Objective To discuss the clinical features of HbeAg-negative chronic hepatitis B patients associate with non-alcoholic fatty liver disease (NAFLD), to value the effect of combining treatment on fatty liver influence and antivi-ral therapy. Methods Nighty eight chronic hepatitis B patients with non-alcoholic fatty liver disease (NAFLD) (Liver pa-thology G≥2 or S≥2,HBV DNA>1 × 105 copies/mL), were observed and given antiviral therapy with interferon alpha 1 b for 24 weeks. These patients were divided into combined treatment group (55 cases treated with interferon alpha 1 b combined with Jian Gan Jiang Zhi pills) and control group (43 cases treated with interferon alpha 1 b) in accordance with random num-ber table. All these patients took Leucoson to prevent blood cells reduction. The combined treatment effect was analyzed by observing and comparing biochemical serum change and HBV DNA negative conversion ratio between two groups. Re-sults After 24 weeks of antiviral therapy in Chronic hepatitis B patients with negative HBeAg associated with NAFLD, ALT and AST decreased significantly in both treatment group and control group. And this change is more obvious in treat-ment group than in control group. TC and TG in treatment group and TC in control group were also dropped with treatment (P<0.05). There is significant difference on HBV DNA negative conversion ratio between treatment groupand control group (98.2%vs 86.0%,P<0.05). Conclusion The combination of antiviral treatment and anti fatty liver treatment can obviously improve liver function and blood lipids, increase negative conversion ratio of HBV DNA for chronic hepatitis B patients asso-ciated with NAFLD.

Objective To compare volumetric size, conformity index (CI), degree of inclusion (DI) of internal gross target volumes (IGTV) delineated on 4D-CT-MIP and PET-CT images for primary thoracic esophageal cancer. Methods Fifteen patients with thoracic esophageal cancer sequentially underwent enhanced 3D-CT, 4D-CT and PET-CT simulation scans. IGTVMIP was obtained by contouring on 4D-CT maximum intensity projection ( MIP). The PET contours were determined with nine different threshold methods (SUV≥2?0, 2?5, 3?0, 3?5), the percentages of the SUVmax(≥20%, 25%, 30%, 35%, 40%) and manual contours. The differences in size, conformity index (CI), degree of inclusion ( DI) of different volumes were compared. Results The volume ratios ( VRs) of IGTVPET2. 5 to IGTVMIP , IGTVPET20% to IGTVMIP, IGTVPETMAN to IGTVMIP were 0?86, 0?88, 1?06, respectively, which approached closest to 1. The CIs of IGTVPET2?0,IGTVPET2.5,IGTVPET20%,IGTVPETMAN and IGTVMIP which were 0?55, 0?56, 0?56, 0?54,0?55, respectively, were significantly larger than other CIs of IGTVPET and IGTVMIP (Z= -3?408-2?215,P <0?05). There were no statistical significance in the DIs of IGTVMIP and IGTVPET2.5,IGTVMIP and IGTVPET20%, IGTVMIP and IGTVPETMAN(0?77,0?82,0?71,0?67, 0?68,0?82,P>0?05). Conclusions The targets delineated based on SUV threshold setting of≥2?5, 20% of the SUVmax and manual contours on PET images correspond better with the target delineated on maximum intensity projection of 4D-CT images than other SUV thresholding methods.

Objective To investigate the differences in position and volume between planning target volumes (PTV) based on positron emission tomography?computed tomography (PET?CT) images with an standardized uptake value ( SUV) no less than 2?5, 20% of the maximum SUV ( SUVmax ), or 25% of SUVmax , three?dimensional ( 3D ) CT, and four?dimensional ( 4D ) CT in thoracic esophageal cancer. Methods Eighteen patients with thoracic esophageal cancer sequentially received chest 3DCT, 4DCT, and [18F]fluoro?2?deoxy?D?glucose (FDG) PET?CT scans. PTV3D was obtained by conventional expansion of 3DCT images;PTV4D was obtained by fusion of target volumes from 10 phases of 4DCT images. The internal gross tumor volumes ( IGTV) , IGTVPET2.5 , IGTVPET20%, and IGTVPET25%, were generated based on PET?CT images with an SUV no less than 2?5, 20% of SUVmax , and 25% of SUVmax , respectively. These IGTVs were expanded longitudinally by 3?5 cm and radically by 1 cm to make PTVPET2.5 , PTVPET20%, and PTVPET25%, respectively. Results PTV3D was significantly larger than both PTV4D and PTVPET(P=0?000 -0?044), while there was no significant difference between PTV4D and PTVPET ( P= 0?216 -0?633 ) . The mutual degrees of inclusion ( DIs ) between PTV3D and PTV4D were 0?70 and 0?95, respectively, which were negatively correlated with 3D?Vector ( P=0?039). The mutual DIs between PTVPET2.5, PTVPET20%, and PTVPET25% were 0?74, 0?72, 0?78, 0?73, 0?77, and 0?70, respectively, which showed no correlation with 3D?Vector (P=0?150 -0?822). The mutual DIs between PTV3D and PTVPET were 0?86, 0?84, 0?88, 0?63, 0?67, and 0?59, respectively. Conclusions It is difficult to achieve complete volumetric overlap of PTVs based on 3DCT, 4DCT and PET?CT in thoracic esophageal cancer due to different target volume information. PET scan during free breathing should be used with caution to generate PTVs in thoracic esophageal cancer.

Objective To investigate the correlations in target volumes based on positron emission tomography CT (PET/CT) and the end-expiration phase of four-dimensional CT (4D-CT) images for non-small cell lung cancer (NSCLC).Methods Seventeen patients with NSCLC sequentially underwent three-dimensional CT (3DCT),4D-CT and 18F-FDG PET/CT thoracic simulation scans.The gross target volume (GTV) was contoured on the end-expiration phase (50％) of 4D-CT and defined as GTV50％.The internal gross target volumes (IGTV) based on PET/CT images (IGTVPET) were determined by the standardized uptake value (SUV) 2.0 (IGTVPET2.0) and 20％ percentage of the maximal standardized uptake value (SUVmax) (IGTVPET20％).The following parameters were calculated to analyze the correlation between IGTVPET and GTV50％ in volume ratio (VR) and conformity index (CI):maximum transverse diameter of GTV50％,volume of GTV50％,the displacement of GTV in the cranial-caudal direction and 3D Vector calculated from 4D-CT dataset as well as the SUVmax.Results There was no significant correlation between the VR of IGTVPET2.0 to GTV50％ and the maximum transverse diameter of GTV50％,volume of GTV50％,the displacement of GTV in the cranial-caudal direction,3D Vector and the SUVmax (P ＞ 0.05).The VR between IGTVPET20％ and GTV50％ inversely related to maximum transverse diameter of GTV50％,volume of GTV50％ and SUVmax (r =-0.663,-0.669,-0.752,P ＜0.05).The CI between IGTVPET2.0 and GTV50％ positively related to volume of GTV50％ and maximum transverse diameter of GTV50％ (r =0.613,0.483,P ＜ 0.05).Conclusions 3D PET images provide a time-averaged image of the tumor during the numerous breathing cycle.They fail to include the full information of moving tumor.The target volumes based on 3D PET might not reflect the real IGTV of NSCLC.

OBJECTIVETo study the prevention and treatment of HBV reinfection after liver transplantation.

METHODSTotal 19 cases of chronic fulminant hepatitis B, the end-stage of liver cirrhosis and liver carcinoma complicated with HBV cirrhosis. Were performed liver transplantation and given anti-viral drugs pre and post transplantation. Famciclovir was administered in 4 cases, lamivudine in 13 cases and lamivudine+HBIG in 2 cases. The serum HBVM and liver biopsy immunohistochemistry were performed.

RESULTSFour cases given famciclovir developed reinfection. Serum HBsAg, HBeAg and HBV DNA were positive in 3 cases. Liver biopsy immunohistochemistry showed HBsAg and HBeAg phenotype. Classical viral hepatitis in 1 case occurred, three cases died. In the lamivudin group 7 cases showed positive for HBsAg, 2 cases positive for HBV DNA, 4 cases HBsAg or HBcAg phenotype. One case showed positive for serum anti-HBc the other negative for HBVM, and liver biopsy immunohistochemistry was negative too.

CONCLUSIONSThese date suggest that anti-virus prevention and treatment in pre and post liver transplantation with HBV infected correlative disease is necessary, feasible and effective.

2-Aminopurine ; analogs & derivatives ; therapeutic use ; Adult ; Antiviral Agents ; Biopsy ; methods ; DNA, Viral ; analysis ; Drug Combinations ; Female ; Hepatitis B ; prevention & control ; Hepatitis B Surface Antigens ; blood ; Hepatitis B e Antigens ; blood ; Humans ; Immunoglobulins ; therapeutic use ; Lamivudine ; therapeutic use ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Postoperative Care ; methods ; Preoperative Care ; methods ; Recurrence

Objective To investigate the food allergy status of infants and young children in community in Shanghai and the influencing factors.Methods The infants aged 0 ～ 36 months in Huamu community in Shanghai were selected and detected with total total serum IgE and 20 specific IgE.Food elimination tests and food stimulation test was used to confirm the allergy.All the confirmed infants were followed up for 6 months.Results The rate of food allergy in children was 9.82％.The most common allergens were egg whites (39.2％) and milk (27.4％).The most common clinical manifestation was eczema.There was no significant difference in food allergy between infants with different sex and birth ways (P ＞ 0.05).With the decreasing of age,the food allergy rate increased significantly.The rate of food allergy was significantly higher in infants with antibiotics,parental allergies and non breast-feeding infants than that with unused antibiotics,non parental allergies and breast feeding.Logistic factor analysis showed that age,use of antibiotics during pregnancy,breast feeding,and parental allergy were the risk factors for food allergy in infants.Conclusion Age,use of antibiotics during pregnancy,breast-feeding,and parents'allergies can significantly affect food allergies in infants and children.

Objective To investigate the food allergy status of infants and young children in community in Shanghai and the influencing factors.Methods The infants aged 0 ～ 36 months in Huamu community in Shanghai were selected and detected with total total serum IgE and 20 specific IgE.Food elimination tests and food stimulation test was used to confirm the allergy.All the confirmed infants were followed up for 6 months.Results The rate of food allergy in children was 9.82％.The most common allergens were egg whites (39.2％) and milk (27.4％).The most common clinical manifestation was eczema.There was no significant difference in food allergy between infants with different sex and birth ways (P ＞ 0.05).With the decreasing of age,the food allergy rate increased significantly.The rate of food allergy was significantly higher in infants with antibiotics,parental allergies and non breast-feeding infants than that with unused antibiotics,non parental allergies and breast feeding.Logistic factor analysis showed that age,use of antibiotics during pregnancy,breast feeding,and parental allergy were the risk factors for food allergy in infants.Conclusion Age,use of antibiotics during pregnancy,breast-feeding,and parents'allergies can significantly affect food allergies in infants and children.

Objective To compare the size of the internal target volume (ITV),biological target volume (BTV) and internal biological target volume (IBTV) based on PET-CT and 4DCT for primary nonsmall cell lung cancer (NSCLC),as well as try to apply IBTV in radiotherapy planning.Methods A total of 15 patients with NSCLC were sequentially scanned by an axial enhanced 3DCT,4DCT and 18F-FDG PET-CT in the thoracic region.The gross target volumes (GTVs) of ten phases of 4DCT images were contoured,and ITV was obtained by fusion of ten GTVs.BTV based on PET-CT images was determined by the SUV 2.0.The IBTV was defined by fusion of ITV and BTV.Planning target volumes (PTVs) based on ITV,BTV,and IBTV (PITV,PBTV,PIBTV) were obtained by ITV,BTV and IBTV with a 10-mm expansion respectively.The metrics of PIBTV,PITV and PBTV were compared,and the planning parameters of target volumes and risk organs were evaluated.Results There was no significant difference between ITV and BTV,but there was significant difference between IBTV and ITV and BTV (F=22.533,P ＜ 0.05).To include more than 95％ volume of IBTV,it is necessary to expand the margin of 9.0(6.0,12.0)mm based on BTV or 10.00(7.0,12.0)mm based on ITV.There was no significant difference between the two groups (P ＞ 0.05).Dice's similarity coefficient of BTV and ITV was 0.72(0.54,0.79).The intensity modulated radiotherapy plan based on PBTV can guarantee 85.6％ (80.5％,91.2％) of PITV to reach the prescription dose,compared with 80.2％ (74.4％,87.6％) of PBTV by the plan from PITV.Additionally,the conformity index and homogeneity index were not ideal.The dosimetric parameters of PITV and PBTV in the PIBTV plan were much better than those in PBTV-and PITV plan.Conclusions The radiotherapy plan based on PET-CT or 4DCT could not guarantee a reasonable dose distribution of PTV expanded from ITV or BTV.Thus,using IBTV for radiotherapy is advised.

Objective:To investigate the correlation between complement C3 and urine protein level and proteinuria remission status in patients with primary membranous nephropathy (PMN), and better guide individualized clinical treatment.Methods:It was a single-center retrospective study. The clinical data of PMN patients who underwent renal biopsy in the First Affiliated Hospital of Nanjing Medical University from January 2017 to June 2022 were collected. Patients with 24 h urinary protein ≥ 3.5 g were followed up after receiving standard treatment, and the last outpatient or inpatient review was used as the end point of follow-up. 24 h urine protein was collected to evaluate the remission status of proteinuria. Kaplan-Meier method was used to analyze the correlation between serum and renal complements and proteinuria remission. Cox regression analysis method was used to analyze the correlation between serum C3 level and renal tissue C3 deposition and proteinuria remission.Results:This study included 507 PMN patients with 312 (61.54%) males, aged 54 (43, 64) years old. Compared with 24 h urinary protein < 3.5 g group, proportion of males ( χ2=22.479, P<0.001), age ( Z=-2.521, P=0.012), systolic blood pressure ( Z=-4.148, P<0.001), diastolic blood pressure ( Z=-4.084, P<0.001), serum anti-phospholipase A2 receptor (PLA2R) antibody titer ( Z=-7.019, P<0.001), total cholesterol ( Z=-8.796, P<0.001), triglyceride ( Z=-6.158, P<0.001), low density lipoprotein cholesterol ( Z=-8.716, P<0.001), serum creatinine ( Z=-7.368, P<0.001), serum C3 ( Z=-3.663, P<0.001), serum C4 ( Z=-6.560, P<0.001), proportion of glucocorticoid use ( χ2=116.417, P<0.001) and proportion of immunosuppressant use ( χ2=53.839, P<0.001) were all higher, while serum albumin ( Z=12.518, P<0.001), estimated glomerular filtration rate ( Z=6.345, P<0.001) and serum IgG ( Z=7.321, P<0.001) were all lower in 24 h urinary protein ≥3.5 g group. There were 268 patients included in the follow-up cohort with baseline 24 h urinary protein of 7.15 (5.14, 10.24) g, serum anti-PLA2R antibody titer of 61.44 (14.35, 193.24) RU/ml, serum C3 of 1.005 (0.864, 1.150) g/L, and serum C4 of 0.260 (0.214, 0.317) g/L. Kaplan-Meier survival curve showed that the incomplete remission rate of proteinuria in serum C3 > 1.005 g/L group was lower than that in serum C3 ≤ 1.005 g/L group (log-rank χ2=4.757, P=0.029). There was no significant difference in the incomplete remission rate of proteinuria between serum C4 ≤ 0.260 g/L group and serum C4 > 0.260 g/L group (log-rank χ2=3.543, P=0.060). Renal C1q (log-rank χ2=0.167, P=0.683) and C4 (log-rank χ2=1.927, P=0.165) deposition had no significant effects on proteinuria remission in PMN patients. The incomplete remission rate of proteinuria in patients with renal C3 deposition was higher than that in patients without renal C3 deposition (log-rank χ2=7.018, P=0.008). Univariate Cox regression analysis showed that serum C3 level and C3 deposition in renal tissues were influencing factors of incomplete remission of proteinuria (both P<0.05), while adjusting for gender, age, mean arterial pressure, serum anti-PLA2R antibody, serum albumin and 24 h urinary protein, serum C3 ≤ 1.005 g/L ( HR=1.374, 95% CI 1.021-1.849, P=0.036), C3 deposition in renal tissues ( HR=1.949, 95% CI 1.098-3.460, P=0.023), and serum C3 ≤ 1.005 g/L combined with C3 deposition in renal tissues ( HR=1.472, 95% CI 1.093-1.983, P=0.011) were independent influencing factors of incomplete remission of proteinuria. Conclusions:The serum C3 level and C3 deposition in renal tissues are closely related to urinary protein level and proteinuria remission status in PMN patients. The patients with higher urinary protein have higher serum C3. For patients with massive proteinuria, serum C3 ≤ 1.005 g/L, C3 deposition in renal tissues, serum C3 ≤ 1.005 g/L combined with C3 deposition in renal tissues are independent risk factors of incomplete remission of proteinuria.