Objective To study programmed death-1 (PD-1) and T-cell immunoglobulin mucin3 (Tim-3) co-expression on peripheral blood mononuclear cells (PBMC) and hepatitis B virus (HBV)-specific CD8+ T cells in patients with chronic HBV infection and its correlation with liver inflammatory activities.Methods One hundred and sixty subjects with chronic HBV infection who visited the outpatient and inpatient Department of Infectious Diseases in the Third Affiliated Hospital of Sun Yatsen University were enrolled,including 63 cases of mild or moderate CHB (MCHB),31 of severe CHB (SCHB),55 of acute-on-chronic liver failure (ACLF) and 11 inactive HBsAg carriers.Twenty healthy subjects were enrolled as controls.Real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect HBV DNA,enzyme-linked immunosorbent assay (ELISA) to measure HBV serological markers,and flow cytometry to detect human leukocyte antigen (HLA)-A2 and determine the expression of PD-1 and Tim-3 on PBMC and HBV-specific CD8+ T cells.Cell counts of Tim-3+,PD-1+,and Tim-3+/PD1+ PBMC and HBV-specific CD8+ T cells were compared among different groups,and their correlation with commonly used inflammatory activity indicators were studied.Analysis of variance and Kruskal-Wallis test were used for measurement data with gaussian distribution and skewed distribution,respectively.Spearman correlation analysis was used to assess the association between Tim-3/PD-1 expression and inflammatory activity indicators.Results The frequency of Tim-3+/PD-1+ PBMC was 0.25 ％ in ACLF group (P=0.0049),0.24 ％ in SCHB group (P-0.0025) and 0.13％ in MCHB group (P=0.0006),which were significantly higher than that in control group (0.03％),and the frequency of Tim-3 /PD-1-PBMC in the three groups were significantly lower than that in control group (P =0.0000),but the differences between HBsAg carriers (0.10％) and controls (0.03％) were not statistically significant (P=0.28).Among 160 subjects,78 were HLA-A2 positive.The frequency of Tim-3+/PD-1+ HBV-specific CD8+ T cells was 68.72％±17.21％ in ACLF group,and 59.66％± 19.25％ in SCHB group,which were significantly higher than that in HBsAg carrier group (33.93％ ± 10.80％,P=0.0000,P=0.0054).The frequency of Tim-3 /PD-1-HBV-specific CD8+ T cells in ACLF group was 2.80％,which was significantly lower than that in HBsAg carrier group (27.24％,P=0.0004).The frequency of Tim3+/PD-1+ HBV-specific CD8+ T cells was positively correlated with alanine aminotransferase (r=0.26,P=0.022),aspartate aminotransferase (r=0.28,P=0.012) and total bilirubin levels (r=0.36,P=0.001); and inversely correlated with albumin level (r=-0.35,P=0.002) in serum.Furthermore,it was positively correlated with international normalized ratio (INR,r=0.34,P =0.045) and model for end-stage liver disease score (r=0.43,P=0.027) in ACLF group.Conclusions Co-expressions of Tim-3 and PD-1 on PBMC and HBV-specific CD8+ T cells are significantly upregulated in patients with CHB,and correlated with liver inflammatory activities.These findings indicate that Tim-3 and PD-1 co-expression may involve in disease activity and liver failure in CHB.

Objective:To investigate a potential role of Toll-like receptor 4(TLR4) ,a pathogen pattern recognition receptor, in the early phase of severely burned rats. Methods: Rats burn model(30% of total body surface area[TBSA],Ⅲgrade) were established with vapor at 108 C for 8 seconds. Rats were sacrificed before and 2,5,12,24,48 and 72 h after burning, and the spleen specimens and peripheral blood samples were harvested. TLR4 mRNA and TNF-?mRNA expression in splenocyte was measured by reverse-transcription PCR(RT-PCR); the expression of TLR4 protein were measured by Western bloting; the endothelial toxicity concentration in plasma was detected by limulus lysate test. Results: It was found that the expression of TLR4 mRNA.TNF-?mRNA,TLR4 protein,and the level of ET were significantly increased in burned group compared with normal control group. The expression of TLR4 mRNA and protein peaked at 8 h after burning, the expession of TNF-?mRNA peaked at 12 h.and the level of ET peaked at 8 h after burnings the peak values of them were (3. 66?0. 51),(2. 27?0. 19), (1.65?0. 23),and (11. 68?2. 63) Eu/ml, respectively, all significantly higher than those of the control group(P

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 investigate the susceptibility of bone marrow mesenchymal stem cell (BMSC) to hepatitis B virus (HBV) infection during induction toward hepatocyte and the role of asialoglycoprotein receptor (ASGPR) in BMSC HBV infection. Methods BMSC obtained from hepatitis B patients were tested for HBV infection and then cultured with HBV infectious serum in vitro and induced to differentiate into hepatocyte through exposure to hepatocyte growth factor (HGF), fibroblast growth factor-4(FGF-4), and epidermal growth factor(EGF). Subsequently these cells were determined for the presence of hepatitis B virus e antigen( HBeAg), hepatitis B virus surface antigen(HBsAg) and ASGPR. All experiments were repeated for 3 times in 5 different samples. The results were analyzed by non-parametric test. Results After 6 days of exposure, BMSC-derived hepatocyte-like cells expressed hepatic special genes and proteins, including alpha fetoprotein(AFP),cytokeratin18 (CK18), albumin (Alb), and manifested hepatocyte functions, including glycogen synthesis, urea secretion and albumin synthesis. Expressions of CK18 and Alb were increased, and AFP was decreased with time of induction. The BMSC were resistant to HBV infection both in vitro and in vivo or after induction toward hepatocyte. ASGPR expression level was low in BMSC, which was increased in the induced BMSC but still lower than that of the control HepG2 cells. Conclusions BMSC are resistant to HBV infection both in vitro and in vivo. The low level expression of ASGPR may be a reason for this.

Objective To evaluate the therapeutic efficacy and its related factors of entecavir treatment for patients with acute on chronic hepatitis B liver failure (ACHBLF).Methods One hundred and eight patients with ACHBLF were enrolled and divided into entecavir group (n=53) and control group (n=55).HBV DNA level, liver function and 48-week survival rate were observed, and C ox regression model was established to identify the factors which may affect the efficacy of entecavir treatment.Results Totally 70 patients died in the study and 66 died within 12 weeks.The statistical difference on cumulative survival rate between two groups was observed from the third week on (χ2=5.357, P ＜ 0.05).The 48-weekcumulative survival rate in entecavir group was 47.2% (25/53), while that in the control group was 23.6%(13/55) (χ2=7.432, P ＜ 0.01).In entecavir group, for patients aged ＜ 40 with serum bilirubin level ＜513 μnol/L and international normalized ratio (INR) ＜ 2.5, the fatality rates decreased 74.9%, 75.3%and 76.0%, respectively.Conclusions Entecavir may improve the survival rate of patients with ACHBLF.Age, serum bilirubin level and INR are major factors related to the therapeutic efficacy.

Objective To investigate the balance of Th1/Th2 cytokines and its relationship with prognosis of severe chronic hepatitis B ( CHB ). Methods Peripheral blood samples were collected from 112 severe CHB patients, 30 CHB patients and 30 healthy controls. IL-4, IFN-γ levels and HBV DNA loads were measured by ELISA and fluorescent PCR, respectively. The levels of cytokines in different stages, and their correlations with HBV DNA loads and short-term prognosis were analyzed. Results Higher levels of IL-4, IFN-γ and Th1/Th2 ratios in peripheral blood were detected in patients with severe CHB than those with CHB and the healthy controls (Z = 8.968, 10. 004 and 26. 067, P =0. 009, 0. 007 and 0. 000). IL4 levels in patients with end-stage server CHB were markedly higher than those in other stages ( Z = 3. 672 and 3. 158, P= 0.000 and 0.002), while their Thl/Th2 ratios were lower (Z=3. 161 and 2. 166, P=0.002 and 0. 030). No significant differences on levels of IL-4, IFN-γ and Th1/Th2 ratios were observed in severe CHB patients with different HBV DNA levels (Z =4.431, 2.626 and 0. 140, P =0.219, 0.403 and 0. 987). Elevated IL-4 was closely correlated with the high case-fatality rate within 12 weeks. Conclusions The balance between Th1 and Th2 cytokines is- disturbed in patients with severe CHB. Thl/Th2 ratio decreases with the aggravation of diseases, which may indicate unfavorable short-term prognosis.

Objective To explore the association between interleukin (IL)-28B variation and spontaneous clearance of hepatitis C virus (HCV) infection.MethodsA total of 280 HCV infected patients including 200 chronic hepatitis C (CHC) patients and 80 spontaneous clearance patients of HCV infection were enrolled in the study.The rs8099917 single nucleotide polymorphyism (SNP) of IL-28B gene was detected and the association between IL-28B variation and spontaneous clearance of HCV infection was analyzed.The data were compared using chi square test.ResultsThe genotype frequencies of TT and non TT (TG and GG) of IL-28B rs8099917 between CHC patients and spontaneous clearance patients were not significantly different ( x2 =15.874,P ＜ 0.01 ). The prevalence of TT genotype in the spontaneous clearance group was 86.2％,which was higher than that in CHC group (62.0％).T and G allele frequencies in CHC group were 78.0％ and 22.0％,respectively,and those in spontaneous clearance group were 92.5％ and 7.5％,respectively,which indicated that T allele was dominant in spontaneous clearance patients. The allele frequency of rs8099917 was statistically different between the two groups (P＜0.01).The spontaneous HCV clear rate in rs8099917 TT patients was 2.84 folds of non-TT patients,while the risk of chronicity of non-TT (TG+GG) patients was 1.36 folds of TT patients.Conclusion The IL-28B (rs8099917) TT genotype is associated with spontaneous clearance of HCV infection,which can be an important factor to predict the spontaneous clearance of HCV.

Objective To evaluate the long following-up outcome of the medial gastrocnemius muscle transferring reconstruction the patella tendon after the wide resection of aggressive bone tumors in the proximal tibia. Methods With the 69 patients of the osteogenetic sarcoma in the proximal tibia were treated with the wide resection and reconstruction the patella tendon. After the long following up the knee extensor,function and complications were evaluated. Results With the 69 patients, the 45 survival patients were followed up for the average 68.6 (24-128) months. The local recurrence rate was 8.7%(6/69). The strength of knee extending was in the average of grade 4.2(3.6-5.0), the degree of knee flexion was in the average of 95°(75°-135°), the degree of knee extension was in the average of-2°(0°-12°), the knees of five patients cannot fully extension. The MSTS functional score was in the average of 77% (23.1/30). Conclusion During the limb salvage of the proximal tibial aggressive bone tumors, the medial gastrocnemius muscle transferring reconstruction the patella tendon could offer the knee extension strength; improve the soft tissue coverage and functional results.

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 apply the model for end-stage liver disease(MELD)and the ChildTurcotte-Pugh(CTP)in predicting short-term prognosis of patients with severe chronic hepatitis B,and to evaluate their clinical value.Methods Data of 115 patients with severe chronic hepatitis B were retrospectively analyzed and all patients were divided into survival gnmp and fatal group by survival status at 3rd month of the treatment.The scores of MELD and CTP were obtained.The accuracies of MELD and CTP were evaluated by the receiver operating characteristic(ROC)curve.The difference between two systems was analyzed by Kaplan-Meier survival curve.Results MELD and CTP scores in fatal group were significantly higher than those in the survival group(t=4.891 and 3.949,P＜0.05),and two systems were significantly correlated(γ=0.500,P=0.000).MELD and CTP scores were good for predicting the fatality rate of patients with severe chronic hepatitis B within 3 months(C-statistic:0.765 and 0.834,respectively),and there was no significant difference between the two systems(Z=1.516,P＞0.05).Patients with CTP＜10.5 or MELD＜27.5 had longer survival time(Z:17.88 and 25.28,P=0.000)and higher survival rates(χ2=16.88 and 31.59.P=0.000)than those with CTP＞10.5 or MELD＞27.5.Conclusion MELD and CTP scores have similar predictive valHe for short-term prognosis of patients with severe chronic hepatitis B.and clinical data should be contained to better predict the short-term prognosis.