Objective To investigate mutations of S protein gene in positive HBsAg and anti-HBs patients with chronic hepatitis B virus (HBV) infection.Methods Fifteen HBsAg(+) and anti-HBs(+) patients and 22 HBsAg(+) and anti-HBs (-) patients (control group) admitted in Renmin Hospital of Wuhan University during January and December 2011 were enrolled in the study.The S protein gene was amplified and sequenced, and the amino acid sequences were translated from the obtained DNA sequences and compared with the reference sequences.Results Compared with the control group, HBsAg (+) and anti-HBs(+) patients showed a higher variability in amino acid within major hydrophilic region (2.95 vs.0.78,x2 =18.059, P＜0.01) and the a determinant (4.44 vs.1.52, x2 =6.985, P＜0.01).The mutations in a determinant at positions P127T, G130E, G130N, M133S, F134I, T140I and G145R were detected only in HBsAg(+) and anti-HBs (+) patients.Conclusion Co-existence of HBsAg and anti-HBs in patients with chronic HBV infection might be associated with the increased amino acid mutations in and around the a determinant of protein S.

Objective To investigate the safety and effectiveness of endoscopic submucosal dissection(ESD)for elderly patients(≥60 years old)with colorectal lesions.Methods Data of 31 elderly patients(≥60 years old)and 23 non-elderly(<60 years old)patients who were found to have colorectal mucosal lesions by colonoscopy and underwent ESD treatment between January 2012 to January 2014 were retrospectively studied.Results There were no statistical differences between the two groups in gender, concomitant diseases,lesion location,lesion size and postoperative pathological diagnosis (P >0.05 ). Thirty-two lesions in elderly group and twenty-five lesions in non-elderly group were all curative resection.En bloc resection rates were 96.9%(31 /32)and 96.0%(24 /25)in the elderly group and non-elderly group respectively;the rates of bleeding during ESD procedure were 3.2%(1 /31 )and 4.3%(1 /23);delayed bleeding rates were 12.9%(4 /31)and 13.0%(3 /23);the rates of perforation was 12.9%(4 /31)and 0;postoperative infection rates were 3.2%(1 /31)and 4.3%(1 /23)respectively.There were no statistical differences between the two groups in any of these data (P >0.05 ).The mean time of follow-up were (14.8 ±1.7)months in elderly group and (14.7 ±1.8)months in non-elderly group,and there was no significant difference between two groups.No residual lesion or recurrent lesion was found in the follow-up period.Conclusion ESD is a safe and effective treatment for the elderly patients with colorectal lesion.

Objective:To investigate the manifestations of liver injury in hospitalized patients with coronavirus disease 2019 (COVID-19), to investigate the prognosis indicators of the disease, and to provide the reference for clinical diagnosis and treatment.Methods:From January 10 to February 14, 2020, at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, the data of 333 hospitalized patients with COVID-19 were collected. The changes of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil), indirect bilirubin (IBil) and albumin of the first liver function test after admission and the reexaminations of liver function test during hospitalization period in patients with liver injury were retrospectively analyzed. Student t test and Chi-square test were used for statistical analysis. Results:Liver injury occurred in 39.6% (132/333) of COVID-19 patients. There was no statistically significant difference in the rate of liver injury between patients in intensive care unit (ICU) and in general ward (45.6%, 26/57 vs. 38.4%, 106/276; χ2=1.026, P>0.05). 67.4% (89/132) of COVID-19 patients with liver injury presented with increased ALT or AST level on admission. During hospitalization, the level of ALT was higher than that of the first examination after admission ((60.28±50.44) U/L vs. (42.25±32.21) U/L), and the difference was statistically significant ( t=-3.230, P<0.05). The levels of ALT and AST of 71.2% (94/132) patients were both <80 U/L, which indicated that most of the patients showed mild liver injury. The patients with elevated level of TBil, DBil and IBil accounted for 3.9% (13/333), 5.4% (18/333) and 2.4% (8/333) of the COVID-19 patients, respectively. The albumin level of COVID-19 patients with liver injury during hospitalization was lower than that of the first examination after admission ((31.8±5.1) g/L vs. (33.7±5.4) g/L), and the difference was statistically significant ( t=2.712, P<0.05). The albumin levels at first examination on admission and reexamination during hospitalization of patients in ICU were both significantly lower than those of patients in general ward ((29.3±3.7) g/L vs. (34.8±5.1) g/L and (27.6±2.8) g/L vs. (32.9±5.1) g/L), and the differences were statistically significant ( t=4.928 and 4.783, both P<0.05). Conclusions:The incidence of liver injury in COVID-19 patients is high. A slight increase in aminotransferase levels is particularly common. Bilirubin abnormality is relatively rare and mild. The level of albumin may be one of the indicators for the severity and prognosis of COVID-19.