Objective The aim of this study was to analyze risk factors which may affect prognosis of patients with hepatits B virus (HBV)-related liver failure,and to construct a model for prognostic evaluation and further assess its predictive ability.Methods In this retrospective cohort study,569 hospitalized patients who were diagnosed with HBV-related liver failure from January 2007 to December 2010 were enrolled.All the patients were followed up and survival analysis was performed using the Kaplan-Meier method.Univariate and multivariate COX proportional hazards regression analyses were applied to variables such as age,sex,complications,biochemical markers,coagulation markers,and HBV DNA levels to construct a model for prognostic evaluation,and 79 independent cases of HBV-related liver failure were used to confirm the model's predictive ability.Accuracy of the constructed model and model for end-stage liver disease (MELD) was evaluated by receiver operating characteristic (ROC) curves.Results The median survival time for all the patients was 59 days.The survival rates at 1,3,6 months were 58.9％,46.2％ and 45.5％,respectively;and survival rates at 1 and 3 years were 44.9％ and 44.5％,respectively.Hepatic encephalopathy,pulmonary infection,upper gastrointestinal bleeding (UGIB),albumin (Alb),aspartate aminotransferase (AST),creatinine (Cr),international normalized ratio (INR) were determined to be independent risk factors (all P＜0.01) which may affect survival of patients with HBV related liver failure.Accordingly,the prognostic index (PI) of the constructed model for prognostic evaluation 4.98 × assignment of hepatic encephalopathy + 4.57 × assignment of pulmonary infection + 4.41 ×assignment of UGIB-9.69 ×lm[Alb (g/L)]+2.46 ×ln[AST (U/L)]+5.18×ln[Cr (mmol/L)]+3.35×ln (INR) 15.36.The area under receiver operating characteristic curve was 0.838 for the constructed model assessing 90-d survival of the patients,and was 0.751 for model for end-stage liver disease,with no significant difference between the two models (Z=1.085,P =0.278).Conclusions Prognosis of patients with HBV-related liver failure can be accurately predicted by the constructed prognostic assessment model,which is consisted of hepatic encephalopathy,pulmonary infection,UGIB,Alb,AST,Cr,and INR as independent risk factors,and is able to predict the 90 d survival.

Objective To investigate the risk factors for the presence of hepatic encephalopathy in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) in the midphase.Methods A total of 287 patients with HBV-related ACLF in the mid-phase were recruited.Clinical data (age,gender,diabetes,liver cirrhosis,upper gastrointestinal hemorrhage,spontaneous bacterial peritonitis,and pulmonary infection) and laboratory findings [albumin,globulin,total bilirubin (TBil),alanine transaminase (ALT),aspartate aminotransferase (AST),glutamyl transpeptidase (γ-GT),alkaline phosphatase,total cholesterol,cholinesterase,creatinine,prothrombin activity (PTA),international normalized ratio,alpha-fetoprotein (AFP),loads of HBV DNA,serum potassium,serum sodium,white blood cell,and platelet count] were included as potential risk factors and analyzed with univariate and multivariate Logistic regressions.Results Multiple Logistic regression analysis indicated that serum potassium(B =-2.006,P =0.000,OR =0.135,95％CI:0.051-0.353),serum sodium(B=-0.096,P=0.014,OR=0.908,95％CI..0.841-0.981),pulmonary infection (B =1.648,P =0.018,OR =5.199,95 ％ CI:1.326-20.386),AFP (B=-0.010,P =0.024,OR =0.990,95％ CI:0.982-0.999) were correlated with hepatic encephalopathy.Conclusion Hypokalemia,hyponatremia,pulmonary infection and low levels of AFP are independent risk factors of the presence of hepatic encephalopathy in patients with HBV-related ACLF in the mid-phase.

Post competency is a kind of necessary ability for professional working.In order to train the students' excellent professional skills,we have conducted exploration and reform in post competency oriented experiment teaching,through reforming experimental courses,changing teaching methods and means of examination,constructing the laboratory etc.,so that we have built a new professional training model in pathological diagnosis and technology specialty experimental teaching.The experimental teaching reform results have improved the experimental teaching quality and the talents capability.

Objective To compare early-stage clinical features and hypothalamic-pituitary-adrenal (HPA) axis neuroendocrine function in first-episode and untreated major depressive disorders with suicide and without suicide. Methods Untreated patients who had a diagnosis as major depression according to ICD-10 were allocated to suicide with major depressive disorder group or non-suicide with major depressive disorder group according to whether the pa?tients had suicidal ideation or behaviours. Patients were assessed before treatment using the 17-item Hamilton Depres?sion Scale (HAMD-17), the Hamilton Anxiety Scale (HAMA), the Yale-Brown Obsessive Compulsive Scale (YBOCS) and the suicide assessment scale. The cortisol (CORT) and adrenocorticotropic hormone (ACTH) levels in serum were measured using a chemiluminescence immunoassay. Results There was no significant difference in demographic data be?tween the two groups (P>0.05). In early-stage clinical features, there were significant differences in changes of sexual ac? tivity and feeling of despair (P<0.05). HAMD total scores were significantly higher in the suicide group (P<0.01), whereas HAMA total scores and Y-BOCS total scores were not significantly different between the two groups (P>0.05). There were no significant differences in CORT or ACTH levels between two groups (P>0.05). There were no significant correlation of suicidal scores with early-stage clinical features, symptom scales scores, CORT or ACTH levels (P>0.05). Conclusion De?creased sexual desire and feeling of despair are more severe in depressed patients with suicide than those without. There is no correlation of early-stage clinical features or HPA axis functions with suicide in patients with depression.

Objective To investigate the predictive factors of virological response in HBeAg-positive chronic hepatitis B (CHB)patients treated with adefovir dipivoxil (ADV).Methods A total of 203 HBeAg-positive CHB patients treated with ADV (Mingzheng)10 mg once daily for 48 weeks were recruited.The gene polymorphisms at positions-238 and-308 in tumor necrosis factor (TNF)-α promoter region were determined by the restriction fragment length polymorphism assay of products amplified using polymerase chain reaction (PCR-RFLP).The serum levels of TNF-a at baseline were measured by enzyme linked immunosorbent assay (ELISA).Hepatitis B virus (HBV)genotypes were tested by real-time fluorescent quantitative PCR and HBV subgenotypes were tested by HBV S gene sequencing.Factors related to ADV response were determined by Logistic regression analysis.Results The HBV DNA negative rate,alanine aminotransferase (ALT)normalization rate,HBeAg loss rate and seroconversion rate,and combined response rate at week 24 and 48 of treatment in 203 patients were 31.5% (64/203),59.1% (120/203),15.8% (32/203),8.9% (18/203),13.3% (27/203)and 58.6% (119/203),78.3% (159/203),29.6% (60/203),16.7% (34/203),25.6% (52/203),respectively.HBV DNA negative rate at week 24 was higher in patients with HBV genotype B,that was higher in patients with TNF-α-308G/A genotype,and that was higher in patients with higher baseline ALT level or lower baseline HBV DNA level [OR = 0.405,95 % CI (0.191 - 0.859),P =0.019;OR=0.292,95%CI(0.132-0.643),P=0.002;OR=0.933,95%CI(0.989-0.997),P＜0.01 ;OR=2.089,95%CI (1.412-3.092),P＜0.01].Meanwhile,HBV DNA negative rate at week 48 were higher in patients with higher HBV DNA negative rate at week 24 or higher baseline ALT level [OR=0.029,95%CI(0.007-0.126),P＜0.01;OR= 0.995,95%CI(0.991-0.999),P=0.016].Conclusions HBV genotype,TNF-α-308 genotype,baseline levels of ALT and HBV DNA are predictors of virological response at week 24 in HBeAg-positive CHB patients treated with ADV.And the HBV DNA negative rate at week 24 and baseline ALT level are predictors of virological response at week 48.

Objective To observe the occurrence and risk factors of arrhythmia in chronic kidney disease (CKD) patients in different stages of renal function. Methods A total of 405 CKD patients were enrolled in this study and none of them received renal replacement therapy.The 24 h dynamic electrocardiogram (DCG) was performed,and baseline characteristics were compared.Multivariable Logistic regression analysis was used to examine the relationship between the severe arrhythmia and the potential risk factors,such as age,gender,CKD stage,diabetes,hypertension,hyperpotassaemia,left ventricular hypertrophy (LVH),etc. Results There were 69 patients (17.04％),79 patients (19.51％),82 patients (20.25％),88 patients (21.73 ％) and 87 patients (21.48％) in CKD stage 1,2,3,4 and 5,respectively.As high as 45.68％ of all the patients had severe arrhythmia,represented by 27.54％,29.11％,42.68％,57.95％ and 65.52％ in CKD stages 1-5 respectively.The occurrence of severe arrhythmia increased as the eGFR decreased in CKD stages 2,3,4 (p＜0.05).On multivariable Logistic regression analysis,the occurrence of severe arrhythmia was related to LVH,CKD stage,diaberes hyertension and hyperpotassaemia are signidicantly assoxiated with severe arrhythmia.

Objective To investigate the predictive value of TNFα,ALT,HBV DNA loads and HBV serological markers in response to adefovir dipivoxil (ADV) treatment for patients with chronic hepatitis B(CHB).Methods Two hundred and three HBeAg.positive CHB patients were administered with ADV 10 mg/d for 48 weeks.HBV serological markers and TNFα at the baseline were determined by enzyme linked immunosorbent assay(EUSA),and HBV DNA loads were detected by PCR.Logistic regression was used to identify predictive factors for serological response at 48th week after the treatment.Results The rates of HBV DNA clearance,ALT normalization,HBeAg lOSS,HBeAg seroconversion and response at 24th week were 31.5%(64/203),59.1%(120/203),15.8%(32/203).8.9%(18/203)and 13.3%(27/203)respectively,while those at 48th week were 58.6%(119/203),78.3%(159/203),29.6%(60/203),16.7%(34/203)and 25.6%(52/203),respectively.Patients who achieved HBeAS loss at 48th week were found to have higher rates of HBV DNA clearance.HBeAg loss and seroconversion at 24th week and higher TNFα at baseline(P=0.017,0.ooI,0.029 and 0.040),while those who achieved HBeAg seroconversion at 48th week were found to have higher rate of HBeAg seroconversion at 24th week.and lower baseline HBV DNA loads(P=0.000 and 0.004).Conclusion For HBeAg.positive CHBpatients with ADV treatment,the rate of HBV DNA clearanee,HBeAg loss and seroeonversion at 24th week and TNFα at baseline may be used to predict the rate of HBeAg 1088 at 48th week:the rate of HBeAgseroconversion at 24th week and baseline HBV DNA loads may be used to predict the rate of HBeAgseroeonversion at 48th week.

Objective To investigate the effect of SVV guided fluid therapy on blood gas and lipopolysaccharide (LPS),procalcitonin (PCT) in patients undergoing resection of gastrointestinal tumor.Methods Sixty patients aged 60 85 years from Jan,2016 to Feb,2017 falling into ASA physical status Ⅱ or Ⅲ,scheduled for elective radical operations for gastrointestinal cancers,were includ ed and randomly divided into two groups (n =30 each) using a random number table:ScvO2 guided fluid therapy (group C),SVV guided fluid therapy (group G).MAP,HR and CVP of patients were recorded at the same time before anesthesia (T0),tumor removal (T1) and the end of surgery (T2)respectively.PH,BE,HCO3-and Lac of venous blood samples and artery blood samples at T0-T2,6 hours after surgery(T3) were recorded.Venous blood samples were collected at T0,T3 to detect LPS and PCT.Crystalloid requirements,colloid requirements,total volume,bleeding volume,peritoneal fluid volume and the use of dopamine were recorded.The time of PACU,time when the patients first exhausted and was fed after operation,length of hospital stay after operation were recorded.Results Compared with group C,BE of artery blood was obviously increased at T2,T3 in group G (P＜0.05);the Lac of artery at T2 and the Lac of artery and venous blood at T3 in group G was obvi ously decreased.LPS and PCT were decreased at T3 in group G (P＜0.05).Compared with group C,the needed colloid was increased in group G,the needed crystalloid and total volume of fluid infused were decreased in group G (P＜0.05).Compared with group C,the time of PACU starting to exhaust and feed,length of hospital was shortened in group G (P＜0.05).Conclusion SW guided goal directed fluid therapy is more conductive to maintain the acid base and reduce the incidence of in fection for the patients with gastrointestinal tumor operation,promote the recovery of gastrointestinal function and decrease the length of hopital after operations.

Objective:To investigate the potential mechanism of microRNA (miRNA) in hepatitis B virus (HBV) infection.Methods:The peripheral blood samples were collected from four chronic hepatitis B (CHB) patients who visited Mengchao Hepatobiliary Hospital of Fujian Medical University in 2017, and those were also collected from four healthy controls. Affymetrix GeneChip microRNA 4.0 was applied to detect the expressions of miRNA between CHB patients and healthy controls. The CHB relative differential expressions of miRNA were obtained. The functions of CHB relative miRNA were analyzed by the combination of bioinformatics tools and public database data.Results:A total of seven miRNA were differentially expressed in the peripheral blood of CHB patients. Among them, miRNA-122-5p (log 2 fold change (log 2FC)=7.78, P=0.007 3), let-7c-5p (log 2FC=3.52, P=0.019 6), miRNA-6794-5p (log 2FC=1.15, P=0.033 2), and miRNA-1226-5p (log 2FC=0.68, P=0.034 3) were up-regulated, while miRNA-619-5p (log 2FC=-1.83, P=0.002 6), miRNA-1273g-3p (log 2FC=-2.69, P=0.025 1), and miRNA-4440 (log 2FC=-3.99, P=0.047 8) were down-regulated. Further analysis showed that these miRNA could directly interact with HBV gene sequence and impact the replication of the virus. Among them, miRNA-122-5p, miRNA-6794-5p and miRNA-1226-5p could negatively regulate target genes expression to influence the formation of ficolin-1 rich granule, ficolin-1 rich granule lumen, podosome and membrane ruffle, which participated in the cell membrane movement and cell-matrix adhesion. Conclusion:MiRNA could impact the molecular movement in the cell membrane and facilitate HBV entry to liver cells, playing an important supporting role in HBV infection process.

Objective To investigate the baseline independent prognostic factors for 24 months survival of hepatitis B virus (HBV)-associated acute-on-chronic liver failure (ACLF) patients treated with telbivudine.Methods The prospective cohort study was conducted in HBV-associated ACLF patients who were hospitalized in Mengchao Hepatobiliary Hospital of Fujian Medical University and volunteered to be treated with telbivudine for more than 24 months.The patients were observed for survival at month 1,3,6,12,and 24 after treatment.The baseline biochemical index,coagulant function,model for end-stage liver disease (MELD) score,HBV DNA level as well as comorbidities were analyzed in this study.The count data were compared with kappa test or Fisher's exact test.For the normal distributed measurement data,the homogeneity test of variances (Levene test) was firstly used for comparison between groups.Further,the group t test was applied for variance homogeneity,while the approximate t test was applied for variance non-homogeneity and the Mann-Whitney U test was applied for the non-distributed measurement data.Results A total of 41 patients were enrolled,including 3 drop-outs and 38 accomplishments.Among these 38 patients,there were 3 females (7.9 ％) and 35 males (92.1％),with ages (38.5 ± 11.1) years.There were 32 patients alive and 6 dead during 1 month's follow-up,while baseline MELD score was the independent prognostic factor (RR=1.864,95％CI:1.151-3.019) for survival.There were 31 patients alive and 7 dead during 3 months' follow-up,while baseline MELD score and upper gastrointestinal hemorrhage (UGH) were the independent prognostic factors (RR =2.053,95％CI:1.163-3.625;RR=394.939,95％CI:1.880-82 948.817).There were both 26 patients alive and 12 dead during 6 and 12 months' follow-up,while baseline MELD score was the independent prognostic factor (RR=1.761,95％ CI:1.230-2.523).At the end of 24 months' follow-up,there were 15 patients alive and 23 dead.Viral rebounds were observed in 6 patients and 3 of them were dead.Baseline HBV DNA level,MELD score and electrolyte imbalance were the independent prognostic factors (RR-9.722,95％ CI:1.607-58.821;RR=l.518,95％ CI:1.066-2.162;RR=87.505,95％ CI:2.263-3 384.232) for 24 months'survival.Conclusions Although telbivudine is not recommended as the first-line treatment,ACLF patients with low MELD score and low HBV DNA level at baseline,individualized treatment may improve patient's survival rate.UGH and electrolyte imbalance may affect the efficacy of telbivudine and reduce the survival rate of ACLF patient.