Hepatitis B virus (HBV)covalently closed circular DNA (cccDNA)is an intermediate replicative episome which is stable and not easy to eliminate.cccDNA serves as the template for HBV replication and plays an important role in persistence of HBV infection in hep-atocytes,and it is also a biomarker of HBV activity.Studies suggested that HBV has extrahepatic infectivity and cccDNA could be detected in peripheral blood mononuclear cells (PBMC).The predictive values of HBV cccDNA in PBMC for HBV recurrence after liver transplanta-tion and antiviral therapy and mother-to -child transmission of HBV in patients with hepatitis B,as well as the possible mechanism of cccDNA involved in extrahepatic HBV infection,are summarized.Therefore,the detection of HBV cccDNA is of great significance for the study and treatment of HBV.

Objective To study the value of HEART scores in predicting the risk of getting acute coronary syndrome in patients with chest pain and assessing the prognosis in order to elucidate the validity of the HEART scores.Methods A total of 1 200 patients with chest pain were continuously observed and followed up,and their HEART scores were calculated.The survival rates were calculated with Kaplan-Meier method and AUROC (area under ROC curve) was used to determine the accuracy of this methods.The HEART scores were compared with TIMI and GRACE scores.Results Low HEART scores (0-3) were found in 34.5％ of the patients and MACE (major adverse cardiac event) occurred in 1.4％ of them.The patients with intermediate HEART scores (4-6) accounted for 50.7％ patients,and MACE was diagnosed in 22.2％ of them.High HEART scores (7-10) were found in 14.85％ patients,and MACE occurred in 60.7％ of them.There was significant difference among these three groups (Log rank P ＜ 0.01).The AUROC of HEART score was 0.83 (95％ CI:0.80-0.85,P ＜0.01),being significantly higher than the GRACE scores (0.76) and TIMI scores (0.72).Conclusions The HEART score is applicable for predicting the risk of getting acute coronary syndrome of chest pain patients in emergency department and the prognosis.

In order to check unhealthy tendencies in the purchase and sale of drugs, the Drug Allocation Center of Jinshan District in Shanghai started from 1996 the practice of centralized purchase of drugs through bidding, originally handled by fax and then via the Internet by the year 2000. Specific measures adopted include: defining the mode of bidding, standardizing the system of authorizing the purchase of drugs form some pharmaceutical companies and conducting yearly checks of them according to relevant laws and regulations. The system of conducting checks at any time with regard to other pharmaceutical companies may also be adopted. On the basis of the above preparations, the computer network framework, the system model and the flow of data exchange of the bidding center should be determined and bidding via the Internet can thus be conducted thereby. Bidding via the Internet makes it possible for medical organizations to conduct zero stock management of drugs, guarantees the timely supply of drugs, is favorable to fair competition and shortens the business cycle.

Objective To explore effects of comfort nursing on anxiety, depression and comfort of surgical patients.Methods Comfort nursing was done to 128 surgical patients, including physical comfort, psychological comfort and social comfort and self-designed questionnaire was made to investigate the comfort of patients during operation. When the patients were hospitalized and after operation, patients’physical states were evaluated with self-rating depression scale(SDS)and self-rating anxiety scale(SAS).Results The score of patients’comfort was (6.5±0.2)and the SDS and SAS were lower than that of patients when hospitalized with statistical difference(P<0.05).Conclusion Comfort nursing can reduce anxiety, depression and increase comfort of surgical patients.

Objective To investigate the clinical features of intrahepatic arteriovenous shunt(AVS) in patients with hepatic carcinoma. Method The clinical data including results of therapy of 538 hepatic carcinoma patients admitted between 1996 and 2001 were retrospectively reviewed. Results There were 71 cases of AVS altogether with 61 cases of arterio-portal shunt and 8 cases of hepatic arterio-venous shunt. Thirty out of 39 AVS cases with fistula formed between hepatic artery and main portal branch developed portal hypertension. The patients received a total of 84 sessions of transarterial chemotherapy and embolization(TACE) with a success rate of 61%(51 sessions).After TACE liver failure ensued in 3 cases. The mean survival time of these patients was 5.77 months. Conclusion Arterio-portal/venous fistula is a common complication among hepatic carcinoma patients which often predicts poor prognosis. A high percentage of AVS patients will not tolerate TACE and in which the portal hypertension will be exacerbated.

Objective To analyze the effects and the complications of partial splenic artery embolization(PSE)and splenectomy offering a feasible way to choose different therapeutic methods for hypersplenism. Methods Forty-six patients treated with PSE and thirty-three undergone splenectomy were compared for their effectivenesses and complications in treating hypersplenism. Results Thrombocyte and leucocyte counts increased markedly after the two kinds of treatment(P 0.05). The complication rate of the PSE was far more than that of the splenectomy(P

Objective To investigate the expression of Bcl-2 and Caspase-3 in placenta tissue of hypertensive disorder complicating pregnancy (HDCP).Methods One hundred and one placentas with preeclampsia (including 51 mild preeclampsia and 50 severe preeclampsia respectively served as low-grade group and high-grade group) and 62 placentas of normal late pregnant women(served as control group) were analyzed for the expressions of Cnspase-3 and Bcl-2 using immunohistochemistry assay(streptavidin-biotin peroyxidase method).Results The positive expression ratio of Bcl-2 was 66% in high-grade group,75% in low-grade group and 84% in control group.There was no significant difference among the three groups (P＞0.05 ).The positive expression rates of Caspase-3 in high-grade group (64%) and low-grade group (53%)were significantly higher than that in control group (23%)(P ＜ 0.01 ).There was no significant difference between high-grade group and low-grade group (P ＞ 0.05).Negative relationship between the expression of Bcl-2 and Caspase-3 could be found with statistical significance (r=-0.199,P ＜0.05).Conclusions Higher expression of Caspose-3 maybe play an important role in the pathogenesis of HDCP.The role of Bcl-2 in HDCP needs to be studied.

Objective To investigate the effect of continuous quality improvement on venous transfusion exosmosis in elderly patients.Methods Through the investigation into venous transfusion exosmosis in 160 elderly patients,the causes for exosmosis were identified,followed by regulating and enforcing improvement measures and assessing the effect.Results The incidence of venous transfusion exosmosis in elderly patients was reduced from 6.40%to 2.57%and the satisfaction of patients improved from 90.00%to 97.50%.Conclusion The continuous quality improvement may effectively reduce the incidence of venous transfusion exosmosis and improve patients’satisfaction.

Objective To study the possible different effects on primary liver cancer of various types of blood supply demonstrated by DSA via hepatic artery radioimmunotherapy with 131Ⅰ-HAb18F(ab')2.Methods Under thyroid protection and negative dermal sensitivity test,46 times of intraarterial injection with a 0.75 mCi/kg dose of 131Ⅰ labeled murine HCC monoclonal antibody fragment [HAb18F(ab')2] were performed in 30 patients of PLC using the Seldinger technique.The shrinkage rates of tumor volume were analyzed according to hyper,moderate and hypo vascular three types provided by DSA.Results The volume shrinkage rates of hyper and moderate vascular HCC were 60% and 37.5% respectively,while that of 2 cases of hypovascular HCC showed significantly reduction.Conclusion 131Ⅰ-HAb18F(ab')2 internal radioimmunotherapy prossesses certain signification volume shrinkage efficacy on different blood supplies provided by DSA.(J Intervent Radiol,2007,16:243-245)

Objective To analyze the clinical effects of 131I-HAb18F(ab')2 radioimmunotherapy via hepatic artery on PLC with portal vein tumor emboli. Methods Under the condition of thyroid protection and negative dermal sensitivity test, 12 times of intraarterial injection with 131I labeled murine HCC monoclonal antibody fragment HAb18F(ab')2 were performed in 8 patients of PLC complicated with portal vein tumor emboli. A 0.75 mCi/kg dose of 131I was administrated individually into certain target vessel after hepatic artery angiography using Seldinger technique. Results 3 of 7 patients with symptoms of pains showed remission with simultaneous improvement and stabilization in Karnofsky score in 3 and 4 patients respectively. AFP levels decreased about 50%(3/6)in 3 cases among those 6 positives and the values of I.B. and ALT changed within a very narrow range to a certain extent after the treatment. The overall rate of CR + PR was 28.6% and similar better result was obtained in a non-symptomatic diffuse PLC patient.1 year survival rate was 12.5%. Conclusion 131I-HAb18F(ab')2 radioimmunotreating drug(0.75 mCi/kg)with hypotoxicity to liver-function can be used as an acceptable method for unresectable PLC with portal vein tumor emboli, especially for those without tumor emboli in the main trunk.