Objective To explore the complication and its cause and treatment of pace markers implantation in older patient.Methods Among 205 older patients aged 70 to 90 years,103 were male,the others were female.Of these patients,162 were implanted with single chamber pace marker,43 with dual chamber pace markers.Results 21 patients happened complication(10.2%),the common complications related to operation were blood effusion and hematoma formation in pocket 12 cases,lead dislodgement 4 cases and infection with or without pocket rapture 2 cases.Occurrence of blood effusion was related to aspirin administration,lead dislodgement and infection with or without pocket rapture were related to operation.Conclusion To pay attention to ample preparation,close operation and strict observation can decrease the complication rate when pace marker is implanted.The serious result will be avoided by timely and effective treatment.The older patient with pace markers implantation is safe.

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 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

ObjectiveTo investigate the association of liver stiffness measurement (LSM) and serum biochemical parameters with hepatic steatosis, liver inflammation, and liver fibrosis in patients with nonalcoholic steatohepatitis (NASH). MethodsA total of 520 patients with NASH who were treated in The Fifth Medical Center of Chinese PLA General Hospital from January 2007 to December 2018 were enrolled, and according to body mass index (BMI) with a cut-off value of 28 kg/m2, the patients were divided into obese group with 151 patients and non-obese group with 369 patients. All patients underwent liver biopsy, and LSM was measured within 3 days before biopsy. Serum biochemical parameters and general clinical data were collected before liver biopsy, and the noninvasive indices aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) were calculated. The t-test was used for comparison of normally distributed continuous between groups, the nonparametric Mann-Whitney U test was used for comparison of non-normally distributed continuous between groups; the chi-square test was used for comparison of categorical data between groups. A Spearman rank correlation analysis was also performed. ResultsAlanine aminotransferase (ALT), aspartate aminotransferase, LSM, controlled attenuation parameter (CAP), spleen length, and APRI gradually increased with the increase in BMI (all P＜0.05). The Spearman correlation analysis showed that LSM, ALT, BMI, and CAP were positively correlated with the degree of hepatic steatosis (r=0.263, 0.327, 0.184, and 0.452, all P＜0.05); LSM, ALT, and CAP were positively correlated with the degree of liver inflammation (r=0.357, 0.278, and 0.121, all P＜0.05); LSM, ALT, BMI, and CAP were positively correlated with the degree of liver fibrosis (r=0.500, 0.216, 0.248, and 0.101, all P＜0.05); age was negatively correlated with the degree of hepatic steatosis, liver inflammation, and liver fibrosis (r=-0.344, -0.129, and -0.163, all P＜0.05). ConclusionLSM, CAP, ALT, and age are significantly correlated with the degree of liver inflammation, liver fibrosis, and hepatic steatosis in NASH patients, and therefore, they can be used in noninvasive diagnostic and predictive models to access the severity of liver injury.

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 .

Objective To evaluate the relationship between the hepatic toxicity induced by chemotherapy in patients with malignant tumor who test positive for HBV markers. Methods From January 2008 to January 2014, 887 cancer patients were treated by chemotherapy. Among 274 cases of patients were HBV positive (positive group), 613 patients were HBV negative (negative group), the liver function after chemotherapy were compared. Results Positive group patients receiving chemotherapy had higher rate of hepatic toxicity than those in negative group (24.1% vs. 11.3%,P<0.01),the incidence rate of 3-4 grade hepatic toxicity in positive group patients was 11.2%(13/116),more than that in negative group 0.65%(4/613). In the different treatment, there were statistically significant in two groups by TP regimen(paclitaxel+cisplatin), CAF(cyclophosphamide+adriamycin+5-Fluorouracil), CHOP(cyclophosphamide+doxorubicin+oncovin+prednisone)liver function after chemotherapy (P<0.05). In the TP scheme leaded to the incidence of abnor-mal liver function was the highest, the incidence rate in positive group was 36%(18/50),the incidence rate in negative group was 15.8%(19/120). Conclusion HBV infection is associated with higher risk of hepatic toxicity in patients with malignant tumor during chemotherapy(led by TP scheme).

Objective: In order to understand the current situation and influencing factors of teaching quality in a Medical University in Yunnan, thus improving the teaching quality of the teachers. Methods: The self-made evaluation forms for teachers' teaching quality which include 9 first-level indicators were adopted. In December 2016, a survey was conducted on some students from grade 2013 to 2016 about the teachers who gave them lectures from September to December 2016, involving 7 different majors, 23 teachers and 18 courses. SPSS 21.0 was used for data analysis. Enumeration data were described by frequencies and percentages. Univariate and multivariate Logistic regression analyses were used for satisfaction. Results: There were 1 542 valid questionnaires collected in this survey. Univariate Logistic regression analysis showed that there were 6 factors related to the overall satisfaction of teachers' classroom teaching quality, which were "whether the courses are professional (OR=1.430)", "curriculum difficulty (OR=1.731)", "curriculum progression (OR=1.620)", "learning time after class (OR=1.141)", "interest before class (OR=1.565)", and "interest after class (OR=2.291)", respectively. Conclusion "courses are professional", "courses are too easy", and "the progression of courses is slow " are favorable factors for high satisfaction degree, while "courses are set up by the departments that the students belong", "learning time used after class is too short", and "interest for study is decreased after class" may be unfavorable factors for high satisfaction degree.

Objective: To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression. Methods: Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment. Results: A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness. Conclusion This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.