OBJECTIVE:To explore the effect of different plasmapheresis supplement timing on therapeutic efficacy of toxic liver injury. METHODS:96 patients with toxic liver injury and divided into group A,B ,C and D with 32 cases in each group ac-cording to different plasmapheresis supplement timing. All patients received plasmapheresis supplement based on routine treatment. In group A,synchronized fluid replacement was 100% fresh plasma;in group B,synchronized fluid replacement was 40% normal saline firstly,and then 60%fresh plasma;in group C,substitute liquid was given till the in vitro blood reached 12%of circulation amount,supplement order as 40% normal saline for the first supplement,and then add 60% fresh plasma. The clinical symptoms and signs,liver function,prothrombin activity and blood biochemical indicators were observed in each group before and after treat-ment. RESULTS:Plasmapheresis supplement had good therapeutic efficacy on toxic liver injury;but the time of clinical symptoms and signs disappearance in group C was significantly shorter than that in group A and B,and the group B was significantly shorter the group A,with statistical significance (P<0.05). The plasma bilirubin,prothrombin activity,albumin levels of 3 groups after treatment were significantly better than before,with statistical significance(P<0.05);the group C was better than the group A and B,and the group B was better than the group A,with statistical significance(P<0.05). Compared with before treatment,the lev-els of AST and ALT in 3 groups decreased significantly after treatment,with statistical significance(P<0.05);the group B and C were better than the group A,with statistical significance(P<0.05);the group B and C was similar to each other,without statisti-cal significance(P>0.05). CONCLUSIONS:Different plasmapheresis supplement timing have different effect on toxic liver injury. The supplement method that giving 40% normal saline for the first supplement,and then add 60% fresh plasma when in vitro blood reach 12%of circulation amount has more significant effect.

Objective: To evaluate the feasibility and effect of transcatheter closure of ventricular septal defects(VSD) using the VSD occluder.Methods: From December 2003 to March 2005,13 VSD patients,8 males and 5 females,ranging in age from 4 to 35(15.2?10.7)years,underwent catheter closure using the VSD occluder.Tthe mean diameter of the VSD obtained by transthoracic echocardiography was 4-12(5.4?1.2) mm.Transcatheter closure was performed under transthoracic echocardiographic guidance after left ventriculography.All patients were followed up 1,3 and 6 months after the procedures. Results: The devices were successfully placed in 12 of the patients and complete closure achieved in 11.Trace residual shunt was observed in 1 patient but disappeared within 10 minutes.No severe complications were noted except 1 case of complete right bundle branch block revealed by electrocardiography. Conclusion: Transcatheter closure of VSD by the VSD occluder is a safe and effective procedure,with good immediate results.Further clinical trials are under way to assess its long-term effect.

Objective To clone and express of Rv0091 encoding protein in Mycobacterium tuberculosis,identify and characterize of the enzyme activities.Methods Construct the Rv0091 prokaryotic expression plasmid,the vector was transformed into E.coli strain BL21trxB.After induced by IPTG,recombinant protein was purified by Ni2+-NTA chromatography and analyzed for purity by SDS-PAGE gels stained with Coomassie Blue.Immunological activity was identified by Western blot.The recombinant protein molecular weight was identified by Mass spectrometry.The enzyme-coupled assay detectes enzyme activity.Results The expression plasmid pET32a-Rv0091 was constructed and expressed in E.coli.BL21trxB,and the optimum expression system was conformed.The purity of the recombinant protein was more than 95％.Western blot analysis confirmed that recombinant protein was one of Mycobacterium tuberculosis proteins.Mass spectrometry identified the relative molecular weight and theoretical molecular weight was basically the same.Enzyme assay showed the recombinant protein able to catalyze the substrate MTA.Enzymatic properties showed that the optimal buffer for the phosphate and Hepes buffer,the poor thermal stability of the enzyme,the optimal temperature of 37℃,optimal pH10-12,when the pH ≤7,the protein denaturation and loss of some vitality.Conclusion The recombinant protein methylthioadenosine nucleosidase(MTAN) was obtained and enzyme activity was detected and plays a key role in the metabolism of Mycobacterium tuberculosis.

Objective To analyze the efficacy of entecavir (ETV) combined with Peg IFNα-2b in chronic hepatitis B ( CHB) patients with low levels HBsAg following initial ETV treatment.Methods Sixty-nine CHB outpatients achieving serum HBsAg ＜2 000 IU/mL and HBV DNA＜100 IU/mL following initial ETV treatment in Pujiang People's Hospital and the First Affiliated Hospital of Zhejiang University School of Medicine from January 2014 to January 2016 were enrolled.Patients were randomly assigned in two groups: 39 patients in combination group received ETV (0.5 mg/d ) and Peg IFNα-2b (1.5 μg· kg－1· week －1, hypodermic injection), and 30 patients in ETV group received ETV (0.5 mg/d) alone.Serum HBsAg quantification, negative conversion rate of HBsAg and HBeAg , and levels of aminotransferase (ALT) were measured at baseline , 12th, 24th, 48th, 72th and 96th week after treatment.Results The levels of HBsAg in the combination group decreased gradually with the prolongation of therapy , which were lower than those in ETV group 24 week after treatment (Z＝－2.566,P＜0.05),and at 48th, 72th and 96th week (Z＝－3.499,－3.825 and －3.864,P＜0.01).Clearance of HBsAg appeared in the combination group at 24th week,the clearance rates were 7.70%(3/39) and 28.20%(11/39) at 24th and 96th week, respectively;while the clearance of HBsAg occurred in ETV group at 96th week, the clearance rate was only 3.30%(1/30).The negative conversion rates of HBsAg in combination group were higher than those in ETV group at 48th,72th and 96th week (P＜0.05 or＜0.01).In the combination group, there were 11 cases of clinical cure , 11 cases of clinical efficacy and 17 cases of clinical effectiveness , while there were 1, 1 and 28 cases in ETV group,respectively.The treatment effect of the combination group was better than that of ETV group(χ2＝18.496,P＜0.01).Serological conversion rates of HBeAg were 30.00%(6/20) and 65.00%(13/20) in combination group at 12th and 96th week, while those were 11.11%(2/18) and 22.22%(4/18) in ETV group at 48th and 96th week.There were significant differences in the HBeAg serological conversion rates at 12th, 24th, 72th and 96th week between two groups (P＜0.05 or ＜0.01). The levels of ALT in combination group increased at 12th and 24th week, which had significant difference compared with ETV group (Z＝－1.236 and －2.658,P＜0.05), and the ALT levels gradually declined 48 week after treatment in combination group and there were no statistical differences between two groups at other time points.The ETV combined with Peg IFNα-2b and low baseline HBeAg levels were associated with the clearance rate of HBsAg (both P＜0.01).Conclusions CHB patients with low HBsAg levels following initial ETV monotherapy can achieve high negative conversion rate of HBeAg and HBsAg with the combination treatment of ETV and Peg IFN α-2b.