Objective To determine the persistence time of genotype 4 hepatitis E (HE) viremia after the onset of clinical symptoms in HE patients and provide essential data for study on HE epidemiologieal transmission, so that to evaluate potential contagiousness of HE patients after clinical stage. Methods The first serum samples from 162 HE patients after hospitalized in Eastern China were collected and tested for hepatitis E virus (HEV) RNA by nested reversed transcription- polymerase chain reaction (RT-PCR). The persistence time of HEV viremia after the onset of clinical symptoms was estimated with Kaplan-Meier survival analysis. Results HEV RNA was detectable in 101 out of 162 serum samples with positive rate of 62.35%, which was all grouped to genotype 4 by homology analysis. Furthermore, HEV RNA was detectable in 74 (64.91%) out of 114 male and 27 (56.25%) out of 48 female, which was not significantly different (χ2 = 1.08, P=0. 30). Kaplan-Meier survival analysis showed that the median persistence time of HEV genotype 4 viremia was 24 days after the onset of clinical symptoms (95% CI: 18-30 days), which meant that the viremia of 50% HE patients remaining detectable up to 24 days after the onset. The 75% and 25% percentiles were 14 days and 31 days, respectively. There was no significant difference of viremia persistence time between male and female (Breslow test: P=0.98, Tarone-Ware test: P=0.91). Conclusions The viremia of 75% patients with HEV genotype 4 infection could persistent until 2 weeks after the onset of clinical symptoms and that of some patients could persistent over 1 month. It is indicated that the viremia is still persistent and HE patient could be a reservoir even after the clinical symptoms disappeared and biochemical marks normalized.

Objective To investigate the application value of hepatectomy using Glissonean pedicle transection for hepatocellular carcinoma (HCC). Methods Clinical data of 54 patients with HCC undergoing radical hepatectomy in the First Affiliated Hospital of Medical College, Xi’an Jiaotong University from January 2002 to December 2012 were analyzed retrospectively. According to different surgical procedure, the patients were divided into hepatectomy with Glissonean pedicle transection group (Glisson group) and hepatectomy with Pringle maneuver (Pringle group) with 27 cases in each group. The informed consents of all patients were obtained and the ethical committee approval was received. In Glisson group, hepatectomy was performed after Glissonean pedicles were dissected and occluded. In Pringle group, hepatectomy was performed after the ifrst porta was occluded using Pringle maneuver. The intraoperative situation, the variation of liver function and incidence of complications after operation of two groups were observed. The patients received follow-up after operation and survival analysis was conducted. The comparison of measurement data between two groups was conducted using t test, the comparison of rates using Chi-square test or Fisher's exact probability test, and the survival analysis using Kaplan-Meier method and Log-rank test. Results The mean of intraoperative blood loss in Glisson group [(135±57) ml] was signiifcantly less than that in Pringle group[(248±87) ml] (t=-5.62, P<0.05). The total bilirubin (TB) level 1 d after operation in Glisson group [(23±5) μmol/L] was significantly lower than that in Pringle group [(34±5) μmol/L] (t=-8.08, P<0.05). In Glisson group, postoperative hemorrhage was observed in 2 cases and infection in 2 cases. In Pringle group, postoperative hemorrhage was observed in 3 cases, infection in 1 case, and bile leakage in 1 case. No signiifcant difference was observed in the incidence of postoperative complications between two groups (P>0.05). The 1-, 3-, 5-year cumulative survival rates were 89%, 50%, 39%in Glisson group and were 82%, 55%, 41%in Pringle group. The 1-, 3-, 5-year disease-free survival rates were 89%, 43%, 34%in Glisson group and were 82%, 47%, 41%in Pringle group. No signiifcant difference was observed in the cumulative survival rates and disease free survival rates between two groups (χ2=0.001, 0.011; P>0.05). Conclusion Hepatectomy using Glissonean pedicle transection is a safe, effective, and feasible surgical procedure for HCC with advantages of less blood loss, milder liver damage.

Objective:Taking emergency department (ED) as a starting point, to analyze the epidemiological characteristics and mortality risk factors of sepsis, and to provide evidences for ED to carry out the strategy of "three early and two lower" for sepsis.Methods:Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gernal Hospital, adult ED patients with sepsis from January 1, 2017 to December 31, 2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020. The epidemiological characteristics of patients were retrospectively analyzed. Chi-square test was used to compare the difference of age, sex, hospitalization times, length of stay, hospitalization cost and infection location between dead patients and survival patients, and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results:A total of 7 494 patients with sepsis in ED were included in this study, and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰, respectively. The main characteristics of patients with sepsis in ED were as follows: 40-69 years old (46.0%), male (59.0%), mostly diagnosed with sepsis (96.8%), mainly treated with urban health insurance (59.6%), and ED diagnosis and treatment fees of 2 000-8 000 Yuan (51.1%). The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%. The main characteristics of hospitalized patients with ED sepsis were as follows: most of them were male (56.2%) patients over 70 years old (56.0%), most of them were diagnosed with sepsis (94.0%) and hospitalized for the first time (76.0%), the median hospitalization time was 15 d, most of them were hospitalized under urban health insurance (65.2%), and the median hospitalization fees was 47 000 Yuan. The risk factors of death were influenced by age and length of stay. Patients aged 70 years or older had a higher risk of death than those aged from 18 to 39 years, and patients with a length of stay of more than 7 d had a lower risk of death than those with a length of stay of shorter than 7 d. The primary infection focus were mainly respiratory and urinary systems, while the death rate of patients with hematological and abdominal infections was relatively high, and the difference was statistically significant ( P<0.01). Respiratory and abdominal infections were risk factors for death in patients with ED sepsis. Conclusions:The composition ratio of sepsis in ED patients is not regular in time, so vigilance of sepsis in elderly men and patients with respiratory system, blood system, urinary system and abdominal infections should be constantly raised. Patients with sepsis who are older, hospitalized more frequently, hospitalized for a shorter time, and infected in the respiratory system or abdomen have a higher risk of death.