Background and aims:Antiviral therapy is essential for hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).No data are available on the long-term prognosis or safety of tenofovir alafenamide(TAF),tenofovir disoproxil fumarate(TDF),or entecavir(ETV)in treating HBV-ACLF globally.This study was conducted to investigate the long-term efficacy and safety of the three nucleos(t)ide analogs in the treatment of HBV-ACLF.Methods:In this prospective,real-world cohort study,patients with HBV-ACLF were assigned to the TAF,TDF,and ETV groups.A total of 199 patients completed the 144-week follow-up.After propensity score matching(PSM),44 patients remained in each group for further analysis of survival status,incidence of hepatocellular carcinoma(HCC),virological response,and liver and renal function indicators.Results:In the original cohort,HCC developed in one patient in each group.No serious drug-related adverse events were observed.In the PSM cohort,the 144-week survival rates were 56.82％,75.00％,and 59.09％in the TAF,TDF,and ETV groups,respectively(P=0.118).When stratified into noncirrhosis and cirrhosis subgroups at baseline,the survival rate of the ETV group was slightly lower than that of the TAF and TDF group in noncirrhosis patients(P=0.338),and the survival rate of the TAF group was slightly lower than that of the TDF and ETV group in cirrhosis patients(P=0.052),but the differences were not statistically significant.The long-term overall survival rates in the TAF,TDF,and ETV groups were comparable.After 144 weeks,no significant difference in the virological response rate or liver or renal function indicators was found among the three groups,except for the level of aspartate amino-transferase,which was significantly higher in the TDF group than in the ETV group at week 144(P=0.001).Conclusions:There were no significant differences in the survival rate,incidence of HCC,efficacy or safety associated with the use of these three nucleos(t)ide analogs in treating HBV-ACLF.Trial registration:ClinicalTrials.gov NCT03920618.

Objective: To study therapeutic effect of atorvastatin on patients with asymptomatic heart failure (AHF) after myocardial infarction, and its influence on prognosis.Methods: Clinical data of 100 AHF patients after myocardial infarction, who were treated in our hospital from Jul 2014 to Jul 2015, were analyzed.According to random number table, patients were randomly and equally divided into routine treatment group and atorvastatin group (received atorvastatin based on routine treatment).Cardiac function indexes, plasma levels of BNP and N-terminal pro B-type natriuretic peptide (NT-proBNP), 6min walking distance (6MWD) and cardiac function score were measured and compared between two groups before and after treatment.Course of treatment was one year.Results: Compared with before treatment, after treatment, there were significant rise in left ventricular ejection fraction (LVEF) and 6MWD, and significant reductions in left ventricular end-diastolic dimension (LVEDd), left ventricular end-systolic dimension (LVESd), plasma levels of BNP and NT-proBNP, and cardiac function score in both groups(P=0.001 all).Compared with routine treatment group after treatment, there were significant rise in LVEF [(52.48±8.65)% vs.(57.86±9.70)%] and 6MWD [(262.60±12.40)m vs.(282.65±15.50)m], and significant reductions in LVESd [(36.23±2.13)mm vs.(30.08±2.05)mm], LVEDd [(58.61±6.40)mm vs.(51.25±6.18)mm], plasma levels of BNP [(267.48±42.10)pg/ml vs.(149.40±32.30)pg/ml] and NT-proBNP [(524.65±138.60)pg/ml vs.(406.20±112.45)pg/ml], and cardiac function score [(2.30±0.22) scores vs.(1.15±0.10) scores] in atorvastatin group(P<0.01 all).Conclusion: Atorvastatin can alleviate left ventricular remodeling, reduce plasma levels of BNP and NT-proBNP, and improve cardiac function in AHF patients after myocardial infarction, which is worth extending.

Objective To investigate the relationship between the plasticity of dendritic spines in entorhinal cortical neurons and mechanism of low-dose ketamine-induced reduction of cognitive dysfunction following sevoflurane anesthesia in aged rats.Methods Thirty-six pathogen-free healthy male SpragueDawley rats,aged 18 months,weighing 500-600 g,were divided into 3 groups (n=12 each) using a random number table:control group (group C),sevoflurane anesthesia group (group Sev) and ketamine group (group K).Group C received no treatment.Group Sev inhaled the mixture of air (flow rate 1 L/min) and 3.6％ sevoflurane for 3 h.In group K,ketamine 10 mg/kg was injected intraperitoneally,and 5 min later the mixture of air (flow rate 1 L/min) and 3.6％ sevoflurane was inhaled for 3 h.Open field test and Morris water maze test were performed 3 days after anesthesia.After the behavioral tests,the animals were sacrificed,and their brains were removed and cut into sections for determination of the density of neurons,density of dendritic spines,and expression of postsynaptic density protein-95 (PSD-95) and synaptophysin (SY38) in superficial laminaes (Ⅱ-Ⅲ) of entorhinal cortex using Nissl's staining,Golgi staining and immunohistochemistry,respectively.Results Compared with group C,the time of staying at the central region was significantly shortened,the escape latency was prolonged,the density of dendritic spines was decreased,and the expression of PSD-95 and SY38 was down-regulated in group Sev (P＜0.05).Compared with group Sev,the time of staying at the central region was significantly prolonged,the escape latency was shortened,the density of dendritic spines was increased,and the expression of PSD-95 and SY38 was upregulated in group K (P＜0.05).There were no significant differences in the density of neurons in entorhinal cortex between the three groups (P＞0.05).Conclusion The mechanism by which low-dose ketamine attenuates cognitive dysfunction induced by sevoflurane anesthesia may be related to the enhanced plasticity of dendritic spines in entorhinal cortical neurons of aged rats.

Background Laser assisted in situ keratomileusis (LASIK) for myopia will change corneal asphericity and further affect the quality of vision.However,how operating parameters such as ablation depth and optic zone diameter affect corneal asphericity is still rarely reported.Objective Aim of this study was to investigate the influence of corneal ablation depth and optic zone diameter on corneal asphericity after LASIK for myopia.Methods This prospective study comprised 175 eyes of 89 patients with the spherical equivalent of (-5.93± 1.98)D and the best corrected visual acuity (BCVA) ≥ 1.0.The flap creation with the femtosecond laser combine iris recognize guided LASIK was performed on the patients who were available for the evaluation at postoperative 6 months.Corneal aspherical index (Q value) at the central corneal 6.0 mm were measured with Orbscan IIz-corneal topography before and 6 months after operation.Corneal ablation depth and optic zone diameter were recorded in operation.The changes of visual acuity and spherical equivalent before and after surgery were compared by self-control method,and the correlations between corneal ablation depth or optic zone diameter with alteration of Q value (AQ) after LASIK were assessed using multiple regression analysis.Results The mean spherical power,cylinder diopter and spherical equivalent were (-5.57 ± 1.89) D,(-0.71 ±0.55) D and (-5.93 ± 1.98) D before surgery,and those after surgery were (-0.25 ±0.30),(-0.14±0.22)D and (-0.32±0.37)D,showing significant differences between before and 6 months after LASIK (t=-32.39,-23.91,-35.18,all at P＜0.01).The Q values at the central corneal 6.0 mm were -0.13 ± 0.09 (-0.47-0.08) in preoperation and 1.09 ± 0.54 (0.22-2.51) in postoperation,with a significant increase in postoperation (t=29.37,P＜0.01).Corneal ablation depth was (95±28) μm and optic zone diameter was (6.32±0.26)mm.Ablation depth appeared to be positive correlation with AQ (β =0.803),and optic zone diameter showed a negative correlation with AQ (β =-0.149),with a multiple regression formula AQ =1.517+0.015×ablation depth-0.3 ×optic zone diameter.Conclusions LASIK for myopia increase corneal Q value.The increase of corneal ablation depth and decrease of optic zone diameter contribute to enlargement of corneal Q value.

OBJECTIVE To evaluate the efficacy and safety of levofloxacin in the treatment of respiratory tract infection in elderly patients. METHODS An open clinical trial was conducted for the treatment of respiratory tract infection in elderly patients.The dosage of the drug was 0.5g once daily injection,the duration of treatment was 7-14 days. RESULTS The total cure rate,the total response rate and the bacterial clearance rate were 56.7%,83.3%,and 82.1%,respectively. CONCLUSIONS Levofloxacin is a drug both effective and safe for respiratory tract infection in elderly patients.The dosage of the drug(0.5g/day) can reach higher clinical effective rate,best tolerance and compliancy.

0.05). Four lesions were only revealed on CE FLAIR whereas 7 lesions were only found on postcontrast T_1WI. Enhancing lesions located in cerebral hemisphere or the forth ventricle was revealed much more on T_1WI than that on CE FLAIR. However, postcontrast fast FLAIR images may be useful in detecting superficial abnormalities and those located in sulcus or lateral ventricle. The enhancement degree of enhanced T_1WI was much more intense than that of CE FLAIR(P0.05) and statistical significance in GWC, CNR and CER(P