Objective To evaluate the effects of nucleoside/nucleotide analogue treatment on immunoglobulin and complement in patients with chronic hepatitis B (CHB).MethodsA total of 157 CHB patients were recruited and divided into CHB group,liver cirrhosis (LC) group and severe hepatitis B (SHB) group.There were 50 patients who received oral antiviral treatment (lamivudine 100 mg/d,or entecavir 0.5 mg/d,or telbivudine 600 mg/d).Serum levels of complement 3 and 4 (C3,C4),C-reaction protein (CRP),hemolytic complement (CH50),immunoglobulin G,M,A (IgG,IgM,IgA),hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) were detected by enzyme-linked immunosorbent assay (ELISA) or immunoturbidimetry.Hepatitis B virus (HBV) DNA was quantified by real-time polymerase chain reaction (RT-PCR) before and 1,2,3 and 4 weeks after nucleoside antiviral therapy.Comparison of means was done by t test and Mann-Whitney test.The correlation was analyzed by Pearson correlation coefficient test.ResultsSerum IgA and IgM levels of SHB and LC patients were significantly higher than those of CHB patients (P＜0.01).Levels of C3,C4,CH50 and CRP were significantly different among three groups.Levels of C3,IgM,IgG and HBV DNA in HBeAg positive patients were significantly different from those in HBeAg negative patients.There was a statistically significant difference of IgA,IgM,C3 and CH50 levels between patients with high HBV DNA level and low HBV DNA level in HBeAg-positive patients.While in the HBeAg-negative patients,only the IgA level was significantly different with HBV DNA levels.After anti-viral treatment,immunoglobulin and HBV DNA levels were all decreased in three groups,while the serum complement level was increased compared to baseline,and the differences became significant at week 4 of treatment. HBV DNA level was negatively correlated with C3 (r=-0.78,P=0.021) and HBeAg titer was positively correlated with C3 (r=0.87,P=0.015).ConclusionsThe immunoglobulin,CRP,C3,C4,and C H50 could reflect the inflammatory activity in liver.The changes of C3 level can predict the efficacy of antiviral therapy.

Objective To study the incidence and distribution features of spontaneous decrease of hepatitis B virus (HBV) DNA level and its correlative factors in chronic hepatitis B (CHB) patients.Methods The incidence,demographic features and distribution of different clinical types of spontaneous decrease of HBV DNA were investigated with clinical epidemiological study in 315 CHB or live cirrhosis (LC) patients.The correlative factors of spontaneous decrease of HBV DNA were analyzed by Logistic regression methods.Results Among the 315 patients,171 patients (54.3%) underwent spontaneous decrease of HBV DNA within 12 weeks,of which 61 patients (19.4%) had undeteetable HBV DNA (＜3 lg copy/mL).The stratified study showed that the incidence of spontaneous decrease of HBV DNA in young patients was 58.6% (116/198 cases),which was higher than that (25.0%,2/8 cases) in juvenile patients (X2 = 2.956,P=0.048).The incidence of decrease in relatively more severe patients was higher than that in relatively less severe patients (all X2 in significant groups＞3.84,all P＜0.05),and the highest incidence was 78.7% (48/61 cases) in patients with chronic severe hepatitis B.The incidence of spontaneous decrease of HBV DNA in hepatitis E virus (HEV)/HBV coinfected patients was 75.0% (21/28 cases),which was higher than that (51.8%,146/282 cases) in single HBV-infected patients (X2 =5.530,P=0.019).The incidence of spontaneous decrease of HBV DNA in patients with alanire aminotransferase (ALT)＞400 U/L was 61.8%(102/165 cases),which was higher than that (46.0%,69/150 cases) in patients with ALT≤400 U/L (X2 =7.922,P=0.005).The incidence of spontaneous decrease of HBV DNA in patients with TBil＞200 μmol/L was 68.7% (79/115 cases),which was higher than that (46.0%,92/200 cases) in patients with TBil≤200 μmol/L (X2 = 15.155,P=0.000).The multivariate Logistic analysis demonstrated that chronic severe hepatitis B,ALT＞ 400 U/L and TBil＞ 200 μmol/L were the correlative factors with spontaneous decrease of HBV DNA in CHB or LC patients (all OR＞1,all P＜0.05).Conclusions The spontaneous decrease of HBV DNA level is a common phenomenon during the natural course (immune clearance phase) of CHB or LC patients.Patients with sever conditions,elevated levels of ALT and total bilirubin (TBil) tend to develop spontaneous decrease of HBV DNA.

Objective To investigate pathogenic bacteria distribution and its effect on the expression of apoptosis protein in patients with acute cerebral infarction (ACI) complicated with pulmonary infection. Methods A retrospective analysis was conducted. From January 2014 to October 2017, the clinical data of 178 patients suffered from ACI hospitalized in Department of Neuromedical Center of Affiliated Hospital of the Chinese People's Armed Police Force Logistics Academy were collected, including 86 cases with ACI complicated with pulmonary infection selected as the observation group, and 92 cases with ACI without pulmonary infection assigned in the control group. The identification and classification of pathogenic bacteria were carried out by using the French BioMieux microorganism fully automatic identification instrument; the contents of serum interleukins (IL-8, IL-17), soluble intercellular adhesion molecule-1 (sICAM-1) and B type lymphocyte tumor-2 related X protein (Bax), B lymphocyte tumor-2 protein (Bcl-2) in two groups were detected by enzyme-linked immunosorbent assay (ELISA). Pearson correlation analysis was used to observe the correlations between sICAM-1 and Bax, Bcl-2 protein expression. Results From the bacterial cultures of 86 patients with ACI complicated with pulmonary infection, 86 strains of pathogenic bacteria were isolated, including 41 strains of gram positive (G+) bacteria (47.67%), mainly Staphylococcus aureus (25.58%); 37 strains of gram negative (G-) bacteria (43.02%), mainly Acinetobacter baumannii (11.63%); 8 strains of fungi (9.30%). The serum levels of IL-8 (μg/L: 0.72±0.15 vs. 0.68±0.09), IL-17 (μg/L: 9.31±3.58 vs. 8.12±2.76), sICAM-1 (ng/L: 421.36±39.74 vs. 385.13±28.59) and Bax (μg/L: 4.52±0.47 vs. 3.86±0.34) in the observation group were significantly higher than those in the control group, while the level of Bcl-2 in the observation group was significantly lower than that in the control group (μg/L: 0.84±0.26 vs. 1.13±0.31), all the differences were statistically significant (all P ＜ 0.05). In the observation group, sICAM-1 was significantly positively correlated with Bax protein (r = 0.401, P ＜ 0.001), while sICAM-1 was significantly negatively correlated with Bcl-2 (r = -0.447, P ＜ 0.001). Conclusion The pathogenic bacteria of ACI patients complicated with pulmonary infection is mainly G+bacteria, the infection can induce elevation of serum pro-inflammatory factors and sICAM-1 levels in the patients, and the mechanisms may be related to the up-regulation of Bax protein expression and down-regulation of Bcl-2 protein expression.

Objective: To investigate the effect of skin soft tissue expansion on repair of large area of scars on extremities. Methods: Twenty-five patients with large area of scars on extremities were admitted to our department from June 2007 to October 2014. There were 14 males and 11 females, aged 4 to 36 years. Operations were performed under local infiltration anesthesia or general anesthesia. In the first stage, 1 to 5 cylindrical expanders with capacities of 250 to 600 mL were placed at left or right sides or at upper or lower parts of the scars. In the second stage, scars of 21 patients were repaired with expanded transverse propulsive and lateral flaps, and scars of 4 patients were repaired with expanded perforator flaps whose pedicles were perforators of brachial artery, superior ulnar collateral artery, or posterior interosseous artery according to areas and shapes of the scars. The secondary wound areas ranged from 13 cm×7 cm to 34 cm×18 cm after dissolution or excision of scars. The areas of flaps ranged from 13 cm×7 cm to 20 cm×12 cm. The donor sites were sutured directly. The flaps after operation and follow-up of patients were observed and recorded. Results: All expanded flaps survived after operation. And the superficial distal part of flap whose pedicle was perforator of posterior interosseous artery in one patient was with necrosis, and other flaps survived well. During follow-up of 3 to 15 months after operation of the second stage, color and texture of flaps were similar to surrounding skin, while extremities of donor sites were thinner and auxiliary incisional scars formed after expansion. Conclusions Expanded flap is a good way to repair large area of scar on extremities. Bilateral skin of scar is the first choice of donor site of expanded flap. If there isn′t enough skin for expanding on bilateral sides, expanded perforator flap designed at upper or lower part of the scar is another choice to repair the scar.

Objective To investigate whether Wnt/β-catenin signaling pathway mediating the neuroprotection of isoflurane post-conditioning in hippocampal neurons damage induced by ischemia/reperfusion injury in rats.Methods According to the randomized principle, 60 male Sprague-Dawley rats were randomly divided into five groups (12 rats in each group):sham group (group S), model group (group M), ISO+model group (group MI), ISO+model+DKK-1 group (group MDI) and model+DKK-1 group (group MD).A rat model of middle cerebral artery occlusion (MCAO) was established with 90 min ischemia followed by 24 hreperfusion.Group S was only exposed to one side of the internal carotid artery without fishing line.Isoflurane post-conditioning groups (group MI, MDI) were immediately treated with 1.5％isoflurane for 60 min at the onset of reperfusion.DKK-1 (5μg/kg) was injected intracerebroventricularly 30 min before the model established in group MDI and group MD.After reperfusion for 24 h, Longa score method was used for neurological deficit score.HE staining and Tunel fluorescence was employed to observe the morphological changes of neurons.Immunohistochemistry and Western Blot were applied to detect the expression of target protein in CA1 region.Results Compared with group S, the neurobehavioral score, the number of apoptosis and the expression of Bax and GSK-3βprotein in group M all increased (P<0.05), while the expression ofβ-catenin and Bcl-2/Bax ratio decreased (P<0.05) ;Compared with group M, the neurobehavioral score, the number of apoptosis and the expression of Bax protein were significantly decreased (P<0.05), while the expression of Bcl-2, β-catenin protein and the Bcl-2/Bax ratio were significantly increased (P<0.05) in group MI.Compared with group MI, the neurobehavioral score, the number of apoptosis, Bax and GSK-3βprotein in group MDI were significantly increased (P<0.05), while the Bcl-2, β-catenin protein expression, and Bcl-2/Bax ratio were significantly decreased (P<0.05).Conclusion Isoflurane post-conditioning may protect the hippocampus neurons against cerebral ischemic reperfusion-induced damage via the way that the Wnt/β-catenin signaling pathway regulates the expression levels of Bcl-2 and Bax proteins in rats.

Objective:To investigate the clinical manifestations and pathogenic gene mutation sites of familial cavernous hemangioma by a pedigree study of this disease.Methods:A family of cerebral cavernous hemangioma who was admitted to the Department of Neurology of the First Affiliated Hospital of Henan University of Science and Technology in April 2019 was diagnosed as cerebral cavernous hemangioma type 1 based on clinical manifestations and head magnetic resonance imaging (MRI), diffusion weighted imaging and susceptibility weighted imaging screening. According to Zabramski classification criteria, the family′s clinical data were collected and genes were sequenced.Results:A 58-year-old female proband had dizziness and headache as the main symptoms, her daughter and son had no clinical symptoms, and her granddaughter had clinical manifestations of cerebral hemorrhage and seizures. The proband and her family members showed multiple cavernous hemangioma on cranial MRI,and the p.L436fs mutation in the KRIT1 gene of familial cerebral cavernous malformation type 1 was confirmed through genetic examination, which was consistent with the Zabramski typing results based on head MRI. The mutation site of the familial spongiform malformation type 1 pathogenic gene was found to be p.L436fs in KRIT1 gene, which has not been reported in familial cerebral cavernous hemangioma type 1 until now.Conclusion:A new p.L436fs mutation of KRIT1 gene was found in familial cerebral cavernous malformation type 1, which expands understanding of the clinical manifestations and pathogenic gene mutation sites of familial cavernous hemangioma.

Objective:To explore the value of amide proton transfer-weighted (APTw) imaging and intravoxel incoherent motion (IVIM) imaging for diagnosing and evaluating the pathological differentiation of cervix squamous cell carcinoma (CSCC).Methods:This study was a diagnostic trial. Totally 56 patients pathologically diagnosed with CSCC at the First Hospital of Lanzhou University from October 2021 to October 2022 were retrospectively collected, as the CSCC group. And 36 female healthy volunteers who underwent physical examinations at the First Hospital of Lanzhou University from October 2021 to October 2023 were recruited as the control group. CSCC patients were divided into well-moderately differentiated ( n=34) and poorly differentiated groups ( n=22). The region of interest was placed in the lesions of CSCC group and normal cervical stroma of control group, and the quantitative parameters for asymmetric magnetization transfer ratio (MTR asym) of APTw imaging and pure diffusion coefficient (D), false diffusion coefficient (D *) and perfusion fraction (f) for IVIM were obtained. The independent sample t test was used to compare the differences in quantitative parameters between the two groups, the logistic regression model was used to establish combined parameters for the quantitative parameters with statistical significance between the two groups. The receiver operator characteristic curve was used to evaluate the diagnostic efficacy of single quantitative parameters and combined parameters to distinguish the CSCC group from the control group, and the well-moderately differentiated group from the poorly differentiated group in CSCC patients. The area under the curve (AUC) was compared using the DeLong test. Results:There were significant differences in MTR asym, D and f between CSCC group and control group ( t=-9.79, 10.09, 11.35, P<0.001). Also, significant differences were found for MTR asym and D between the well-moderately differentiated and poorly differentiated group ( t=4.11, -3.76, P<0.001). There was no significant difference in other quantitative parameters ( P>0.05). When comparing the CSCC group and control group, the AUC (95% CI) of MTR asym, D, f and combined parameter (MTR asym+D+f) were 0.887 (0.804-0.944), 0.940 (0.871-0.979), 0.968 (0.909-0.993), 0.995 (0.950-1.000). The AUC of the combined parameter was higher than those of MTR asym and D, with statistical significance ( Z=3.07, 2.06, P=0.002, 0.040). When comparing the well-moderately differentiated and poorly differentiated group, the AUC (95% CI) of MTR asym, D, and combined parameter (MTR asym+D) were 0.789 (0.660-0.887), 0.775 (0.644-0.876), 0.852 (0.731-0.932). There was no significant difference between each two AUCs ( P>0.05). Conclusion:The quantitative parameters of APTw and IVIM imaging can be used to diagnose and preliminarily evaluate the pathological differentiation of CSCC. Joint parameters can improve the diagnostic efficiency of CSCC.

Objective To identify the etiology of the first local dengue infection outbreak in Hubei Province in 2019, and to determine the serotype and genotype of the virus and trace its source. Methods Serum samples were collected from dengue fever cases in the acute phase. The IgM and IgG antibodies were detected by enzyme-linked immunosorbent assay (ELISA)，and the serotype was determined by fluorescence quantitative PCR. C6/36 cells were used to isolate virus and obtain virus E gene and complete genome sequence for systematic evolution analysis to trace the possible source of infection. Results The pathogen of the outbreak was identified as dengue serotype I infection，and five virus strains were isolated. Sequence analysis showed that the virus belonged to genotype I of dengue I, and had the highest homology with the strain isolated in Guangzhou, 2019. Conclusion The first local dengue infection outbreak in Hubei Province in 2019 was caused by genotype I of the type I dengue virus.

Objective:To investigate the differences of white matter diffusion properties between vulnerable and resistant individuals to continuous attention after sleep deprivation.Methods:According to the psychomotor vigilance test performance before and after sleep deprivation, the participants were divided into the vulnerable group( n=24) and resistant group( n=25). All participants underwent diffusion tensor imaging (DTI) scans.Tract based spatial statistics(TBSS) was used to compare fractional anisotropy(FA), mean diffusivity(MD), axial diffusivity(AD), radial diffusivity(RD) maps between the two groups.Spearman correlation analysis was conducted by SPSS 24.0 to investigate the relationships between the altered DTI metrics and PVT task performance. Results:(1) Compared with resistant group, FA value of vulnerable group decreased in the body of corpus callosum(x, y, z=-8, 9, 25, t=-7.855), right superior longitudinal fasciculus(x, y, z=-39, -7, 26, t=-6.252), bilateral anterior limb of internal capsule(x, y, z=-13, 8, 13, t=-5.235; x, y, z=12, 8, 3, t=-5.024) and right posterior thalamic radiation(x, y, z=-26, -56, 17, t=-5.469)(TFCE corrected, P<0.05, cluster size≥50 voxel). (2) Compared with resistant group, MD value of vulnerable group increased in the body of corpus callosum(x, y, z=-3, -6, 26, t=7.613), right superior longitudinal fasciculus(x, y, z=-31, -19, 38, t=5.314), bilateral anterior limb of internal capsule(x, y, z=-16, 7, 8, t=6.898; x, y, z=15, 5, 7, t=6.652), splenium of corpus callosum(x, y, z=27, -53, 17, t=6.541), and AD value increased in the right superior longitudinal fasciculus(x, y, z=-33, -19, 39, t=4.892), splenium of corpus callosum(x, y, z=-22, -49, 21, t=5.450), genu of corpus callosum(x, y, z=4, 26, 0, t=4.332), as well as RD value increased in the right superior corona radiata(x, y, z=-17, 1, 33, t=7.558), body of corpus callosum(x, y, z=4, -8, 26, t=6.699), right anterior limb of internal capsule(x, y, z=-12, 7, 3, t=5.212) (TFCE corrected, P<0.05, cluster size≥50 voxel). (3) Correlational analysis revealed that the negative correlations were found between PVT task performance and the FA value in the right superior longitudinal fasciculus( r=-0.492, P<0.001), right anterior limb of internal capsule( r=-0.510, P<0.001), right posterior thalamic radiation( r=-0.502, P<0.001) and body of corpus callosum( r=-0.464, P<0.001). The positive correlations were found between PVT task performance and the MD value in the body of corpus callosum( r=0.500, P<0.001), right superior longitudinal fasciculus( r=0.499, P<0.001), splenium of corpus callosum( r=0.462, P<0.001), right anterior limb of internal capsule( r=0.471, P<0.001), and AD value in right superior longitudinal fasciculus( r=0.643, P<0.001), as well as RD value in right superior corona radiate( r=0.498, P<0.001) (Bonferroni corrected, P<0.003). Conclusion:Differences in the microstructural characteristics of white matter fiber tracts in specific brain regions may constitute the potential neuropathological basis for the phenotypes of vulnerable and resistant individuals to continuous attention after sleep deprivation.

Objective:To explore the methodology of the evidence-based expert consensus formulation process of traditional Chinese medicine(TCM)nursing taking stroke as an example.Methods:First,preliminary and comprehensive presentation of all stroke-related symptoms and corre-sponding TCM nursing techniques involved were revealed through bibliometric analysis.Then,selection of stroke symptoms and TCM nursing techniques for inclusion in the consensus was performed using an expert consultation method.Next,we determined the search strategy for a precise evidence search;conducted an evaluation of evidence quality and the grade of the evidence;and completed evidence extraction,evidence analysis,and evidence synthesis based on the included symptoms and TCM nursing techniques.The Delphi method was then applied to determine the strength of each recommendation and the choice of nursing care points by referring to the Grading of Recommendations,Assessment,Devel-opment,and Evaluations grid.Finally,we conducted an external expert validation of the Delphi results to form an expert consensus guideline.Results:Through the bibliometric analysis,22 stroke symptoms and 18 TCM nursing techniques were identified in the literature.Then,after expert consultation,22 symptoms and 111 pairs of symptoms combined with TCM nursing techniques were selected for the evidence search.Evidence integration yielded 10 stroke symptoms corresponding to 29 bodies of evidence;these 10 symptoms were retained through the Delphi consultation,and recommendation strength results for 26 recommendations were obtained.A total of 9 symptoms were further retained for expert external validation to form 24 rec-ommendations,with a recommendation process score range of 7.64-9.99 points and a more scientific and standardized recommendation-formation process.Conclusion:Owing to the current limited conditions of evidence-based resources for TCM nursing,the present consensus-building process represents only a preliminary exploration of an evidence-based expert consensus for TCM nursing to provide a reference for a more scientific and standardized methodology.