Asian-pacific area,especially China,is Hepatitis B high epidemic area.Since 2011,the first generation of oral direct anti-HCV agents (DAAs) came to clinical use,the treatment of chronic hepatitis C has switched from interferon-based regimen era to DAA era.There is an increased awareness of hepatitis B (HBV) reactivation in chronic hepatitis C (CHC) patients coinfected with HBV treated with pan-oral direct-acting antivirals(DAAs).Compared with interferon-based regimen,HBV reactivation occurred earlier and more severe among patients received DAA regimen,and even fetal cases or case end up with liver transplantation was reported.Thus,association of liver diseases called to alert the occurrence of HBV reactivation among CHC patients who received DAAs regimen.It is hence important to have HBV serology screened in all CHC patients before initiation of pan-oral DAAs therapy and the usefulness of preemptive administration of effective anti-HBV nucleos(t) ide analogues in coinfected patients need to be further studied.

Objective To investigate the effect and safety of solifenacin on urination in patients with overactivity bladder (OAB) by randomized controlled clinical trials. Methods One hundred and eight patients with OAB were randomized divided into observation group and control group, each with 54 patients. The patients in two groups were respectively treated by solifenacin and tolterodine. After treatment for 8 weeks, the curative effect, urination and adverse reaction were compared between two groups. Results The total effective rate in observation group was 85.19%(46/54), in control group was 68.52%(37/54), there was significant difference (P<0.05). After treatment for 8 weeks, the frequency of urination for 24 h in observation group was less than that in control group [(7.2 ±3.1) times vs. (9.7 ±3.2) times], the levels of initial micturition desir bladder volume, maximum bladder pressure volume, maximum urine flow rate in observation group were better than those in control group:(215.4±34.6) ml vs. (184.1±42.1) ml, (341.6±24.5) ml vs. (283.4±24.8) ml, (20.4±5.8) ml/s vs. (16.8±7.1) ml/s, there were significant differences (P<0.05). The total scores and urgency scores of OAB symptom score (OABSS) in observation group were significantly lower than those in control group: (3.7±2.5) scores vs.(4.9±2.1) scores, (0.4±0.1) scores vs. (0.7±0.4) scores, P<0.05. The adverse reaction rate in observation group was 18.52%(10/54), in control group was 48.15%(26/54), there was significant difference ( P<0.01). Conclusions Solifenacin can improve urination in OAB patients, and compared with tolterodine, it has higher efficacy and less adverse reaction. It is worthy of clinical application.

Objective The study was to investigate the value of deduction and application of anterior compression index in evaluation of atlantoaxial dislocation and restoration. Method Twenty-eight cases of the control group and 28 cases of atlantoaxial dislocation treated with posterior restoration and screw-rod internal fixation technique before and af?ter surgery were recruited in this study and their data was retrospectively analyzed. All of the people underwent sagittal computerized tomography scan films. The anterior compression index was measured in all cases. Results The mean value of anterior compression index of the control group was 87.86±24.98. The mean value of anterior compression index of the preoperative patients was 230.44 ± 97.60 and the mean value of the postoperative patients was 106.27 ± 73.53. There was significant difference in those two parameters between the preoperative patients and the controls(t=-7.50,P<0.0001). There was no significant difference between the postoperative patients and the control group (t=-1.26, P=0.2171). Anteri?or compression index were significantly lower after surgical operation (t=10.35, compared with before, P<0.0001). Con?clusion Anterior compression index can be an excellent measurement tool for the assessment of relationship of atlas and axis in atlantoaxial dislocation patients before and after posterior restoration operation.

Objective To investigate the change of AQP1 and AQP2 before and after the release of obstruction and explore the relationship between reabsorption dysfunction of renal tubule and the change of AQPs. Methods The model of unilateral ureter obstruction (UUO) was established by surgery. Western blot and immunohistochemistry were used to study the expression of AQPs before and after obstruction. Results In UUO model, both AQPs began to down-regulate one day after obstruction, the expression of both AQPs became lower one day after the release of obstruction. And they started to up-regulate 7 day after the release of obstruction. AQP2 became normal since 14 days after the release of obstruction, and AQP1 became normal since 21 days after the release of obstruction. Conclusion The expression of AQP1 and AQP2 were descended in hydronephrosis. The dysfunction of renal tubule and the osmotic-dependent polyuria after the release of obstruction in UUO were caused by the down - regulation of AQPs.

Objective To analyze the current status of studies related to home enteral nutrition (HEN) in China,and provide scientific basis for the research and management of HEN in China.Methods We searched CNKI and WanFang Data since it built to January 1st,2018.The included studies were screened and categorized by publication information,study type,subjects of the study,topic,interventions and outcomes.Descriptive analysis was conducted after extraction of information.Results A total of 153 studies were included,of which 37 were observational studies,102 were experimental studies,12 were case report,and 2 were exploring articles.Since 2012,the number of studies has been increasing.Most of the subjects were elderly people who were diagnosed with diseases of digestive system,head and neck tumors and diseases of nervous system.These studies were featured as small sample size and short intervention time,follow-ups by telephone and home visit,less than 1/4 providing professional nutrition support team,and outcomes mainly as complication,nutritional biochemical indices,anthropometric indices and prognosis.Conclusion HEN in China is still in its infancy.The number of relative studies is still small and quality of literatures is very low,but it has been increasing.At present,there are some problems in the implementation of HEN in China,such as lack of standardized management model and professional team,short-term intervention,and single follow-up mode.The elderly and patients with digestive disease,head and neck tumors and nervous disease are the key subjects;more professional nutrition support team and scientific management model should be established in the future.

Objective To evaluate the effectiveness and safety of direct-acting antiviral agents (DAA) treatment in Chinese chronic hepatitis C (CHC) patients with genotype (GT) 1b HCV infection in a real world setting .Methods The consecutive GT1b CHC Chinese patients treated with sofosbuvir (SOF) plus daclatasvir (DCV) (n＝62) or SOF plus ledipasvir (LDV) (n＝171) were enrolled from July 2014 to December 2016 at 302 Military Hospital of China .The treatment duration for all the patients was 12 weeks .All the clinical parameters were measured at baseline and then 4-weekly till 12 weeks after the end-of-treatment (EOT ).Baseline clinical characteristics ,treatment efficacy ,safety and tolerance were compared .Serum HCV RNA concentration was detected by means of COBAS TaqMan assay with a lower detection limit of 15 IU/mL ,and liver stiffness was measured using FibroScan?.Sustained virologic response (SVR) was defined as HCV RNA under the lower limit of quantification 12 weeks after EOT (SVR12).Students′t-test ,pearson χ2 test ,Spearman rank correlation analysis and Fisher exact test were used for comparison between groups when appropriate .Results Among 233 patients ,173 cases had baseline HCV RNA level ≥ 6 .0 lg IU/mL and 97 cases hade liver stiffness measurement (LSM )≥17.5 kPa.The baseline liver inflamation ,liver fibrosis ,and HCV RNA load of patients in the two groups were not significantly different (all P＞0 .05).The HCV RNA of all the 233 patients was undetectable at the end of 12-week treatment ,while 2 patients relapsed after 12 weeks of EOT with the overall SVR12 of 99.1% .HCV RNA decline was significantly faster in patients with lower LSM than those with higher LSM (ρ＝0 .233 ,P＝0 .001) ,and SVR12 was higher in those with lower LSM .In terms of other clinical characteristics of SOF+DCV and SOF+LVD groups ,alanine transaminase declined from (68 .0 ± 60 .1) and (70 .1 ± 56 .1) U/L to (21 .1 ± 10 .9) U/L and (15 .3 ± 9 .5) U/L ,respectively ,total bilirubin declined from (21 .3 ± 17 .3) and (18 .2 ± 14 .0) μmol/L to (13 .2 ± 6 .7) and (10 .2 ± 4 .6) μmol/L , respectively ,AFP declined from 19 .6 (10 .6 ,62 .3) and 15 .0 (12 .0 ,25 .0) μg/L to 6 .5(4 .5 ,18 .7) and 7 .8(5 .3 ,15 .4) μg/L ,respectively ,LSM declined from 17 .6 (8 .9 ,25 .4) and 15 .7 (7 .8 ,23 .9) kPa to 13.9(6 .5 ,21 .4) and 9 .1(5 .6 ,19 .9) kPa ,respectively ,serum album elevated form (37 .5 ± 5 .8) and (38 .7 ± 5 .5) g/L to (41 .3 ± 4 .7) and (42 .8 ± 5 .1) g/L ,respectively ,platelet elevated from (120.9 ± 78 . 2)×109/L and (136 .6 ± 65 .8 )× 109/L to (139 .5 ± 71.8 )× 109/L and (149 .7 ± 71.4 )× 109/L , respectively .Reports of adverse events were low in both groups .Conclusions Both SOF + DCV and SOF/LDV therapy are highly effective with ＞ 98% of SVR12 and reduce LSM value significantly with good safety for CHC GT1b Chinese patients .

Objeetive To explore the clinical application value of new modified paracalculous ureteral catheter in ureteroscopic holmium laser lithotripsy for the treatment of large middle and lower ureteral stone.Methods From January 2014 to January 2017,86 patients with unilateral middle and lower ureteral large stone were treated in Jingzhou Central Hospital.By adopted to random digital table,86 patients were randomly separated into two groups,all of whom were treated with ureteroscopic holmium laser lithotripsy.Forty-three cases were underwent new modified laser lithotripsy with ureteral catheter inserted beneath the stone.Normal saline was injected continuously through the catheter during lithotripsy procedure (modified lithotripsy group).Forty-three cases were underwent direct ureteroscopic holmium laser lithotripsy (direct lithotripsy group).The outcome data were compared between the two groups,such as the operation time,stone clearance rate,ureteral perforation,transit to open surgery,postoperative urinary sepsis,perirenal hematoma,ureterostenosis and other complications.Measurement data were expressed as ((x) ± s),and t test was used for comparison between groups.Results All the patients in the modified lithotripsy group were completed successfully without ureteral perforation,rupture,loss of lithotripsy channel,transit to open surgery,perirenal hematoma,and urinary sepsis and so on.In the direct lithotripsy group,there were 5 cases of ureteral perforation,4 cases of lithotripsy channel loss,6 cases of transit to open surgery,2 cases of perirenal hematoma,1 case of urinary sepsis.The operation time of the two groups was (39.5 ± 7.2) min and (47.2 ± 11.6) min,respectively,t =-4.975,P =0.001.Stone clearance rate was 100％,91.1％.The patients in both groups received an average of 1 year out-patient follow-up.There were 3 cases of mild ureterostenosis in the modified lithotripsy group,which were not re-operated.In the direct lithotripsy group,there were 5 cases of mild ureterostenosis,and 2 cases of severe ureterostenosis,which were re-operated.Conclusion It is safe and effective to use the new modified paracalculous uteteral catheter in the ureteroscopic holmium laser lithotripsy of large middle and lower ureteral stone,which can shorten the total operation time and reduce the occurrence of complications.It has a higher clinical value.

Objective:To correlate blood lipids and body mass index (BMI) with Helicobacter pylori (Hp) infection. Methods:A total of 303 participants who underwent physical examinations at The 903 Hospital of PLA Joint Logistics Support Force from May 2022 to May 2023 were included in this case-control study. These patients were divided into an Hp-infected group ( n = 97) and a non-Hp-infected group ( n = 206) based on whether they had Hp infection or not. Participants' body height and weight were recorded, and BMI was calculated. The levels of four blood lipid indicators were determined using an automatic biochemical analyzer. The distribution of different BMIs and abnormal statuses of these four blood lipid indicators were compared between the two groups. Spearman correlation analysis was used to analyze the correlation between Hp infection and these four blood lipid indicators. A multivariate logistic regression model was applied to analyze the influential factors for Hp infection. Results:The number of participants who had 24 kg/m 2 ≤ BMI < 28 kg/m 2 [39.17% (38/97)] and the number of participants who had BMI ≥ 28 kg/m 2 [10.31% (10/97)] in the Hp-infected group was significantly higher than those in the non-Hp-infected group [19.90% (41/206) and 2.43% (5/206), χ2 = 12.71, 7.11, P < 0.001, 0.008]. The decrease rate of high-density lipoprotein cholesterol (HDL-C), increase rate of low-density lipoprotein cholesterol (LDL-C), increase rate of triglyceride (TG), and increase rate of total cholesterol (TC) in the Hp-infected group were 23.71% (23/97), 31.96% (31/97), 17.53% (17/97), and 22.68% (22/97), respectively, which were significantly higher than 9.22% (19/206), 11.17% (23/206), 7.28% (15/206), and 8.74% (18/206) in the non-Hp-infected group ( χ2 = 11.59, 19.47, 7.33, 11.19, P = 0.001, < 0.001, 0.007, 0.001). The Spearman analysis showed that Hp infection was linearly positively correlated with BMI, LDL-C, TG, and TC ( r = 0.571, 0.519, 0.473, 0.535, all P < 0.001), while it was linearly negatively correlated with HDL-C ( r = -0.628, P < 0.001). Multivariate logistic regression analysis showed that BMI ≥ 24 kg/m 2, decreased HDL-C, increased LDL-C, elevated TG, and elevated TC are independent risk factors for Hp infection. Conclusion:Blood lipids and BMI are closely associated with Hp infection, and abnormal blood lipids and elevated BMI are independent risk factors for Hp infection.

ObjectiveTo explore the risk of different levels of pre-pregnancy obesity on trimester-specific thyroid dysfunction. MethodsQuestionnaire information， blood samples， and urine samples from a 2017 pregnancy cohort study in Shanghai， China were collected. A total of 2 455 pregnant women were included in the analysis. Pre-pregnancy BMI was calculated based on the height and self-reported pre-pregnancy weight. Serum TSH， total thyroxine （TT4）， free thyroxine （FT4）， total triiodothyronine （TT3）， free triiodothyronine （FT3）， thyroid globulin antibody（TgAb）， and Thyroid peroxidase antibody （TPOAb） were measured using the electrochemiluminescence method. Urine iodine levels were measured using the acid digestion method. Levels of thyroid function indexes of pregnant women with different degrees of obesity during pre-pregnancy were compared， and trimester-specific thyroid dysfunction was evaluated according to the reference range of trimester-specific thyroid hormone established by this cohort. Multivariate logistic regressions analysis was used to assess the correlation between pre-pregnancy obesity and trimester-specific thyroid dysfunction. ResultsAs the degree of obesity increased， maternal levels of FT3 and TT3 gradually increased during pregnancy （P<0.001， P=0.001）， while FT4 levels gradually decreased （P=0.001）. Multivariate logistic regression analysis showed that compared with the normal weight group， pregnant women who were overweight or obesity before pregnancy had a significantly higher risk of hypothyroxinemia （OR=3.85， 95%CI： 2.08‒7.14， P<0.001） and high TT3 （OR=2.78， 95%CI： 1.45‒5.26， P=0.002） during pregnancy. ConclusionPre-pregnancy overweight or obesity can increase the risk of thyroid dysfunction during pregnancy.