Objective To study the activation effect of HBV RNase H protein on the transcription of cellular apoptosis susceptibility gene (CAS). Methods The promoter of DNA sequence of CAS gene was identified in GenBank by bioinformatics and amplified from HepG2 genome by PCR using sense (5′-GGTACCCGATTACATGTTGTACATGAAGG-3′) and antisence (5′-CTCGAGGCTGAGTTCCATTGCTATAG-3′) primers. As these primers contained Kpn I and Xho I recognition sites on their respective 5′-ends, the amplified DNA fragments were tested by sequencing and then subcloned into Kpn I/Xho I sites of pCAT3-Basic reporter vector by routine molecular biological methods. The reconstructed plasmid named pCAT3-CASp was identified by enzyme digestion of Kpn I/Xho I, in which the expression of chloramphenical acetyltransferase (CAT) was under the control of the promoter of CAS. The HepG2 cells were transfected by pCAT3-CASp, and then co-transfected by pCAT3-CASp and pcDNA3.1(-)-RH plasmids. At the same time, the empty pCAT3-basic and pCAT3-TXNRD1p were transfected (self-contructed by the authors) as controls. After 24h culturing, cells were collected and the expression of CAT activity was detected by ELISA according to the manufacturer′s protocol. Results The optical density of expression of CAT of pCAT3-CASp was 0.043 by ELISA, in contrast, the optical density of expression of pCAT3-Basic was 0.024. The expression of CAT in co-transfection of pCAT3-CASp and pcDNA3.1(-)-RH(0.065) was 1.5 times as higher as pCAT3-CASp plasmid (0.043), and 2.7 times as higher as pCAT3-Basic. Conclusions The CAS gene promoter identified in present study has transcription activity and HBV RNase H protein may activate the expression of CAS gene.

Objective To investigate the safety and feasibility of laparoscopy-assisted radical gastrectomy in elderly gastric cancer patients aged over 70 years.Methods Clinical data of 222 elderly gastric cancer patients aged over 70 years receiving surgery from January 2010 to January 2015 were retrospectively analyzed.Patients were divided into the laparoscopy-assisted radical gastrectomy group (LAG group,n=106) and the conventional open gastrectomy group (OG group,n=116),depending on the surgery type.General information,surgical parameters,intra-operative blood pressure fluctuations & blood gas analysis,postoperative recovery and complication rates were compared between the two groups.Results There were no significant differences between the two groups in gender,age,preoperative coexisting diseases,tumor size and location,TNM staging or extent of resection (all P＞0.05).Compared with the OG group,blood loss (86.9±38.9) ml vs.(168.8±49.1) ml,t=10.923,P＜0.01),operative incision length [(9.20±1.55) cm vs.(16.50± 2.12) cm,t=8.788,P＜0.01],time to bowel function recovery [(3.20±1.09) d vs.(5.50±1.16) d,t=4.590,P＜0.01],hospital stay [(11.82±3.92) d vs.(16.14±4.69) d,t=2.234,P＜0.05] and postoperative complications (12.3％ vs.26.4％,x2 =5.186,P＜0.05) were reduced in the LAG group.The LAG group had higher levels of partial pressure of carbon dioxide in arterial blood (PaCO2) and lower levels of base excess than the OG group [(48.10±5.53) mmHg vs.(40.25± 4.66) mmHg,(-7.45±3.72) mmol/L vs.(-3.35±1.98) mmol/L,t=6.908 and 3.619,P＜ 0.01 and 0.05].However,there were no significant differences between the two groups in partial pressure of oxygen (PaO2),arterial oxygen saturation (SaO2) or hydrogen ion concentration (all P＞ 0.05).No significant differences in operation time or number of retrieved lymph nodes were found between the two groups [(196.1 ± 23.4) min vs.(184.2 ± 26.9) min,(28.7 ± 6.5) vs.(27.3 ± 5.6),t=1.174 and 0.515,both P＞0.05].Conclusions Laparoscopy-assisted radical gastrectomy is safe and practical in elderly patients aged over 70 years with gastric cancer and can achieve comparable effects of open radical gastrectomy with less invasiveness and faster recovery.

Objective To explore the effectiveness and safety of totally laparoscopic distal gastrectomy (TLDG)and laparoscopically assisted distal gastrectomy (LADG)for gastric cancer.Methods The comparative studies of TLDG and LADG published between 2008 and 2014 were searched from PubMed,EMBASE,Chinese Biomedical Literature Database (CBM),China National Knowledge Infrastructure (CNKI). After screening for inclusion, data extraction,and quality assessment,RevMan 5.3 software was used for Meta-analysis.Results Ten studies of 2 212 patients were included in the Meta-analysis,among whom 930 cases underwent TLDG and 1 282 cases underwent LADG.The results of Meta-analysis indicated that compared with LADG,TLDG had the advantages of less blood loss (WMD= - 20.70,95%CI:- 30.81 - - 10.59,P <0.01),less usage of analgesic (WMD=-0.38,95%CI:-0.74 - -0.02,P =0.04),more retrieved lymph nodes (WMD= 2.98,95%CI:0.71 -5.26,P =0.01).However,the Meta-analysis showed no statistically significant differences in the operation time, postoperative time-to-first flatus and oral intake,postoperative hospital stay,length of proximal resection margin, C reaction protein (CRP)level at postoperative day 1,incidence of overall complications and anastomosis-related complications.Conclusion TLDG is safe and effective with less blood loss, less pain than those of LADG. Moreover,it has comparable results to conventional LADG,with no increase of postoperative complications.

Objective To determine the power-time-ablation scope correlogram of a water-cooled single needle electrode radiofrequency (RF) ablation system and to establish a theoretical basis for its practical application.Methods RF ablations were performed using a water-cooled single needle electrode radiofrequency ablation system developed by the authors using fresh ox liver as well as liver and muscles of healthy adult New Zealand white rabbits.The temperature of the ablation area was monitored using a multichannel thermometric system.The maximum ablation scope was determined by detecting the rim at which the temperature was no less than 50 °C.The specific absorption rate (SAR) of the isolated liver tissue was calculated.Results In the treatment voltage range of 100-130V,the process was smooth and steady.No impedance variation was obvious.The maximum diameter of a single ablation was 51 cm.With the treatment voltage at 140-170 V,a larger ablation area could be reached in less time,but eventually the impedance began to increase while the ablation area was no longer expanded.When the treatment voltage reached the range of 180-200 V the impedance almost always increased rapidly out of limits,and the treatment system stopped automatically.The measured SAR value was consistent with the theoretical value.Pathology confirmed that both liver tissue and muscle tissue manifested typical coagulative necrosis.Conclusions The power amplifier,cooling,thermometric and control sections of the RF ablation system worked stably,and the practical ablation effect met the design and clinical treatment requirements.

Objective To assess the therapeutic effectiveness of monotherapy of adefovir dipivoxil (ADV) and lamivudine (LAM),or ADV administered in combination with LAM,in order to find the effective and secure therapy for decompensated cirrhosis patients following chronic hepatitis B. Methods Totally 64 decompensated cirrhosis patients following chronic hepatitis B were divided into 2 groups by using a prospective randomized grouping method. In group A,patients received the therapy of adefovir dipivoxil (10mg/d) combined with lamivudine (100mg/d); and in group B,a monotherapy of adefovir dipivoxil (10mg/d) was used. The period of treatment was 48 weeks. Levels of serum ALT,HBeAg and HBV-DNA were detected in week 12,24,36 and 48 respectively. The liver function was evaluated with Child scores on these time points. Data were analyzed by a blinded independent investigator. Results After 48 weeks treatment,HBV DNA negative conversion rate of the two groups were 87.1%and 78.8%.The virtual rate were 96.8% and 87.9%;HBeAg negative conversion rate were 83.9%,and 57.6%. HBeAg/anti-HBe seroconversion rates of the two groups were 41.9%and 24.2%. Normalization of serum ALT levels were observed in 96.8% patients of group A and 97.0% of group B. Conclusion The combination therapy of adefovir dipivoxil (ADV) and lamivudine (LAM) could reduce the occurrence of drug resistance,and increase the anti-viral effect. It is a secure management for chronic hepatitis B virus infection.

OBJECTIVETo evaluate the advantage and short-term efficacy of three-dimensional (3D) laparoscopic-assisted D2 radical gastrectomy for gastric cancer.

METHODSClinical data of 116 gastric cancer patients who underwent laparoscopic-assisted D2 radical gastrectomy in our department from January 2014 to August 2015 were analyzed retrospectively. Among 116 patients, 56 received 3D and 60 received two-dimensional(2D) technique respectively. All the surgeries were performed by the same team. The operative parameters, short-term efficacy and hospital expense were compared between the two groups.

RESULTSThere were no significant differences between the two groups in baseline data(all P>0.05). All the operations were performed successfully without conversion. Compared with 2D group, 3D group had shorter operative time [(186.2±22.8) minutes vs. (198.1±26.4) minutes, t=2.589, P=0.011], less intraoperative blood loss [(73.6±28.5) ml vs. (88.1±32.3)ml, t=2.555, P=0.012]. Whereas no significant differences in dissected lymph nodes(36.5±6.6 vs. 34.5±5.4, P=0.073), time to first flatus[(3.1±1.5) days vs. (3.3±1.8) days, P=0.729], length of hospital stay[(11.7±2.9) days vs. (12.6±3.1) days, P=0.088], incidence of postoperative complications [8.9%(5/56) vs. 11.7%(7/60), P=0.628] and hospitalization cost [(8.6±1.4)×10(4) yuan vs. (8.1±1.2)×10(4) yuan, P=0.055] were found between two groups.

CONCLUSIONThree-dimensional laparoscopic-assisted D2 radical gastrectomy may be advantageous over two-dimensional laparoscopic-assisted D2 radical gastrectomy.

Blood Loss, Surgical ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

This paper introduces HIFU system software based on a phased-array HIFU device. Combined with the database and computer graphics technology, this HIFU system software can be used to develop the therapy planning semi-automatically, implement the pilot project efficiently and accelerate the clinical studies.
Computer Graphics ; High-Intensity Focused Ultrasound Ablation ; methods ; Software ; Software Design

OBJECTIVETo investigate reliability of FibroScan (FS) in diagnosing size of oesophageal varices (OV) in patients with liver cirrhosis.

METHODSA total of 260 patients with liver cirrhosis were enrolled in the study. All patients underwent endoscopy to assess OV stage and FS to measure liver stiffness. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic reliability of FS.

RESULTSThe FS values according to OV stage were 20.9 ± 10.3 kPa for patients without OV, 32.2 ± 13.5 kPa for patients with mild OV, 45.6 ± 18.3 kPa for patients with moderate OV, and 55.1 ± 15.6 kPa for patients with severe OV. Significant differences were found among the groups (P < 0.001) as well as between any two groups (t=6.574, 10.533, 13.247, 4.719, 7.072 and 2.171, P less than 0.05 respectively). ROC curves of FS for the diagnoses of patients with various OV stages showed the following:with vs. without OV, 0.824 (95% CI:77.5% to 87.4%); less than moderate vs. more than moderate OV, 0.849 (95% CI:79.6% to 90.2%); and less than severe vs. severe OV, 0.871 (95% CI:81.1% to 93.0%); the corresponding FS cut-off values were 22.8 kPa, 30.6 kPa, and 34.6 kPa.

CONCLUSIONLiver stiffness measurement by FibroScan allows prediction of the oesophageal varices stage in patients with liver cirrhosis.

Adult ; Elasticity Imaging Techniques ; Esophageal and Gastric Varices ; diagnosis ; etiology ; Female ; Humans ; Liver Cirrhosis ; complications ; diagnosis ; Male ; Middle Aged

Objective To evaluate the effectiveness and safety of direct-acting antiviral agents (DAA) treatment in Chinese chronic hepatitis C (CHC) patients with genotype (GT) 1b HCV infection in a real world setting .Methods The consecutive GT1b CHC Chinese patients treated with sofosbuvir (SOF) plus daclatasvir (DCV) (n＝62) or SOF plus ledipasvir (LDV) (n＝171) were enrolled from July 2014 to December 2016 at 302 Military Hospital of China .The treatment duration for all the patients was 12 weeks .All the clinical parameters were measured at baseline and then 4-weekly till 12 weeks after the end-of-treatment (EOT ).Baseline clinical characteristics ,treatment efficacy ,safety and tolerance were compared .Serum HCV RNA concentration was detected by means of COBAS TaqMan assay with a lower detection limit of 15 IU/mL ,and liver stiffness was measured using FibroScan?.Sustained virologic response (SVR) was defined as HCV RNA under the lower limit of quantification 12 weeks after EOT (SVR12).Students′t-test ,pearson χ2 test ,Spearman rank correlation analysis and Fisher exact test were used for comparison between groups when appropriate .Results Among 233 patients ,173 cases had baseline HCV RNA level ≥ 6 .0 lg IU/mL and 97 cases hade liver stiffness measurement (LSM )≥17.5 kPa.The baseline liver inflamation ,liver fibrosis ,and HCV RNA load of patients in the two groups were not significantly different (all P＞0 .05).The HCV RNA of all the 233 patients was undetectable at the end of 12-week treatment ,while 2 patients relapsed after 12 weeks of EOT with the overall SVR12 of 99.1% .HCV RNA decline was significantly faster in patients with lower LSM than those with higher LSM (ρ＝0 .233 ,P＝0 .001) ,and SVR12 was higher in those with lower LSM .In terms of other clinical characteristics of SOF+DCV and SOF+LVD groups ,alanine transaminase declined from (68 .0 ± 60 .1) and (70 .1 ± 56 .1) U/L to (21 .1 ± 10 .9) U/L and (15 .3 ± 9 .5) U/L ,respectively ,total bilirubin declined from (21 .3 ± 17 .3) and (18 .2 ± 14 .0) μmol/L to (13 .2 ± 6 .7) and (10 .2 ± 4 .6) μmol/L , respectively ,AFP declined from 19 .6 (10 .6 ,62 .3) and 15 .0 (12 .0 ,25 .0) μg/L to 6 .5(4 .5 ,18 .7) and 7 .8(5 .3 ,15 .4) μg/L ,respectively ,LSM declined from 17 .6 (8 .9 ,25 .4) and 15 .7 (7 .8 ,23 .9) kPa to 13.9(6 .5 ,21 .4) and 9 .1(5 .6 ,19 .9) kPa ,respectively ,serum album elevated form (37 .5 ± 5 .8) and (38 .7 ± 5 .5) g/L to (41 .3 ± 4 .7) and (42 .8 ± 5 .1) g/L ,respectively ,platelet elevated from (120.9 ± 78 . 2)×109/L and (136 .6 ± 65 .8 )× 109/L to (139 .5 ± 71.8 )× 109/L and (149 .7 ± 71.4 )× 109/L , respectively .Reports of adverse events were low in both groups .Conclusions Both SOF + DCV and SOF/LDV therapy are highly effective with ＞ 98% of SVR12 and reduce LSM value significantly with good safety for CHC GT1b Chinese patients .

Hepatitis C virus (HCV) is one of leading causes for chronic liver diseases, the treatment area has been changed rapidly since direct acting antiviral agents (DAAs) were approved to treat patients with chronic HCV infection. To cure hepatitis in 2030 is the goal set by World Health Organization. However, globally, especially in China, there are still many difficulties needing to be resolved on the cure road of chronic hepatitis C, such as large patient population, high percentage of untreated patients, nonstandard DAA treatment, low efficacy of special groups, and resistance-associated variants in baseline, etc. This comment will focus on the new demands for HCV related clinical examinations for DAA treatment, so as to improve the treatment effectiveness and to help achieve the goal of eliminating viral hepatitis .