OBJECTIVE:To evaluate the curative effect and safety of reduced glutathione for injection(Atomolan) on the Alcoholic Liver Disease(ALD).METHODS:This was a randomized,placebo controlled study,in which the reduced glutathione for injection(Gluthion) was used as control substance.A total of 261 ALD patients were randomly divided into 2 groups in 1:1 ratio(trial group,n=135;control group,n=126).The dosage,route and course of treatment in two groups were the same.Clinical data including biochemical parameters,symptoms and signs in two groups were monitored.RESULTS:The excellent effective rate,effect rate and total effective rate in the trial group were 58.5%,23.7% and 82.2%,respectively,those in the control group were 57.9%,22.2% and 80.2%,respectively,showing no significant difference between the 2 groups(P=0.90).CONC-LUSION:The study showed that the domestic glutathione for injection had a sound efficacy in improving clinical symptoms and recovery of liver biochemical parameters,showing equivalent efficacy to the control preparation good safety.

Objective To detect the ascites CD64 index of patients with decompensated cirrhosis ,and explore the value in the di-agnosis of spontaneous bacterial peritonitis (SBP) .Methods Decompensated cirrhosis with ascites patients were divided into non-SBP group ,SBP suspected group and SBP diagnosed group .Two control groups were composed of patients with ascites culture pos-itive and non-SPB group .SBP suspected group were further grouped according to abdominal pain and the percentage of peripheral blood neutrophils .The CD64 index was detected by flow cytometry .Compared the difference of ascites CD64 index after treatment , and analyzed diagnosis performance of procalcitonin in human peripheral blood and ascites white blood cell count of SBP .Results The level of the ascites CD64 index was significantly higher in SBP diagnosed group (179 .39 ± 65 .56)and SBP suspected group (115 .49 ± 58 .42)than that of non-SBP group(26 .88 ± 26 .05)(P<0 .01) .The differences of the ascites CD64 index between SBP suspected associated with abdominal pain group and SBP suspected associated with painless group was not statistically significant (P>0 .05) .The level of the ascites CD64 index in SBP suspected with percentage of peripheral blood neutrophils elevated group was increased significantly than non-elevated group(P<0 .05) .CD64 index level in effective treatment group was significantly lower than the ineffective treatment group(P<0 .01) .The area of the ascites CD64 index under the curve was greater than procalcitonin in human peripheral blood and ascites WBC count ,and had a higher sensitivity and specificity .Conclusion The detection process of the ascites CD64 index is fast and with less influential factors ,which provides a new choice for the clinical diagnosis of SBP .

Objective To detect any association between chemosensitivity of tumor in vitro and clinico-pathological characteristics of patients with breast cancer, such as age, pathological type, pathological grade, as well as local lymph nodal status. Methods Sixty patients with breast cancer were tested with tissue culture-end point staining-computer image analysis (TECIA) after resection of the primary lesion or biopsy. Their chemosensitivity to seven common anticancer drugs were evaluated, which were fluorouracil (5-Fu), vinorelbine(NVB), cisplatin(DDP), paclitaxel(TAX), docetaxel(TAT), doxorubicin(ADM) and epirubicin(EADM). Results 31.67% of the total 60 specimens were resistant to all of 7 drugs. The sensitive rate of the tissues to a specific drugs was 60.00 % (36/60) for EADM, 54.00 %(32/60) for NVB, 36.00 %(22/60) for DDP or TAT, 30.00 %(18/60) for TAX, 26.00 %(16/60) for 5-Fu and 16.00 %(10/60) for ADM in turn. The sensitive rate of invasive carcinoma group was higher than non-invasive carcinoma group (74.47 % vs 46.15 %, P< 0.05), and grade Ⅲ group higher than grade Ⅰ or grade Ⅱ group (90.91% vs 54.55 %, 90.91% vs 55.56%, P<0.01). The differences of sensitive rates among three different age groups and between two groups with/ without lymph nodal metastasis were not significant statistically (P > 0.05). Conclusion The total sensentive rate of breast cancer might be relatively high to EADM, NVB and TAT, and TECIA could be an important reference for clinical individual chemotherapy.

Medical ethics is correlated with further development of affiliated teaching hospital.Our hospital took ‘ Bethune spirit’ and philosophy of forgiveness and kindheartedness as guidance and became the first batch of Bethune spirit model hospital of Chongqing.Teaching quality was improved by providing lectures about ‘ Bethune spirit’ for medical students and equally emphasizing medical knowledge and medical ethics education.Anti-corruption and academy governing movements with the subject of ‘ Bethune spirit’ were carried out to repel academic misdeed,with the result that clinical,teaching and scientific works were promoted and advanced.

Medical science has both the characteristics of natural science and humanities.Modem medical education pays more attention to the close association between professional education and humanistic education.How to handle the relationship between infectious disease and humanistic education has become more and more important.In current study,integrating humanistic education in clinical infectious disease teaching not only improved infectious disease teaching effect but also established good medical ethics and increased the comprehensively quality.

Objective To explore the effects of transplantated bone marrow mesenchymal stem cells (MSCs) on myocardial fibrosis with the aid of ultrasound-mediated microbubbles (MB) and bispecific antibody(BiAb) combination.Methods With the aid of MB,isolated MSCs from male mice and the BiAb were transfused into female mice with isoproterenol-induced myocardial fibrosis via tail vein (MSCs + BiAb + MB group).BiAb was producted with anti-CD29 which can recognize MSCs and anti-myosin light chain antibody (AMLCA) which can specifically bind to injured myocardium.There were six groups investigated:MSC + BiAb + MB,MSC,BiAb,MB,MSC + BiAb,untreated,and control groups.Five weeks after treatment administration,the expressions of sex-determining region of Y-chromosome (SRY) in myocardium were detected by fluorescent quantitative PCR.The distribution of collagen was observed by sirius red staining.Heat shock protein-70 (HSP-70) in myocardium was detected by immunohistochemistry.Results The highest homing number of MSCs was in the MSCs + BiAb + MB group,MSCs + BiAb group ranked the second,and lowest in MSCs group.Compared to the untreated group,the MSCs + BiAb + MB,MSCs + BiAb and MSCs groups had less collagen deposition (P ＜0.05),and decreased level of HSP-70.Compared to those of the MSCs group,the collagen deposition were decreased in MSCs + BiAb + MB group (P ＜0.05).Conclusions MB and BiAb can promote the homing number of MSCs in mice.MB can further the homing rate and the repairing efficacy of MSCs.The homing MSCs can prevent the process of myocardial fibrosis.And HSP-70 was involved in the internal mechanism.

OBJECTIVETo assess the clinical value ofprocalcitonin in cirrhotic patients with severe infection by comparing the serum procalcitonin levels in those patients with and without liver cirrhosis when suffering from sepsis.

METHODSA total of 225 septic patients were included in the study,including 91 patients without hepatopathy, 80 patients with cirrhosis, and 54 patients with chronic liver disease. The serum procalcitonin level was measured in all patients and statistically assessed for correlation with relevant clinical biochemistry indicators. The t-test, ANOVA test, Mann-Whitney U test, chi-square test and Spearman's correlation analysis were used for statistical analyses.

RESULTSThe patients with cirrhosis showed significantly lower serum procalcitonin levels (0.84 (0.32-3.44) ng/ml) than the patients with no hepatopathy (2.17 (0.70-9.18) ng/ml) or the patients with chronic liver disease (2.12 (0.33-13.61) ng/ml) (both P less than 0.05); the patients in the no hepatopathy group and the chronic liver disease group showed statistically similar levels of serum procalcitonin (P=0.616). The patients with cirrhosis of Child-Pugh grade C showed significantly higher level of serum procalcitonin (1.25 (0.54-4.61) ng/ml) than those patients with Child-Pugh grade B (0.33 (0.14-1.31) ng/ml; P=0.026), suggesting that patients with Child-Pugh C stage cirrhosis may be more susceptible to gram-negative bacterial infection. In the cirrhosis group,serum procalcitonin level was positively correlated with white blood cell (WBC) count (r=0.312) and percentage of neutrophils (N%) (r=0.228) (both P less than 0.05). Correlation analysis of the no hepatopathy group and the chronic liver disease group showed no correlation between serum procalcitonin level and either WBC or N%.

CONCLUSIONUnder the sepsis condition, cirrhotic patients have lower serum procalcitonin level than patients without cirrhosis, and the serum procalcitonin level is positively correlated with WBC count and N%.

Objective: To investigate the value of neutrophil-lymphocyte ratio (NLR) in predicting hepatitis B-related liver failure. Methods: A total of 349 subjects were enrolled, among whom 60 were healthy persons who underwent physical examination (group A), 111 had severe chronic hepatitis B (group B), 92 had decompensated hepatitis B cirrhosis (group C), and 86 had acute-on-chronic liver failure (ACLF) (group D). Routine blood test results, liver function parameters, and coagulation parameters were collected, and NLR was calculated. According to disease progression, group B was further divided into groups B1 (with progression to ACLF) and B2 (without progression to ACLF). NLR was compared between groups, and its prognostic value was evaluated. Results: NLR was 2.22(1.76-3.05) in group A, 2.54(1.78-3.49) in group B, 3.07(1.95-5.04)in group C, and 3.41(2.01-5.15) in group D, and NLR gradually increased with the aggravation of disease condition. The univariate and multivariate regression analyses of groups B1 and B2 showed that NLR and prothrombin activity were prognostic factors for disease progression. There was a significant difference in baseline NLR between groups B1 and B2 (3.87 ± 1.54 vs 2.71 ± 1.54, P = 0.004). There was a significant increase in NLR when severe hepatitis B in 16 patients progressed to ACLF (P = 0.042). The receiver operating characteristic (ROC) curve analysis showed that the cut-off value of NLR for predicting the progression of severe hepatitis B to ACLF was 2.79, with an area under the ROC curve (AUC) of 0.739 (P = 0.002). NLR was also a reference index for judging end-stage liver disease with a cut-off value of 3.94 (AUC = 0.612, P = 0.001). Conclusion Peripheral NLR can reflect disease progression and predict the development of liver failure.

Objective To study the efficacy and safety of percutaneous transhepatic one-step biliary fistulation (PTOBF) with rigid cholangioscopic lithotripsy for treatment of complicated hepatolithiasis under the ultrasonic navigation technique.Methods In this retrospective study,PTOBF lithotripsy surgery was performed in 94 patients with hepatolithiasis under general anesthesia with tracheal intubation,and with percutaneous transhepatic puncture of targeted bile duct under ultrasonic navigation in The First Affiliated Hospital of Guangzhou Medical University.Biliary expanders were used along a guidewire to expand the sinus gradually until 14Fr to establish a fistulous channel.Lithotripsy was then performed through the channel by rigid cholangioscopy.The operation-related data were collected and analyzed,including puncture and fistula establishment success ratio,complication rate,intraoperative blood loss,residual and recurrence hepatolithiasis rates.Results 94 patients (total 122 patient-times) underwent PTOBF lithotripsy.There was no perioperative mortality.The overall puncture success rate was 100％,and the fistula/puncture rate was 97.5％ (119/122).In 118 patients success was achieved in 2 time (96.7％).The complication rate was 9.6％ (9/94).The average intraoperation blood loss were (24.9 ± 21.3)ml.The residual calculus rate after therapy was 13.8％ (13/94).All patients were followed-up for a period that ranged between 18 and 30 months.The recurrence rate was 14.9％ (14/94).Conclusions Ultrasonic navigation technique plays an important role in bile duct puncture,sinus expansion and rigid cholangioscopic lithotripsy for treatment of complicated hepatolithiasis.PTOBF lithotripsy is a safe and effective procedure,which provides a new way in mini-invasive treatment for hepatolithiasis.It is worth generalizing.

Objective:To study the use of percutaneous transhepatic one-step biliary fistulation based on three-dimensional visualization technology (3D-PTOBF) in the treatment of complex hepatolithiasis.Methods:A retrospective analysis was conducted on 116 patients with complex hepatolithiasis treated in the First Affiliated Hospital of Guangzhou Medical University from January 2016 to December 2019. There were 56 patients in the 3D-PTOBF group (treated by 3D-PTOBF), and 60 patients in the traditional PTOBF group (received traditional PTOBF approach). The stone clearance rate, postoperative complication rate, intraoperative blood loss, hospitalization time, number of cholangioscopic treatment procedures and stone recurrence rate were compared between the two groups.Results:When compared with the traditional PTOBF group, the 3D-PTOBF group had significantly less procedures (1.43±0.71 vs. 2.07±1.22, P<0.05), and shorter hospital stay (4.6±2.3 d vs. 6.1±2.9 d, P<0.05). There were no significant differences in the immediate stone clearance, final stone clearance, postoperative complications and stone recurrence rates between the two groups (all P>0.05). Conclusion:3D-PTOBF was safe and feasible to treat complex hepatolithiasis. When compared with PTOBF, it had the advantages of shorter operation time and decreased hospital stay.