Objective:To explore the prognostic value of serum deoxyribonuclease 1 like 3 (Dnase1L3), C-reactive protein/albumin ratio (CAR) combined with monocyte to high-density lipoprotein cholesterol ratio (MHR) in decompensated hepatitis B cirrhosis patients.Methods:A prospective selection was conducted on 236 decompensated hepatitis B cirrhosis patients (liver disease group) admitted to the Third Hospital of Qinhuangdao from January 2020 to December 2021, and 185 healthy volunteers (control group) who underwent outpatient physical examinations. The serum levels of Dnase1L3, CAR, MHR, and liver function were detected, and Pearson analysis was conducted to investigate the correlation between Dnase1L3, CAR, MHR, and liver function. Tracking the survival status of patients after 30 days of hospitalization, the risk factors affecting 30 day mortality in decompensated hepatitis B cirrhosis patients were analyzed using a multivariate logistic regression equation. The receiver operating characteristic (ROC) curve analysis was used to assess the value of Dnase1L3, CAR, and MHR in predicting 30 day in-hospital mortality in decompensated hepatitis B cirrhosis patients.Results:The serum levels of Dnase1L3, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBiL), CAR, and MHR in the liver disease group were higher than those in the control group (all P<0.05). The serum levels of Dnase1L3, CAR, and MHR in the liver disease group were positively correlated with AST, ALT, and TBiL (all P<0.05). Among 236 patients, 32 died within 30 days. Model for end-stage liver disease (MELD) scores>18, high Dnase1L3, high CAR, and high MHR were risk factors for 30 day mortality in decompensated hepatitis B cirrhosis patients (all P<0.05). The combined prediction of Dnase1L3, CAR, MHR, and MELD scores for 30 day mortality in decompensated patients with hepatitis B cirrhosis showed an area under the curve of 0.904, which was higher than the predicted values of 0.719, 0.678, 0.763, and 0.742 for individual indicators. Conclusions:The serum Dnase1L3 levels, CAR, and MHR are elevated in patients with decompensated hepatitis B cirrhosis, and are associated with the degree of liver function damage and mortality within 30 days of hospitalization. They have high value in predicting the prognosis of decompensated hepatitis B cirrhosis.

Objectives:To understand the awareness rate and its influencing factors of their HBV infection status among HBsAg-positive persons aged 15-69 years in China.Methods:A cross-sectional design was used to conduct a questionnaire survey on the awareness of their infection status among HBsAg-positive persons aged 15-69 years who were identified in the 2020 national hepatitis B seroepidemiology survey. The awareness rate of the whole respondent and respondents with different characteristics were described, and the differences were compared with the χ2 test. The logistic regression model was used to analyze the factors influencing the awareness rate. Results:The overall awareness rate among the respondents was 43.10% (1 828/4 241). The awareness rate was lower in males than in females (41.30% vs. 44.65%). The awareness rate was lower in the 60-69-years-old age group than in other age groups (30.38% vs. 36.77%-57.58%). The awareness rate was lower in rural areas than in urban areas (39.43% vs. 47.32%). The awareness rate was lower in regions with a per capita gross domestic product (GDP) below RMB 54 000 than in regions with a per capita GDP of RMB 54 000 and above (36.81% vs. 41.61%-50.30%). The awareness rate was lower in respondents without other liver diseases than with other liver diseases (41.52% vs. 60.68%). The awareness rate was lower in respondents without a family history of hepatitis B-related disease or unknown family history than with a family history (43.58% vs. 68.26%; 24.71% vs. 68.26%). Multivariate logistic regression analysis showed that male [odds ratio ( OR)=0.841, 95% confidence interval ( CI): 0.734-0.964], high school and below [primary school and below, junior middle school, high school/technical secondary school, OR (95% CI): 0.247 (0.190-0.321), 0.451 (0.352-0.577), 0.634 (0.486-0.827)], rural areas ( OR=0.822, 95% CI: 0.715-0.945) and regions with a per capita GDP below RMB 80 000 [54 000-80 000, OR (95% CI): 0.810 (0.688-0.954), below RMB 54 000, OR (95% CI): 0.793 (0.669-0.941)] were the negative factors influencing the awareness rate. While 30-39-years-old ( OR=2.089, 95% CI: 1.626-2.683) and 40-49-years-old ( OR=1.590, 95% CI: 1.250-2.023) age groups, with other liver diseases ( OR=2.244, 95% CI: 1.754-2.871) and family history related to hepatitis B ( OR=2.688, 95% CI: 2.242-3.223) were the positive factors influencing the awareness rate. Conclusion:The overall awareness rate of their infection status among HBsAg-positive persons aged 15-69 years is 43.10% in China. Health promotion and coverage expansion on HBV screening should be further strengthened to achieve the proposed World Health Organization's target of 90% HBV infection diagnosis rate by 2030.

Objective To investigate the effect of IFN-γ on the proliferation and migration of esophageal squamous cell carcinoma cell line Eca9706 and related mechanism. Methods Cells were cultured in vitro and treated with interferon-γ. Cell morphology changes were observed under microscope, cell proliferation ability was detected by CCK-8 experiment, and cell migration ability was detected by cell scratch experiment and Transwell experiment. Real-time PCR method was used to detect the expression efficiency of chemokine CXCL8 (interleukin 8), and the ELISA experiment was used to detect the change of CXCL8 secretion. Results Compared with the blank control group, Eca9706 cells treated with different concentrations of interferon-γ did not change significantly in cell morphology. CCK8 experiment confirmed that the proliferation ability of Eca9706 cells after IFN-γ treatment was significantly reduced (P < 0.01). Cell scratch experiment found that IFN-γ significantly decreased the migration ability of Eca9706 cells (P < 0.01). Transwell experiment showed that after IFN-γ treatment, the migration ability of Eca9706 cells was significantly inhibited (P < 0.01). CXCL8 gene expression level in Eca9706 cells treated with interferon-γ was significantly down-regulated (P < 0.01), and the amount of CXCL8 secretion significantly reduced (P < 0.05). Conclusion Interferon-γ can inhibit the proliferation and migration of esophageal cancer cell line Eca9706, which may be related to its inhibition of the expression and secretion of CXCL8.

Objective To investigate expression of cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) and squamous cell carcinoma antigen (SCC-Ag) in cervical cancer patients with lung metastasis before treatment and their prognostic value. Methods The pretreatment serum expression levels of SCC-Ag and CYFRA21-1 of 72 cervical cancer patients with lung metastasis were measured. Survival rate analysis and Cox proportional hazard model were performed to evaluate the prognostic significance of two pretreatment variables. Results The media survival time (MST) of 72 patients was 14 months, and 38 (52.8 %) patients with pulmonary metastasis occurred in 1 year of treatment. The pretreatment serum SCC-Ag and CYFRA21-1 levels in the patients with tumor diameter over 4 cm or with squamous cell carcinoma were higher than those in the other patients (all P<0.05). The MST in the pretreatment serum CYFRA21-1 positive group (>3.3 mg/L) was higher than that in the negative group (13 months vs 19 months, P< 0.05), and the MST in the SCC-Ag positive group (>1.5 mg/L) was also higher than that in the negative group (14 months vs 21 months, P<0.05). The result of Cox regression analysis showed that the tumor diameter (OR = 11.6, P = 0.01), pretreatment serum SCC-Ag (OR= 4.2, P= 0.01) and CYFRA21-1 (OR= 8.2, P= 0.05) levels were independent prognostic factors of overall survival. Conclusion Pretreatment CYFRA 21-1 and SCC-Ag levels may be considered as useful prognostic indicators for cervical cancer patients with lung metastasis.

Objective To observe and compare in vivo segmental lumbar motion between symptomatic L4 isthmic spondy?lolisthesis (IS) patients and L4 degenerative spondylolisthesis (DS) patients during functional weight?bearing activities. Methods Fifteen symptomatic L4 IS patients and fifteen symptomatic L4 DS patients were recruited. Fifteen asymptomatic volunteers were en?rolled as the control group. The L4,5 vertebral segment motion of each subject was reconstructed using three?dimensional computed tomography and a solid modeling software. In vivo, lumbar vertebral motion during functional postures (flexion?extension, left?right twisting and left?right bending) was observed using a dual fluoroscopic imaging technique. The spinal function unit was divided in?to anterior and posterior segments by the isthmic cleft. Local coordinate systems were established at the vertebral body, to obtain the 6 degree?of?freedom (DOF) intervertebral range of motion (ROM) at L4,5 and the ROM between the anterior and the posterior segments of L4 IS. Results The motion of IS at L4,5 was found to be increased. The migrations along both sagittal and vertical axis were significantly larger than control group (P<0.05). During left?right twisting, the migration along sagittal axis was significantly larger than control group (P<0.05);the rotation along vertical axis was significantly larger than DS and control group (P<0.05). During left?right bending, the migration along frontal axis was significantly larger than DS and control group ( P<0.05). The inter?vertebral ROM at L4,5 showed no significant difference between DS and control group. The migration between anterior and posteri?or segments of IS L4 was larger in standing than supine (P<0.05). The relative migration along sagittal axis between anterior and posterior segments of IS L4 was significantly larger in flexion than standing (P<0.05). Conclusion A spondylolytic defect does lead to detectable instability or hypermobility in the lumbar spine compared with degenerative spondylolisthesis and normal group. From supine to standing posture, migration at isthmic cleft along sagittal and coronal axis are identified in IS spondylolithesis.

10.3969/j.issn.2095-4344.2013.23.006

Objective To evaluate the mid-term clinical and radiographic results of artificial disc replacement (ADR) for discogenic low back pain.Methods From July 2004 to July 2007,21 patients with discogenic low back pain,aged from 26 to 67 years,underwent lumbar ADR with the Charité Ⅲ artificial disc at 22 levels and Activ L prosthesis at 2 levels:L4-5 5 cases,L5S1 13 cases,L4-5 and L5S1 3 cases.The diagnosis was proved by discography in all the patients.The clinical and radiographic results were evaluated and compared between pre-,post-operation and finial follow-up.Results All patients were followed up for 4to 7 years (average,5.1 years).There were statistical differences between pre-operation and final follow-up in Oswestry disability index and Visual Analogue Scale for back pain and leg pain.All the prostheses were mobile without dislocation,breakage,subsidence or spontaneous fusion,only a slight scoliosis was noted in one patient.At the ADR levels,the anterior and posterior intervertebral height increased averagely 6.3 mm and 1.9 mm respectively,the lordosis increased 2.9°,and the mean range of motion (ROM) was 4.6°.At the adjacent level proximal to ADR,the intervertebral height and lordosis decreased slightly,and the ROM decreased 2.5°.The total lumbar lordosis increased 7.8°,and the total lumbar ROM increased 2.4°.According to MRI and CT scans,the degeneration of proximal adjacent disc and facet were not evident,however the degeneration of facets at the ADR levels was evident.Conclusion The 5 years results of ADR for discogenic low back pain were satisfactory,with preserved motion at the ADR level,and the degeneration of adjacent level was not evident.However,there was obvious degeneration in facet joints of the ADR level.

Objective To evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability.Methods A retrospective review was performed on 15 patients with upper cervical fracture and instability treated with cervical pedicle screw fixation and fusion from September 2006 to January 2009.There were 11 males and 4 females,at average age of 41.2 years(range,18-60 years).Of all,there were five patients with atlas fracture and dislocation(including three simple anterior arch fractures and two Jefferson fractures),three with axis fracture and dislocation,one with dens fractures plus nonunion,two with C2,3 fracture and dislocation and four with atlantoaxial instability without fracture.The main clinical complaints included local neck pain and/or tetraplegia.Halo traction was recommended to restore the cervical sequence preoperatively in all patients.All 15 patients were treated by cervical pedicle screw-rods internal fixation and bone graft fusion.During the operation,the point and angle of the implanted pedicle screws were determined by preoperative X-ray and CT scan and the bony channel drilled with free-hand before implantation of the Summit or Vertex pedicle screws(22-26 mm long)and posterior interlaminar autologous or allogeneic bone fusion.Patients could get out of bed with neck collar at days 1-2 after operation.Results A total of 64 cervical pedicle screws were implanted in all 15 patients,with no vertebral artery injury,spinal cord injury or cerebrospinal fluid leakage.Postoperative X-ray and CT scan confirmed satisfactory internal fixation.The clinical symptoms were improved significantly.Fourteen patients were followed up for 12-36 months,which showed bony fusion,with no looseness or breakage of the screws.Neurologic impairment was improved in all patients,with no complications associated with the cervical pedicle screw.Conclusions Cervical pedicle screw internal fixation can reestablish the upper cervical vertebrae stability and help to recover the spinal cord and nerve function and hence is a reliable method for upper cervical fracture and/or instability.

Objective To evaluate the efficacy of mobile endospine system for sequested lumbar disc herniation.Methods From May 2007 to December 2009,31 patients of sequested lumbar disc herniation were treated with mobile endospine system,including 17 men and 14 women with a mean age of 46 years (32-59 years).Patients complained severe leg and low back pain with disability.According to MRI,the sequested nucleus herniated from the disc of L2-3 in 1 case,L3-4 in 1,L4-5 in 16 and L5S1 in 13;and the direction of herniation was caudal in 24 cases,cephalic in 6 and indistinguishable in 1.The patients were followed up for 12 months (range,6-24 months) ,and the results were evaluated according to Macnab scale.Results The procedure was technically successful in all the patients:the sequested nucleus was completely extracted.The protruded disc was treated with discectomy in 30 cases,and the nearly intact disc was left untouched in one patient.Among the 24 cases with caudal herniation,sequested nucleus situated ventrally beneath the dural theca and the transitional nerve root in 15 cases,between the nerve root and dural theca in 5,and dorsally on the nerve root and dural theca in 4.All the 6 cephalic herniation situated beneath the dural theca,1 of them reached the level of pedicle,and 2 herniated into the intervertebral canal.The sequested disc presented as indistinguishable signal on MRI included nucleus,annulus and cartilage endplate,and situated dorsally around the dural theca.The mean operative time was 50 min (range,40-70 min) with a mean blood loss of 80 ml (range,30-200 ml).There was no complication of nerve injury.Only too much facet was resected in 2 patients without clinical symptom.The results were excellent in 21 cases and good in 10 cases,and all of them were satisfied with this procedure.Conclusion The working canal and visual field of mobile endospine system is movable,so the sequested nucleus can be extracted completely with good results.

ObjectiveTo evaluate the effectiveness at anterior lumbar interbody fusion (ALIF) with a single cage alone in treatment of lumbar degenerative disc disease(DDD).MethodsThirty-four patients aged from 26 to 67 years (mean,52) were enrolled in this study,including 10 males and 24 females.Preoperative diagnosis included:degenerative spondylolithesis in 11 cases,discogenic low back pain in 21,and revision for failed posterior surgery in 2.Objective level located in L4.5 in 12 cases,L5S1 in 20,and double discs(L4.5,L5S1) in 2.All the patients received extraperitoneal approach ALIF.Surgical time,blood loss,perioperative complications and postoperative ambulation were noted.Postoperative function status was evaluated by 100 mm Visual Analog Scale (VAS) and Oswestry Disability Index (ODI50).AP,lateral and dynamic X-rays were routinely taken during follow up,according to which disc height,migration of implant and bony fusion were measured.ResultsAll the surgeries were performed successfully with a mean surgical time of 90 min and blood loss of 200 ml.An injury to the bifurcation of vena cave was encountered in an early case,after meticulous repairing of the vessel,the surgery was finished successfully.Peritoneum rupture was noticed in one case.One case of postoperative cage migration was revised and reinforced with additional fixation system.All the patients were followed up for an average of 36 months(range,12-60).All the patients were satisfied with the pain relief and returned to normal social life and working.VAS decreased from preoperative 70 to postoperative 5,and ODI decreased from 41％ to 6％.All but one migration case reached sound fusion with a fusion rate of 97％.ConclusionOwing to multiple advantages,complete removal of degenerative disc,compressive bone graft,sufficient graft area,early ambulation,less complication,extrapefitoneal approach for ALIF comes up with satisfying clinical outcomes.This mini_invasive technique provides a valuable alternative to treatment of lumbar DDD when appropriate indication is selected.