ObjectiveTo investigate the clinical epidemiologic characteristics of chronic subdural hematoma and risk factors for its recurrence so as to offer scientific basis for treatment and prognostic evaluation. MethodsA retrospective study was done on clinical data of 150 adults with chronic subdural hematoma from the Traumatic Brain Injury Database of Neurosurgery Department of General Hospital of Tianjin Medical University to analyze the clinical characteristics and the postoperative recurrence factors of the chronic subdural hematoma.ResultsHematoma volume of the patients in the recurrence group was more than that in the non-recurrence group.Age ＞ 80 years and brain atrophy were two independent risk factors for postoperative recurrence of the chronic subdural hematoma.The recurrence rate was declined with the decrease of hematoma density on CT.The recurrence rate of the chronic subdural hematoma in the high-density group was significantly higher than that in the low-and iso-density groups. ConclusionsPreoperative hematoma volume,onset age,brain atrophy and hematoma density on CT are significantly correlated with the postoperative recurrence of the chronic subdural hematoma.A detailed clinical and radiological evaluation is of great importance for the treatment and prognostic evaluation of the chronic subdural hematoma.

Objective To evaluate the clinical application significance of the direct drug susceptibility test and the conventional drug susceptibility test in blood bacterial infection .Methods 280 specimens of positive blood culture in our hospital from March 2012 to April 2014 were randomly selected and performed the the direct drug susceptibility test and the conventional drug suscepti‐bility test .The correlation of the bacterial identification results and the drug susceptibility test results between these two kinds of method was investigated .Results The consistence of the direct bacterial identification method and bacterial identification method was 92 .5% ,the consistence rate of sensitivity ,drug resistance and moderate sensitivity had no statistical differences between the two kinds of method (P>0 .05) .Conclusion The direct drug susceptibility test can shorten the report time of blood culture posi‐tive specimen and effectively guide the rational use of antibiotics in clinic .

Objective To investigate the epidemiological characteristics and therapeutic strategies of patients infected with hepatitis C virus (HCV)genotype 6 in Guangxi area.Methods Serum samples were collected from 150 patients with serologic HCV RNA positive in Guangxi, China. Reverse transcription nested polymerase chain reaction (PCR)was employed to amplify HCV NS5B fragments and the DNA products were sequenced.The sequences obtained were compared with the sequences deposited in GenBank to construct a phylogenetic tree.Among the patients who accomplished 48-week treatment of interferon plus ribavirin and 24-week follow-up after stopping medication,10 cases were infected with genotype 6a and 28 cases with genotype 1 HCV.The virological responses were evaluated at week 4,week 12,week 24 of treatment and week 24 after the end of the treatment.Results Among all recruited 150 cases,21 (14.0%)cases were HCV genotype 6 including two subtypes 6a (n = 20 )and 6d (n = 1 ). Genotype 6 HCV mainly affected intravenous drug users, especially with age of ≤ 40 years old. Phylogenetic tree showed that there was very close evolutionary distance between HCV 6 strains of Guangxi and Hongkong,China strains (Y12083,DQ 480515)and Vietnam strain (EU246930).All of 10 HCV genotype 6a patients who completed 48 weeks of antiviral therapy achieved sustained virological response (SVR).The rate of SVR was higher than that of genotype 1 patients,but without statistically different significance (10/10 vs 75 .0%,P >0.05).Conclusion HCV genotype 6 in Guangxi area mainly affects young intravenous drug users with age of ≤ 40 years old,which has high homology with Hongkong,China and Vietnam standard strains.Patients with HCV 6 genotype infection treated with interferon plus ribavirin for 48 weeks usually achieve favorable SVR.

ObjectiveTo investigate the curative effect of recombinant bovine basic fibroblast gnowth factor (rbbFGF)in the treatment of senile diabetic foot ulcer and summarize the nursing methods.Methods 28elderly patients with senile diabetic foot ulcer were divided into the control group and the treatment group with 14 patients in each group.The control group was given medical treatment and local wound dressing change,the treatment group was given rbbFGF based upon the above method.The degree of granulation tissue maturity,wound healing time and therapeutic effects were compared between these two groups.The nursing measures were summarized.ResultsOn the 9th day and 13th day,granulation tissue maturity degree of the treatment group was better than the control group.On the 14th day,21th day and 28th day,endepidermis growth velocity of the treatment group was better than the control group.The wound healing time of the treatment group was (29.87±5.73) d and was significantly shorter than (38.49±6.58) d of thecontrol group.The therapeutic effect of the treatment group was better than that of control group on the 28th day.ConclusionsApplication of rbbFGF has good curative effect on senile diabetic foot ulcer and suitable nursing care methods contributes to recovery of elderly patients.

Objective:To compare the similarities and differences of clinical characteristics of human immunodeficiency virus (HIV)-negative and HIV-positive patients with talaromycosis marneffei (TSM).Methods:The clinical data of 175 inpatients diagnosed with TSM in First Affiliated Hospital of Guangxi Medical University from May 2012 to April 2019 were retrospectively analyzed. The patients were divided into HIV-positive group and HIV-negative group according to the results of HIV confirmation test. The clinical manifestations, laboratory examination indicators (white blood cell count, hemoglobin, albumin, CD4 + T lymphocyte count and C-reactive protein (CRP)) between the two groups were compared. Mann-Whitney U test and chi-square test were used for statistical analysis. Results:Among 175 TSM patients, 85 were HIV-positive and 90 were HIV-negative patients. The main clinical manifestations of fever and lymphadenopathy in the HIV-positive group and HIV-negative group were 71 (83.53%) cases and 73 (81.11%) cases, 50 (58.82%) cases and 47 (52.22%) cases, respectively, and there were both no statistical differences ( χ2=0.175 and 0.771, respectively, both P>0.05), while respiratory symptoms, weight loss and subcutaneous masses were 62 (72.94%) cases and 81 (90.00%) cases, 73 (85.88%) cases and 56 (62.22%) cases, one (1.18%) case and 16 (17.78%) cases, respectively, the differences were all statistically significant ( χ2=8.514, 12.630 and 13.737, respectively, all P<0.01). Hemoglobin in HIV-positive group and HIV-negative group were 90.50 (77.00, 113.95) g/L and 88.65 (72.85, 99.93) g/L, respectively. The difference was statistically significant ( Z=2.023, P=0.043). The ratios of albumin<30 g/L, CRP>10 mg/L in the two groups were 69.41%(59/85) and 60.00%(54/90), 94.37%(67/71) and 94.19%(81/86), respectively, and the differences were both not statistically significant ( χ2=1.693 and 0, respectively, both P>0.05). The ratios of cases with white blood cell counts >10×10 9/L and CD4 + T lymphocyte count<50/μL in the positive and negative groups were 3.53%(3/85) and 81.11%(73/90), 80.77%(63/78) and 1.75%(1/57), respectively, the differences were both statistically significant ( χ2=107.095 and 82.467, respectively, both P<0.01). Conclusions:In TSM patients, HIV-negative with subcutaneous masses, and increased white blood cell counts are common. Decreased body weight and CD4 + T lymphocyte count<50/μL in HIV-positive patients are more common than HIV-negative patients.

ObjectiveTo investigate the incidence rate of resistance-associated variants (RAVs) in the non-structural protein 5B (NS5B) region in patients with hepatitis C virus (HCV) genotype 1b (GT1b) infection in Guangxi, China, as well as its difference between male and female patients. MethodsA total of 60 previously untreated patients with HCV GT1b infection who were admitted to The First Affiliated Hospital of Guangxi Medical University from April 2016 to September 2018 were enrolled. Their baseline serum samples were collected. The NS5B region fragments were amplified by nested PCR and gene sequencing was performed, and then the sequencing results were compared with standard strains in GeneBank. The t-test was used for comparison of age, HCV RNA, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) between male and female patients, and the Fisher′s exact test was used for comparison of mutation rate of drug-resistance sites. ResultsOf all 60 patients, 55 obtained the complete sequence information of the NS5B region, and the incidence rate of RAVs in the NS5B region was 96.3%. C316 (94.5%), A338 (70.9%), and T19 (74.5%) were the main mutation sites, and multisite mutations such as C316+T19 and C316+T19+A338 were observed. There was no significant difference in the incidence rate of RAVs between male patients and female patients ［95.8% (23/24) vs 96.8% (30/31), P=1.000］. ConclusionPatients with HCV GT1b infection in Guangxi have a high incidence rate of RAVs in the NS5B region, with both single-site and multisite mutations. There is no significant difference in the incidence rate of RAVs between male and female patients.

OBJECTIVETo investigate the common rule hepatic energy metabolism on rats by six cold property of traditional Chinese medicines (TCM).

METHODThe activities of Na+ - K+ - ATPase, Ca2+ - ATPase and SDH, the content of hepatic glycogen, and the mRNA expression of hepatic uncoupling protein 2 (UCP2) were measured after the rats and been administrated with water extracts of Radix Sophorae Flavescentis, Fructus Gardeniae, Cortex Phellodendri, Radix Scutellariae, Rhizoma Coptidis, Radix Gentianae respectively at 6.0, 7.0, 8.4, 6.0, 7.0, 4.0 g x kg(-1) doses for 30 days, twice a day.

RESULTThe activities of Na+ - K+ - ATPase, Ca2+ - ATPase and SDH were depressed significantly by six cold property TCM. The decreased tendency of SDH was observed by six cold property of TCM, while statistical significance was obtained in Cortex Phellodendri, Radix Scutellariae, Rhizoma Coptidis, Radix Gentianae. The increased tendency of hepatic glycogen content was found by six cold property TCM, while statistical significance was not obtained in six groups. The decreased tendency of the mRNA expression of UCP2 was found by six cold property TCM, while statistical significance was obtained in Radix Sophorae Flavescentis, Cortex Phellodendri, and Radix Scutellariae groups.

CONCLUSIONThe six cold property TCM have the good effects on hepatic energy metabolism by decreasing the activity of mitochondria SDH to reduce the production of ATP by decreasing the activities of Na+ - K+ - ATPase, Ca2+ - ATPase to cut down the consumption of ATP, by decreasing the mRNA expression of hepatic UCP2 to decrease the heat production.

Adenosine Triphosphate ; metabolism ; Animals ; Calcium-Transporting ATPases ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; Energy Metabolism ; drug effects ; Gardenia ; chemistry ; Gentianaceae ; chemistry ; Ion Channels ; genetics ; Liver ; drug effects ; metabolism ; Male ; Mitochondrial Proteins ; genetics ; Polymerase Chain Reaction ; Rats ; Rats, Sprague-Dawley ; Scutellaria baicalensis ; chemistry ; Sodium-Potassium-Exchanging ATPase ; metabolism ; Succinate Dehydrogenase ; metabolism ; Uncoupling Protein 2

Objective To explore the influence factors on hepatitis B virus (HBV) relapse after nucleos(t)ide analogues (NA) withdrawal in the chronic hepatitis B (CHB) patients who met NA cessation criteria. Methods Eighty-one consecutive CHB patients were treated with NA, 38 with lamivudine (LAM), 25 with adefovir dipivoxil (ADV), 12 with entecavir (ETV), 6 with LAM +ADV. Among recruited patients, 40 were hepatitis B virus e antigen (HBeAg) positive, 41 were HBeAg negative, 67 of them were initial treatment, 14 were retreatment due to resistance to NA at baseline. The treatment was discontinued after meeting China therapeutic end-point criteria. HBV DNA, HBV serological markers, alanine aminotransferase (ALT) were measured respectively at baseline, every month before virological response, every 3 months after virological response, every month within first 6 months and every 2 months over 6 months after drugs withdrawal. Twelve probable influence factors on relapse which were sex, age, HBV family history, baseline HBV DNA,baseline HBeAg status, baseline ALT, virological response time, total duration of treatment, duration of additional treatment, the level of hepatitis B virus surface antigen (HBsAg) at cessation therapy,initial treatment or retreatment, drug category were analyzed with univariate, multivariate Cox regression modle and stratified analysis. The cumulative relapse was calculated by the Kaplan-Meier method. Results A total of 36 patients (44. 4%) relapsed within 1 year. Initial treatment or retreatment, HBV family history, virological response time, the level of HBsAg at cessation therapy were independent risk factors. The relapse rate of retreatment was higher than that of initial treatment (78.6% vs 37. 3% , χ2 = 7. 983, P = 0. 005) , those of patients with HBV family history higher than without family history (64. 5% vs 15.0%, χ2 =12. 096,P = 0.002), those of patients obtained virological response within 3 months lower than after 3 months(34. 0% vs 64. 3% , χ2 =6. 823,P=0. 009) , those of patients with HBsAg≤150 μg/L at cessation therapy lower than >150 μg/L(27. 6% vs 53. 8%, χ2=5. 199,P=0. 023). Conclusions Retreatment, HBV family history, later virological response and higher HBsAg level at cessation therapy are risk factors of relapse after NA withdrawal. Such patients should be treated with prolonged duration after meeting end-point criteria to strengthen the efficacy.

Objective To evaluate the efficacy and drug resistance profiles of nucleosides (NA) retreatment in NA experienced chronic hepatitis B (CHB) patients. Methods Totally 104 NA experienced CHB subjects were enrolled in this study.All these subjects had received at least 3 months NA monotherapy and stopped the treatment,and then received NA retreatment for at least one year.The subjects were divided into three groups according to the following criteria:reached the therapy endpoint of China guideline when they stopped NA-naive treatment (group A,n =39); did not reach the therapy endpoint when they stopped NA-naive treatment but hepatitis B virus (HBV) DNA＜1.0× 103 copy/mL (group B,n=33); and with HBV DNA＞1.0× 103 copy/mL (group C,n=32).The efficacy and drug resistance profiles of retreatment were compared among three groups. The effects of baseline alanine aminotransferase (ALT) levels,HBV DNA levels and HBeAg titers on the retreatment efficacies were analyzed. The mutations of HBV P gene were detected by nested polymerase chain reaction (PCR) and direct sequencing.The data were analyzd by Wilcoxon test and x2 test.Results The time to ALT normalization in patients with baseline ALT＜ 1.3 × upper limit normal (ULN) was shorter than that in patients with ALT≥1.3×ULN (2 months vs 4 months; Z=2.281,P=0.023).The time to virological response in patients with baseline HBV DNA＜5 lg copy/mL was shorter than that in patients with HBV DNA≥5 lg copy/mL (1 month vs 2 months; Z=2.054,P =0.040). The time to virological response and ALT normalization in baseline HBeAg negative were both shorter than those in patients with baseline HBeAg positive patents ( 1 month vs 3 months and 2 months vs 4.5 months,respectively; Z=2.580 and 2.304,respectively; both P＜0.05). The subjects in group A achieved virological response and HBeAg seroconversion after retreatment earlier compared to previous NA-naive therapy ([1.61 ± 1.76] months vs [3.48±4.066]months and [3.38 ± 3.34] months vs [9.92-11.22] months,respectively; Z=-2.854 and-1.094,respectively; both P＜0.05).The cumulative HBeAg seroconversion rate in group A was higher compared to those in group B and group C (80.0％ vs 36.8％ and 37.5％,respectively; x2 =4.368 and 5.100,respectively; both P＜0.05).Thirteen patients developed clinical resistance and four of them developed genotypic resistance proved by PCR direct sequencing.Among the patients retreated with the same regimen as previous in the C group,the cumulative resistance rate was highest compared to group A and B (44％ vs 9％ and 0,respectively; x2 =5.019 and 6.588,respectively;both P＜0.05).No resistance was detected in the 14 patients retreated with combined NA treatment without cross resistance.Conclusions For NA experienced CHB patients who fulfill the indication of antiviral therapy,the retreatment should be started as earlier as possible. Retreatment with NA combination without cross resistance can prevent (reduce) the risk of developing drug resistance.

Objective To observe the incidence of spontaneous clearance of hepatitis B virus (HBV) DNA in chronic hepatitis B (CHB) patients ,and to investigate the related factors of the spontaneous clearance of HBV DNA and to determine the time to start antiviral therapy .Methods Patients who met the inclusion criteria were recruited from the follow-up cohort of chronic HBV infection from January 2008 to August 2017 for observation .The liver function including alanine aminotransferase (ALT) levels ,HBV DNA load and serum markers of HBV were measured at baseline ,month 1 ,month 3 and month 6 of follow-up . Evaluation index included cumulative HBV DNA negative conversion rate and cumulative HBeAg negative conversion rate .Multivariable analysis was used to analyze the factors associated with the spontaneous clearance of HBV DNA .Results A total of 116 patients were recruited in this study .All the patients showed ALT level elevation at baseline .Without antiviral treatment ,the cumulative HBV DNA negative conversion rate was 12 .9％ after 6-month observation .HBeAg negative conversion rate was 22 .5％ .Multivariable analysis showed that patients without a family history of HBV infection ,baseline ALT level >3 times the upper limit of normal (ULN) and HBV DNA level <6 lg copies/mL had higher cumulative HBV DNA spontaneous clearance rate .HBV DNA negative conversion rate in patients whomet all the above three conditions was up to 75％ .Conclusions In CHB patients and ALT level elevation for the first time , some patients could achieve spontaneous clearance of HBV DNA without antiviral therapy .Patients without a family history of HBV infection ,baseline ALT level >3 ULN and HBV DNA level <6 lg copies/mL have higher rate of cumulative HBV DNA spontaneous clearance .