dipivoxil (ADV) or switch-to telbivudine (LdT).Hepatitis B virus (HBV) virological and serological data were collected at week 12,24 and 48 after the initiation of optimal therapy.Adverse reactions were also monitored.Therapeutic efficacy was compared between two groups of patients before and after treatment by x2 test.Kruskall Wallis test and Mann-Whitney test were used for analysis of continuous variables.Results Among 193 HBeAg positive CHB patients treated with interferon,67 had suboptimal response and were enrolled.Forty five cases received peg IFN-α-2a add-on ADV treatment and 22 cases received switch-to LdT treatment.After 48 weeks of optimized therapy,the total tBeAg seroconversion rate was 25.3 ％.The rates of HBeAg loss,HBV DNA negative and alanine aminotransferase normalization were 26.8％,73.1％ and 83.5％,respectively.The peg-IFN-α-2a switch-to LdT strategy had better HBV DNA inhibition efficiency compared with the peg-IFN-α-2a add-on ADV strategy at week 12,24 and 48 (P=0.00,0.00 and 0.01,respectively).However,there was no significant difference of HBV DNA negative rate between two groups at week 48 (x2 =0.01,P=0.89).The obviously intolerable adverse reaction was not reported in two optimized strategy groups.Conclusions The 48-week optimized treatment for HBeAg positive CHB with suboptimal response to peg-IFN-α-2a at week 24 could achieve a higher HBeAg seroconversion rate.The switch-to LdT strategy may have better HBV DNA inhibition efficiency.Both strategies show satisfactory safety and tolerance.

Objective To investigate the effects of waist-to-hip ratio (WHR) on the formation of carotid plaque in the middle-aged and elderly people.Methods A total of five thousand and ninety-nine participants who have taken physical examination in Tangshan Kailuan Company from June 2010 to October 2011(above 40 years old,no previous history of ischemic stroke,transient ischemic attack,myocardial infarction) were enrolled in this study.Questionnaire survey,blood biochemical and carotid artery ultrasound examination were used to examine the subjects.According to WHR,quartile division was used to divide the subjects into four groups.The detection rates of carotid plaque among the 4 groups were compared.Multivariate logistic regression analysis was used to analyze the factors effecting carotid artery plaques.Results (1) The detection rate of carotid artery plaque increased with the increase of WHR,the rates of the first,second,third and fourth group were 20.7% (571/2 753),21.9% (604/2 753),27.5% (758/2 753) and 29.8% (820/2 753) respectively.The difference was statistically significant(P=0.000).(2) Logistic regression model was used to analyze multiple factors affecting the detection rate of carotid plaque.After the correction of other factors,compared with the first group,the carotid artery plaque detection rate in the second,third,fourth group were all increased,the OR values were 1.23(95%CI:1.10~1.54),1.65(95%CI:1.52~2.13),1.67(95%CI:1.54~2.17),respectively.Conclusion The increased WHR in the middle-aged and elderly population may increase the risk of carotid plaque formation.

Objective To analysis the relationship between of waist-to-height ratio(WHtR) and the non-alcoholic fatty liver disease(NAFLD).Methods A total of 7 896 were selected as observed subjects from the Kailuan Group in 2011-2012 health physical examination.A questionnaire survey,blood biochemical and abdominal ultrasound examination were finished by trained medical staff.According to previous study recommended cut points the observed subjects was divided into two groups:abdominnal obesity group(WHtR≥0.5,n=3 185) and non-abdominnal obesity group(WHtR<0.5,n=479).According to the WHtR and its quartile,the observed subjects was divided into four groups(first(WHtR<0.47),second(0.47≤WHtR<0.51),third(0.51≤WHtR<0.55) and forth(WHtR≥0.55) quartile groups).NAFLD detection rate of the four groups were Compared.Multiple Logistic regression analysis was used to analyze the influencing factors of the NAFLD.Results (1)The detection rate of NAFLD in abdominnal obesity group was higher than that in non-obesity group(62.7% vs.21.5%,P<0.01).Along with increasing WHtR level in the 4 quartile groups,the incidence of NAFLD was progressively increased,being 12.6 %,38.1%,57.5% and 72.5% respectively in the total population.After stratified by gender,15.1%,40.6%,59.6% and 75.0% in male,7.8%,31.5%,48.3% and 63.8% in female.In the same WHtR group,the NAFLD detection rate of male was higher than female,the differences were statistically significant(P<0.01).(2)Multiple logistic regression analysis showed that compared with the first quartile group,the second,third and forth quartile groups had increased risk of NAFLD after adjusting age,gender and other risk factors,the OR value being 3.19,5.93 and 9.81 in the total population.After adjusting above factors,the OR value being 3.12,6.02 and 10.45 in male,3.32,5.37 and 7.57 in female,respectively.Conclusion The incidence of NAFLD is increased along with the increasing the WHtR.

Objective:To analyze the risk factors for the progression of acute kidney injury (AKI) in decompensated cirrhosis patients with acute kidney injury.Methods:The basic data and laboratory results of decompensated cirrhosis patients with AKI hospitalized in the Department of Infectious Diseases, The First Affiliated Hospital of Naval Medical University from May 2016 to November 2021 were collected. Treatment and intervention were performed according to the International Club of Ascites guidelines. According to the outcome of AKI during hospitalization, patients were divided into the progression group and the non-progression group. Two independent sample rank sum test, two independent sample or approximate t test, chi-square test and binary logistic regression analysis were used for statistical analysis. Results:A total of 263 decompensated cirrhosis AKI patients were enrolled, including 50 in the progressive group and 213 in the non-progressive group. Univariate analysis showed that there were statistically significant differences in baseline total bilirubin, alanine aminotransferase, prothrombin time, serum sodium, white blood cell count, model for end-stage liver disease score, proportion of patients with infection, proportion of patients with upper gastrointestinal hemorrhage, and proportion of patients with primary AKI stage between the two groups ( Z=-6.49, -3.53, t=-3.06, 3.40, -3.55, -8.19 and χ2=14.64, 8.40, 103.98, respectively, all P<0.050). Binary logistic regression analysis showed that primary AKI stage (stage two odds ratio ( OR)=33.176, 95% confidence interval ( CI) 11.294 to 97.458, P<0.001; stage three OR=114.139, 95% CI 25.321 to 514.515, P<0.001), upper gastrointestinal hemorrhage ( OR=3.850, 95% CI 1.238 to 11.971, P=0.020) and total bilirubin ( OR=1.009, 95% CI 1.005 to 1.012, P<0.001) were the risk factors for the progression of AKI in patients with decompensated cirrhosis. Conclusions:Decompensated cirrhosis patients with AKI stage two or three, high baseline total bilirubin value or gastrointestinal hemorrhage have a high risk of AKI progression. It is necessary to strengthen the assessment and take targeted intervention measures at early stage in the clinical practice.

Based on Yichang health big data platform, 850 608 patients from September 2018 to September 2019 were included in this study. According to the date of birth, the participants were divided into early childhood famine exposure group, fetal famine exposure group and non-famine exposure group. The incidence of adult herpes zoster (HZ) in Yichang city was analyzed, and the correlation between early life famine exposure and adult HZ was analyzed. In 2019, the crude incidence rate of adult HZ in Yichang was 6.83‰. The crude incidence rate of adult HZ in females (7.26‰) was higher than that in males (6.40‰). Compared with the non-famine exposure group, fetal famine exposure was associated with the incidence of adult HZ ( OR=1.21; 95% CI: 1.01-1.45, P=0.041). After stratification by sex, fetal famine exposure was only found to be associated with the onset of adult HZ in females ( OR=1.28, 95% CI:1.02-1.61, P=0.034).

Objective:To investigate and establish the related factors of non-invasive score model for prediction of non-alcoholic fatty liver disease in chronic hepatitis B patients with normal or mildly elevated alanine aminotransferase (ALT).Methods:A total of 128 cases with chronic hepatitis B who had undergone liver biopsy were included. According to the presence or absence of hepatocyte steatosis on the pathological results of liver biopsy, they were divided into a fatty infiltration and a non-fatty infiltration group. Patients' demographic characteristics, laboratory test indexes, and pathological test results were collected. Univariate and multivariate logistic regression analysis combined with clinical screening variables were used to establish a predictive model. The prediction efficiency of the new model was evaluated by the receiver operating curve, and the difference between the accuracy of the new model and ultrasound in the diagnosis of fatty liver was compared by Delong's-test.Result:Multivariate regression analysis showed that serum triglyceride, serum uric acid and platelets were highly correlated with intrahepatic steatosis ( P<0.05). The regression equation triglyceride-uric acid-platelet (TUP)-1=-8.195+0.011×uric acid+1.439×triglyceride+0.012×platelet count was established by combining the above variables. Tthe equation TUP-2=-7.527+0.010×uric acid+1.309×triglyceride+0.012×platelet count+1.397×fatty liver (ultrasound) was established (yes=1; no=0) after incorporating the results of abdominal ultrasound. The diagnostic value of TUP-1 and TUP-2 models for fatty liver was better than that of ultrasound alone and there was no statistically significant difference in diagnostic value between TUP-1 and TUP-2 models ( Z=1.453, P=0.146). Conclusion:Compared with abdominal ultrasonography alone, the new model is more effective in diagnosing fatty liver and has good application value.

Based on Yichang health big data platform, 850 608 patients from September 2018 to September 2019 were included in this study. According to the date of birth, the participants were divided into early childhood famine exposure group, fetal famine exposure group and non-famine exposure group. The incidence of adult herpes zoster (HZ) in Yichang city was analyzed, and the correlation between early life famine exposure and adult HZ was analyzed. In 2019, the crude incidence rate of adult HZ in Yichang was 6.83‰. The crude incidence rate of adult HZ in females (7.26‰) was higher than that in males (6.40‰). Compared with the non-famine exposure group, fetal famine exposure was associated with the incidence of adult HZ ( OR=1.21; 95% CI: 1.01-1.45, P=0.041). After stratification by sex, fetal famine exposure was only found to be associated with the onset of adult HZ in females ( OR=1.28, 95% CI:1.02-1.61, P=0.034).