Objective To explore the application of central venous catheter(CVT) in hemodialysis.Methods The clinical data of 2 206 cases of CVT patients were analyzed retrospectively,and the catheter puncture site,the catheter indwelling time,4 weeks of blood flow rate and the incidence of catheter related infections,and so on were observed.Results Internal jugular vein in 2 033 cases,the femoral vein in 173 cases.Internal jugular vein indwelling catheter time was (40.6 ±32.7) d,the femoral vein catheter indwelling time was (22.4 ± 16.3) d,and the difference was statistically significant (P＜ 0.05).Blood flow patency rate in four weeks was of 96.4％ (1 959/2 033) indwelling catheter in internal jugular vein,which was significantly higher than that of the femoral vein in 83.2％ (144/173),and the difference was statistically significant (P ＜ 0.05).Femoral vein catheter related infection rate was 11.0％ (19/173),significantly higher than that of internal jugular vein in 3.6％ (73/2 033),the difference was statistically significant (P ＜ 0.05).Conclusion Application of CVT for hemodialysis is convenient and reliable,with low infection rate,fewer complications,operation technology level is the key to success.

OBJECTIVETo observe the effect of hepatitis virus B on the detection rate of core antigen of hepatitis virus C in sera of chronic hepatitis C patients.

METHODHCVcAg and HCV RNA in sera were detected in 88 patients with chronic hepatitis C and 62 patients co-infected with HCV and HBV. At the same time, HBV DNA and HBeAg in sera were detected in 62 patients infected with HCV and HBV. Then we analyzed the correlation between HCVcAg and HBeAg/HBV DNA. The detection rates of HCVcAg in 88 patients with chronic hepatitis C and 62 patients co-infected with HCV and HBV were 72.7% (64/88) and 38.7% (24/62), respectively (x2 = 17.358, P less than 0.01).

RESULTSThe detection rates of HCV RNA in 88 patients with chronic hepatitis C and 62 patients co-infected with HCV and HBV was 81.8% (72/88) and 53.2% (33/62)respectively (x2=20.110, P less than 0.01). In 62 patients infected with HCV and HBV, the detection rate of HCVcAg in HBeAg positive patients and HBeAg negative patients were 28.6% (12/42) and 60% (12/20), respectively (x2 = 7.547, P = 0.011). Moreover, the positive rates of HBV DNA in HBeAg positive patients and HBeAg negative patients were 42.9% (18/42) and 80% (16/20), respectively (P more than 0.05). The detection rates of HCVcAg in HBV DNA positive patients and HBV DNA negative patients were 39.1% (18/46) and 37.5% (6/16), respectively (x2 = 0.013, P = 0.908). Compared with the detection rates of HCVcAg in patients only infected with HCV, the detection rate of HCVcAg in HBeAg or HBV DNA negative patients infected with HCV and HBV were 60% (12/20) (x2 = 1.266, P = 0.261) and 37.5% (6/16) (x2 =7.635, P less than 0.01), respectively.

CONCLUSIONThe detection rate of HCVcAg in patients infected with HCV and HBV is relatively low. The reason is possibly that HBeAg inhibits duplication of HCV and decreases the expression of HCVcAg.

Coinfection ; immunology ; virology ; DNA, Viral ; Hepacivirus ; immunology ; Hepatitis B ; immunology ; virology ; Hepatitis B virus ; Hepatitis C Antigens ; blood ; Hepatitis C, Chronic ; immunology ; virology ; Humans

OBJECTIVETo provide reliable evidence for acupuncture treatment of vascular dementia (VD).

METHODSMulti-central randomized controlled trial method was adopted and 270 cases enrolled were randomly assigned to an acupuncture-medicine group, an electroacupuncture group and a medication group. The acupuncture-medicine group were treated by scalp electroacupuncture on Sishencong (EX-HN 1), Baihui (GV 20), Shenting (GV 24), Fengchi (GB 20) and oral administration of Nimodipine; the electroacupuncture group were treated with scalp electroacupuncture; the medication group were treated with simple oral administration of Nimodipine. They were treated for 6 weeks. Mini-mental state scale (MMSE), ability of daily life-rating scale (ADL-R) and P300 were detected before and after treatment.

RESULTSThe total effective rate for cognition improvement was 86.59% in the acupuncture-medicine group, 82.05% in the electroacupuncture group and 43.21% in the medication group, the electroacupuncture group and the acupuncture-medicine group being better than the medication group; and their total effective rates for improvement of ability of daily life were 59.76%, 65.38% and 32.10%, respectively, the electroacupuncture group and the acupuncture-medicine group being better than the medication group. Scores for MMSE and ADL-R and P300 examination indicated that there were significant differences as the acupuncture-medicine group and the electroacupuncture group compared with the medication group (P < 0.01).

CONCLUSIONScalp electroacupuncture or scalp electroacupuncture combined with oral administration of Nimodipine has a better therapeutic effect in improvement of recognition function and the ability of life activity than simple oral administration of Nimodipine with a higher safety.

Acupuncture Points ; Aged ; Dementia, Vascular ; drug therapy ; physiopathology ; therapy ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Nimodipine ; therapeutic use

OBJECTIVETo investigate the effects of cAMP-response element binding protein-1 (CREB-1) on transforming growth factor-b3 (TGF b3) mRNA expression and promoter activity in hepatic stellate cells (HSCs).

METHODSFreshly isolated HSCs from rats were divided into six groups: CREB-1 expression plasmid transfected group (C), siRNA-CREB-1 plasmid transfected group (S), negative control group (N), forskolin treated group (F), H-89 treated group (H), and blank group (B). Rats in each group were further sub-divided according to whether (+) or not (-) they were exposed to exogenous TGF b3. TGF b3 mRNA expression was measured by real time quantitative PCR. HSCs of the C, S, N, F, H and B groups were transfected with the TGF b3 promoter luciferase reporter plasmid (PGL3-TGF b3-P; W group), the TGF b3 promoter luciferase reporter plasmid with CRE mutation (PGL3-basic-TGF b3P-mCRE; M group) and the renilla luciferase control plasmid (pRL-SV40; control group). TGF b3 promoter activity was assessed by luciferase reporter assays.

RESULTSCompared to N(-), the TGF b3 mRNA expression was reduced to 0.69+/-0.15 in S(-) (P less than 0.05) and increased to 4.68+/-2.76 in C(-) (P more than 0.05). Compared to B(-), the TGF b3 mRNA expression was reduced to 0.57+/-0.08 in H(-) (P less than 0.05). The differences between N(+) and N(-), S(+) and S(-), B(+) and B(-), and H(+) and H(-) were all significant (P less than 0.05). The values of TGF b3 promoter activity in S(W), N(W), and C(W) were 0.062+/-0.013, 0.122+/-0.011, and 0.165+/-0.016 (P less than 0.05), but the changes of TGF b3 promoter activity in S(M), N(M), and C(M) were not significant (P more than 0.05). The values of TGF b3 promoter activity in H(W), B(W), and F(W) were 0.154+/-0.010, 0.188+/-0.016, and 0.276+/-0.031 (P less than 0.05), but the changes of TGF b3 promoter activity in H(M), B(M), and F(M) were not significant (P more than 0.05).

CONCLUSIONIncreased levels of CREB-1 mRNA or p-CREB-1 up-regulate the TGF b3 mRNA expression and promoter activity in rat HSCs. The CRE site in the TGF b3 promoter is critical for this effect, and the gene's activity becomes significantly decreased when the site is missing. Exogenous TGF b3 enhances expression of endogenous TGF b3 in rat HSCs.

Animals ; Cells, Cultured ; Cyclic AMP Response Element-Binding Protein ; metabolism ; Hepatic Stellate Cells ; metabolism ; Promoter Regions, Genetic ; RNA, Messenger ; genetics ; Rats ; Transforming Growth Factor beta3 ; genetics

Objective To investigate the level of the serum chemokine RANTES and its correlation with serum biochemical indices of liver function test, HBeAg and HBV DNA load in patients with chronic hepatitis B.Methods 144 patients with chronic hepatitis B (observed group) and 18 normal cases (control group) were enrolled in this study. The serum level of chemokine RANTES was detected with an ABC-ELISA assay. Statistical analysis was performed on the software of SPSS13.0. Results The serum chemokine RANTES level in the observed group (3930.12 ng/ml±2856.96) ng/ml was significantly higher than that in the control group (329.46 ng/ml±152.23) ng/ml. The results from the observed group indicated the positive correlation of serum RANTES level with indices of liver function test, including ALT (r=0. 197, P=0.018), AST(r=0.239, P=0.004) and TBil (r=0.316, P=0.001), but did not with PTA (r=-0.078, P=0.357). Neither difference of serum chemokine RANTES level between HBeAg-positive group and HBeAg-negative group nor that between high HBV DNA load group (≥105 copies/ml) and low HBV DNA load group (< 105 copies/ml) were statistically significant (P=0.407 and 0.185, respectively). Conclusions Serum chemokine RANTES level in patients with chronic hepatitis B elevates significantly and is not affected by HBeAg or HBV DNA load. Its positive correlation with indices of liver function test indicates that RANTES might play an important rule in the pathogenesis of chronic hepatitis B.

Objective To analyze different clinical features from patients with chronic hepatitis B between HBeAg negative and positive. Methods 354 patients with chronic hepatitis B (124 cases with HBeAg positive and 230 cases with HBeAg negative) were enrolled into this retrospective investigation. Comparisons were conducted according to their demographic, liver biochemical, virological characters and clinical diagnosis types.chronic hepatitis occupied a lower proportion (P=0.007and 0.014). But fulminant hepatitis had a higher HBeAg positive group,but TBil in HBeAg negative group was higher; AST had no statistical significance between than HBeAg positive group(37.4% vs 55.6%, P=0.1301). Conclusion HBeAg-negative patients compared with HBeAg-positive patients had older age, lower serum HBV DNA level and other characteristics; HBeAg-negative patients maybe had serious disease.

Objective To investigate the short-term efficacy of antiviral therapy in acute-on-chronic liver failure associated with hepatitis B.Methods A total of 348 patients with acute-on-chronic liver failure associated with hepatitis B,of which 173cases of low viral load(HBV DNA<105copise/ml)and 175 cages of high viral load (HBV DNA≥105copies/ml),were divided into two groups.One was treated with antiviral therapy(LAM or ETV or Ltd)and routine supportive therapy,and the other received supportive therapy only.The clinical features,survival rate and the short-term efficacy of antiviral therapy were compared between the two.Results It sas indicated in Cox regression analysis of multiple factors that antiviral therapy is the favorable factor of affecting pmgnosis.The survival rate of the group receiving antiviral therapy was higer than that of the one in control group in a 24-week observation.In patients with 4 weeks treatment there were statistical significant differences(P≤0.05)in beth the Ievd of TBil in serum and the decreasing amplitude of HBV DNA between the two groups.Also after 24-week therapy the survival rates of the patients with both low and high viral load was higer in the group with antiviral therapy,and that made statistically significant(P≤0.05).Conclusion Antiviral therapy can improve the survival rate of the acute-on-chronic liver failure associated with hepatitis B.And it is also needed in patients with low viral load.

Objective To investigate whether the combination therapy of pegylated IFNα-2a plus adefovir dipivoxil (ADV) improve the efficacy of the treatment in CHB patients with HBeAg positive or not. Methods 57 CHB patients with HBeAg positive received 48-week pegylated IFNα-2a therapy were enrolled into this study. If serum HBV DNA levels exceeded 1000 copies/ml at week 24, the patients were assigned to group A (pegylated IFN-α2a plus ADV, 21 cases) or group B (pegylated IFNα-2a only, 14 cases);otherwise, they received the unceasing monotherapy of pegylated IFNα-2a (group C, 22 cases). Results At week 48, HBeAg seroconversion rates were 23.8% , 28.6% and 63.6% (A vs C,P=0.014), but rates of aminotransferases normalization and HBV DNA suppression (< 1000 copies/ml) were not statistically significant among three groups. But during week 24 to week 48, rates of HBeAg seroconversion, aminotransferases normalization and HBV DNA suppression were also not statistically significant between group A and B. But amplitude of DNA drop in group A was much more than that in group B (2.60±1.37 vs 0.86±2.09, P=0.005). Conclusion An ADV add-on therapy in pegylated IFNα-2a treatment seems able to improve the inhibition of HBV DNA in chronic hepatitis B patients with HBeAg positive. It requires a large, double-blind, randomized clinical trial to further provent.

Objective To investigate the efficacy of nucleot (s)ide analogues therapy in patients with HBeAg-negative cirrhosis in China. Methods 111 patiens with HBeAg-negative cirrhosis were divided into antiviral group (58 cases, 25 entecavir, 19 adefovir dipivoxil, 13 lamivudine, 1 telbivudine) and control group (53 cases, supportive and symptomatic treatment). These two groups were matched for demography, liver function and Child-Push score. Results At the 96th week, the rate of ALT normalization and HBV DNA drop (lg copies/ml) in antiviral group were higher than those in control group(P<0.05). The rates of HBV DNA negative (< 500copies/ml) were 88.7% (47/53) and 32.5% (13/40) , respectively (P < 0.05). There were no differences in the rates of developing HCC and undergoing variceal bleeding between antiviral group and control group (P>0.05 ). 15.4% patients with lamivudine treatment emerged YMDD mutations. 10.5% patients with adefovir dipivoxil treatment emerged virologic breakthrough and hepatitis flare during the second year. 2 patients (3.5%) in treatment group and 6 patients (11.5%) in control group died of liver failure or variceal bleeding or HCC (P>0.05). Conclusions Neucleot (s) ide analogues are effective in suppressing HBV replication in patients with HBeAg-negative cirrhosis, but the impact of which on the mortality and complications of cirrhosis should be prolongly observed. For continuing treatment, the neucleot(s) ide analogues with strong effective and low resistance are the first choices to prevent viral mutation and drug resistance.

Objective To evaluate the relationship of the expression of bone morphogenefic protein7 (BMP-7) in the liver and the liver fibrosis and inflammation in patients with chronic hepatitis B virus (HBV) infection,to explore the role of BMP-7 in the fibrogenesis of chronic hepatitis B.Methods 81 patients chronically infected with HBV were enrolled.Liver biopsy were performed in all these patients.The hematoxylin staining and reticular fiber staining were performed for the grading of inflammation and staging of fibrosis,respectively.The patients were divided into different groups by the inflammatory grade or fibrosis stage (8,14,19,22,18 patients with inflammatory grade of G0,G1,G2,G3,G4,respectively;8,16,21,24,12 patients with fibrosis stage of S0,S1,S2,S3,S4,respectively).Then the immunohistochemical staining by BMP-7 were performed.The expression of BMP-7 in the liver was evaluated by digital image quantitative analysis system.We compared the expression of BMP-7 in the liver with different inflammatory grade and fibrosis stage.Results The expression of BMP-7 in the liver tissue increased with the increase of hepatic inflammatory grade and fibrosis.When liver biopsy showed a severe intrahepatic inflammation,the expression of BMP-7 significantly increased,regardless the intrahepatic fibrosis stage.Similarly,when liver biopsy showed a severe intrahepatic fibrosis,the expression of BMP-7 also significantly increased,regardless the intrahepatic inflammatory grade.Conclusion BMP-7 may play an important role as anti-inflammatory and anti-fibrogenic effect in the fibrogenesis of chronic hepatitis B.