Hepatitis B virus (HBV) infection causes pathological changes of the liver,including liver inflammation,hepatocyte necrosis,and even liver fibrosis,and promotes the progression from chronic hepatitis to liver cirrhosis and liver cancer,but related mechanisms remain unclear.The mechanism for the interaction between hepatocytes infected by HBV and uninfected hepatocytes/host immune system might be exosomes-mediated cell-cell communication in liver microenvironment.Many studies have demonstrated that viral infection can regulate the production of exosomes and affect their composition,and viral microRNAs,proteins,and even the entire virion can be incorporated into the exosomes,which can affect the immune recognition of viruses or regulate the function of adjacent cells.This article elaborates on the production and composition of exosomes and their roles in viral infection,as well as the research advances in the association between exosomes and HBV infection.

Objective To study the influence of mobile management software education to the young and middle-aged type 2 diabetes patients′ knowledge and behavior. Methods 130 cases of diabetes patients was selected in 2015.10 to 2016.04 which came from the endocrine ward of the center hospital of Dalian ,68 males and 62 females.63 cases were divided into experimental group and 67 cases in control group, according to the random number table method. The control group was given the regular out-of- hospital management mode, and the experimental group was managed by the diabetes mobile management software. Six months after the intervention, the effects of two groups on blood glucose, metabolic index, diabetes knowledge, self-management efficacy and self-management behavior were observed. Results There was no significant difference in fasting blood glucose, postprandial 2 h bloodglucose and glycosylated hemoglobin between the two groups before the intervention (P > 0.05).After intervention for three months, the date in control group respectively (8.81 ± 2.02) mmol/L, (12.44 ± 2.53) mmol/L, (8.41±1.40)%. experimental group respectively (7.91±2.29) mmol/L, (10.65±2.87) mmol/L, (7.83± 1.25)%. The difference was statistically significant (t=2.320, 3.691, 2.416, P < 0.05 or 0.01). After intervention for six months, these numbers in control group were (7.96±1.79)mmol/L,(10.61±2.12) mmol/L,(7.85±1.24)%. The experimental group were (7.00±2.00) mmol/L, (8.93±2.16) mmol/L, (7.20±1.25)%. The difference was statistically significant(t=2.805, 4.368, 2.914, P < 0.01).Compared the related knowledge scores (Good, general, poor) before intervention ,the difference was not statistically significant (P>0.05).After 3 months of intervention, the cases in control group was 5, 57 ,1 respectively, the experimental group were 15,46,0 respectively. After 6 months intervention, the control group was 40, 32, 0. The experimental group were 48, 14, 0. After 3 months and 6 months intervention. There was significant difference between the two groups, (Z=2.637, 2.055, P<0.01 or 0.05). scores of diabetes mellitus (high level, medium level, low level)in the two groups was no significant difference (P > 0.05), before the intervention. After 3 months intervention ,cases in control group were 49,131respectively, the experimental group were 54,5,0 , after 6 months intervention ,control group were 59,4,0 ,respectively , the experimental group were 61,0,0. After 3 months and 6 months intervention, there was significant difference between the two groups (Z=2.103, 1.992,P<0.05). Diabetes self- management effectiveness score(good, moderate, poor) was compared in two groups. There was no significant difference between the two groups before and after 3 months intervention (P>0.05). After 6 months of intervention, cases in the control group was 9,54,0,respectively, the experimental group were 43, 18, 0, the difference was statistically significant (Z = 6.315, P < 0.01). Conclusions The education model of diabetes mobile management software can help to improve the standard rate of glucose and other metabolic indexes, at the same time also improve the level of knowledge and behavior of middle-aged and young patients with type 2 diabetes, but it′s long-term effect needs further study.

Objective To explore the effects of rural family nursing intervention on psychological status of patients with cerebral apoplexy hemiplegia.Methods This community area was randomly divided into the intervention group and the control group, and 42 stroke patients with hemiplegia were randomly selected in each group. Patients in the intervention group were given family rehabilitation nursing intervention for 12 months by community nurses who received training and evaluation, while patients in the control group received original care mode, regular blood pressure measure, and routine follow up. Patients' psychological status before and after intervention were investigated.Results After 12 months' family rehabilitation nursing intervention, the psychological status of patients in the intervention group was significantly improved, and the differences between two groups were statistically significant (P<0.01).Conclusions Rural family rehabilitation nursing intervention can significantly improve the psychological status of patients with stroke, promote patients' recovery, and improve the quality of life of patients.

Objective To scale the frequencise of medical X-ray diagnosis based on the survey conducted in 58 hospitals to the all hospitals in Henan province,in order to make them available for providing the basis for reasonable application of diagnostic radiology.Methods Stratified sampling method was used to select medical institutions at different levels in 6 cities in the province as sample hospitals.The information of examined patients on sex,age,diagnostic type and exposure category were gathered and the results were analyzed.Results The sex ratio of male and female examined patients was close to 1∶1.The largest proportion,60.47％,of examined patients was from the age group of above 40 years old among the three age groups.Medical diagnositc medical X-ray examinations mainly include conventional X-ray photography and CT examination,accounting for 52.15％ and 40.31％,respectively.Chest examination contributed the largest propotions,23.84％,of conventional diagnositic X-ray examination and,13.25％,of CT examination respectively.CT examinations were mainly concentrated in the secondary and tertiary hospitals,accounting for 21.54％ and 72.99％ of the total CT examinations,respectively.Contrast examination,mammography and extracorporeal lithotripsy were concentrated in the tertiary hospitals,accounting for 77.82％,95.01％ and 100％ of the same type of examinations,respectively.Conventional photographic examinations were mainly conducted in primary hospitals,accounting for 74.56％ of all types of examinations in the primary hospitals.By using multiple linear regression model,the diagnostic examination frequency in 2016 was estimated to be 826 examinations per 1 000 population,of which the frequency of dianostic X-ray examination and CT examination were 541 per 1 000 and 285 per 1 000,respectively.Conclusions The frequency of diagnostic radiology in Henan has increased rapidly in recent years.All types of diagnostic radiology equipment are unevenly distributed in hospitals at different levels which posed a challenge for health care.Relevant departments should make efforts to reallocation of diagnostic radiology equipment in such hospitals and make utilization of health resources more reasonable.

The clinical data and the genetic study results of a patient with Liddle syndrome were reported.The genomic DNA of peripheral blood mononuclear cells was extracted and the mutation sites of all the exons in 36 genes related to hypokalemia were screened by high-throughput sequencing.Genetic validation of patients and their parents was performed by direct sequencing.The patient presented with severe hypokalemia,low aldosterone and hypertension.The results of gene sequencing showed that the SCNN1B gene exon 13 584 codon 1751C-T,and the corresponding encoded amino acid changed from alanine to valine (A-V).Eleven families and 33 cases of Liddle syndrome diagnosed by genetic analysis were reported in Chinese literature from 1998 to June 2018.The literature review showed that all patients had hypertension,87％ (28/32) had hypokalemia and 85％ (23/27) had low aldosterone.The onset age of 21 patients was＜20 year,among whom cerebral stroke occurred in 3 patients.The normal blood pressure can be achieved by low-salt diet and administration of amiloride or triamterene.The most common mutations were missense mutations (7/11).Liddle syndrome is a controllable and treatable disease,early detection,diagnosis and treatment can avoid serious complications.

Objective:To analyze the distribution of clopidogrel metabolism-related gene variability in Kawasaki disease (KD) children with coronary artery lesions (CAL) across different age groups and the impact of genetic variability on the efficacy of clopidogrel antiplatelet therapy.Methods:A retrospective cohort study was conducted. Clinical data were collected from 46 KD children with CAL who were hospitalized in the Cardiovascular Center of Children′s Hospital of Fudan University between January 2021 and August 2022 and were treated with clopidogrel, including gender, age, body mass index, course of KD, CAL severity grade, and baseline platelet count. According to their age, the children were divided into ≥2-year-old group and <2-year-old group. Their platelet responsiveness was assessed by adenosine diphosphate-induced platelet inhibition rate (ADPi) calculated via thromboelastography, and children were categorized into high on-treatment platelet reactivity (HTPR) and normal on-treatment platelet reactivity (NTPR) groups. Genotypes of CYP2C19, PON1 and ABCB1 were detected. The t test, one-way analysis of variance and Chi-square test were used for intergroup comparison. Results:Among the 46 KD children with CAL, 34 were male and 12 were female; 37 were ≥2-year-old and 9 were <2-year-old; 25 cases were in the HTPR group and 21 cases were in the NTPR group, with 19 HTPR and 18 NTPR in the ≥2-year-old group, and 6 HTPR and 3 NTPR in the <2-year-old group. Genetic analysis showed that 92 alleles among the 46 children, with frequencies of CYP2C19*1, CYP2C19*2, CYP2C19*3, CYP2C19*17, PON1 192Q, PON1 192R, ABCB1 3435C, ABCB1 3435T at 59% (54/92), 32% (29/92), 9% (8/92), 1% (1/92), 36% (36/92), 64% (59/92), 63% (58/92) and 37% (34/92), respectively. Analysis of the impact of genotype on ADPi revealed that in children aged ≥2 years, those with CYP2C19*1/*3 genotype had significantly lower ADPi than those with CYP2C19*1/*1 genotype ((34±15)% vs. (61±29)%, t=2.18, P=0.036). There were also no significant difference in ADPi among children with PON1 192Q homozygous, PON1 192R heterozygote and PON1 192R homozygous genotypes ((40±22)% vs. (52±33)% vs. (65±27)%, F=2.17, P=0.130), or among those with ABCB1 3435C homozygous, ABCB1 3435T heterozygote and ABCB1 3435T homozygous genotypes ((55±34)% vs. (60±27)% vs. (49±24)%, F=0.33, P=0.719). In <2-year-old group, there were no significant differences in ADPi across CYP2C19*1/*1, CYP2C19*1/*2 and CYP2C19*2*2 genotypes ((40±20)% vs. (53±37)% vs. (34±16)%, F=0.37, P>0.05). There were no significant differences in ADPi across CYP2C19*1/*1 and CYP2C19*1/*3 genotypes ((44±27)% vs. (42±20)%, t=0.08, P>0.05). There were no significant differences in ADPi across PON1 192Q homozygous, PON1 192R heterozygote and PON1 192R homozygous genotypes (45% vs. (55±27)% vs. (24±5)%, F=1.83, P>0.05). There were no significant differences in ADPi across ABCB1 3435C homozygous, ABCB1 3435T heterozygote and ABCB1 3435T homozygous genotypes ((36±16)% vs. (50±35)% vs. 45%, F=0.29, P>0.05). The risk analysis of HTPR in different genotypes revealed that in children aged ≥2 years, carrying at least 1 or 2 loss-of-function alleles of CYP2C19 was a risk factor for HTPR ( OR=4.69, 10.00, 95% CI 1.11-19.83, 0.84-119.32, P=0.033, 0.046, respectively), and PON1 192R homozygosity and carrying at least one PON1 192R allele were protective factors against HTPR ( OR=0.08, 0.13, 95% CI 0.01-0.86, 0.01-1.19, P=0.019, 0.043, respectively). Conclusion:KD children aged ≥2 years carrying CYP2C19 loss-of-function alleles and PON1 192Q are more likely to develop HTPR.