ObjectiveTo investigate the influence of different virologic responses on long-term survival rate and incidence rate of liver cancer in patients with decompensated hepatitis B cirrhosis. MethodsA total of 378 patients with decompensated hepatitis B cirrhosis who were admitted to The Affiliated Hospital of Xuzhou Medical University from September 2010 to September 2016 were enrolled, and according to whether HBV DNA was continuously undetectable during antiviral therapy, they were divided into sustained virologic response group with 243 patients and non-sustained virologic response group with 135 patients. The patients were stratified according to the application of different antiviral drugs. Baseline data were recorded and the patients were followed up to the occurrence of end events or study endpoint to record death and hepatocellular carcinoma (HCC). The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used to compare survival rates between groups. ResultsCompared with the non-sustained virologic response group, the sustained virologic response group had a significantly lower 5-year cumulative incidence rate of HCC (7.4% vs 19.3%, χ2=10.627, P=0.001) and a significantly higher 5-year transplant-free survival rate (93.4% vs 80.7%, χ2=12.594, P＜0.001). For the sustained virologic response group, there were no significant differences between the entecavir group and the non-entecavir group in the 5-year transplant-free survival rate (94.7% vs 90.2%, χ2=1.122, P=0.290) and the 5-year cumulative incidence rate of liver cancer (6.4 % vs 9.7%, χ2=0.552, P=0.458). For the non-sustained viral response group, there were also no significant differences between the entecavir group and the non-entecavir group in the 5-year transplant-free survival rate (78.4% vs 82.8%, χ2=1.526, P=0.217) and the 5-year cumulative incidence rate of liver cancer (21.5% vs 17.1%, χ2=1.844, P=0.174). ConclusionAntiviral therapy can improve the prognosis of patients with decompensated hepatitis B cirrhosis, and sustained virologic response can reduce the incidence rate of liver cancer and prolong survival time.

Objective:To investigate the level of plasma Betatrophin in pregnant women with gestational diabetes mellitus (GDM) and its correlation with the control of blood glucose.Methods:Forty-five pregnant women with GDM(GDM group) who received regular obstetric examinations in the Huaihua First People′s Hospital from July 2019 to January 2021 and 50 pregnant women with normal glucose tolerance (NGT) (NGT group) during the same period were enrolled in this study. Blood glucose and blood lipid indicators were collected, plasma Betatrophin level was detected, Logistic regression analysis was used to screen the influencing factors of blood glucose control effect, the pregnancy outcome was followed up, the predictive value of Betatrophin level in blood glucose control and pregnancy outcome was evaluated by receiver operating characteristic (ROC) curve.Results:The levels of systolic blood pressure, diastolic blood pressure, fasting plasma glucose (FPG), 2 h postpartum blood glucose (2 h PG), glycosylated hemoglobin (HbA 1c), fasting insulin (FINS), 2 h postprandial insulin (2 h FINS), insulin resistance index (HOMA-IR), low density lipoprotein cholesterin (LDL-C) and plasma Betatrophin in the GDM group were higher than those in the NGT group, and insulin function index (HOMA-β) and high density lipoprotein cholesterin (HDL-C) were lower than those in the NGT group ( P<0.05). Pearson correlation analysis showed that plasma Betatrophin level was positively correlated with HbA 1c and HOMA-IR in pregnant women and the GDM group ( r = 0.310, 0.314, 0.341, 0.333; P<0.05). In the GDM group, 12 patients with poor glucose control, 33 patients with good glucose control, the FPG, HbA 1c, HOMA-IR and plasma Betatrophin levels in poor glucose control patients were higher than those in good glucose control patients, HOMA-β was lower than that in the good glucose control patients: (5.82 ± 0.98)mmol/L vs. (5.04 ± 1.11) mmol/L, (9.78 ± 2.15)% vs. (8.22 ± 1.41)%, 2.71 ± 0.56 vs. 2.24 ± 0.48, (1 345.12 ± 256.32) ng/L vs. (1 165.10 ± 217.41) ng/L, 144.15 ± 22.71 vs. 158.63 ± 20.26, there were statistical differences ( P<0.05). The area under the curve of plasma Betatrophin level to predict the effect of blood glucose control was 0.775. A total of 8 pregnant women with GDM had poor pregnancy outcome, and the area under the curve predicted pregnancy outcome by plasma Betatrophin level was 0.728. Conclusions:The level of plasma Betatrophin in patients with GDM is closely related to the degree of insulin resistance and the effect of blood glucose control, and can provide some reference for clinical evaluation and therapeutic effect prediction.

Objective To evaluate the safety of enhanced recovery after surgery (ERAS) programs in pancreas surgery.Methods A computer search was performed on databases which included the Wanfang,CNKI,VIP,PubMed,Cochrane Library,Embase and Sciencedirect for randomized controlled trials or case-control studies on ERAS programs in pancreatic surgery published between January 1995 and August 2017.Two researchers independently evaluated the quality of the studies which met the inclusion criteria and performed a meta-analysis using the RevMan5.3.5 software.Results Four randomized controlled trials and twenty one case-control studies which included 4 063 patients entered into the meta-analysis.These patients included the ERAS group (n =2 052) and the control group (n =2 011 who underwent traditional perioperative management).Compared with the control group,the ERAS group had a lower postoperative complication rate (OR =0.57,95％ CI:0.45 ～0.71,P ＜0.05),a lower delayed gastric emptying rate (OR =0.46,95％ CI:0.37 ～ 0.59,P ＜ 0.05),a lower abdominal infection rate (OR =0.68,95％ CI:0.53 ～ 0.88,P ＜ 0.05),a shorter hospital stay (WMD =-4.86,95％ CI:-6.10 ～-3.62,P ＜ 0.05)and intensive care stay (WMD =-1.04,95％ CI:-2.01 ～-0.08,P ＜ 0.05).No significant differences existed in the mortality,readmission and postoperative pancreatic fistula rates between the two groups.Conclusion Perioperative implementation of ERAS programs was safe and effective in pancreatic surgery,and decreased postoperative complication rates and promoted recovery.

Obesity is one of the most serious global public health issue. In addition to advocating healthy lifestyle, scientists are devoted to developing healthy and effective ways to tackle obesity. In recent years, vagus nerve stimulation has been revealed to have potential therapeutic effect on obesity, which may be related to regulating endocrine hormones and body metabolism, affecting different nerve functions, regulating inflammatory and immune pathways, adjusting intestinal flora and circadian rhythm, and so on. Current researches focus on percutaneous stimulation(auricular vagus nerve stimulation), subcutaneous stimulation(cervical and abdominal vagus nerve stimulation), and gastrointestinal stimulation(the implantation of vagus nerve stimulation device and vagus nerve blocking device). Growing number of studies have confirmed that these stimulation methods have favorable effects on obesity with less side effects. Moreover, the mechanism of Chinese traditional acupuncture for obesity treatment is similar to that of vagus nerve stimulation. Most of vagus nerve stimulation is conveyed via physical therapy. It is highly feasible and theoretically has few side effects, therefore is easy to be accepted by obese subjects and may become a promising approach for obesity treatment.

Objective:This study was to investigate the expression of long noncoding RNA (lncRNA) KCNQ1OT1 during the differentiation program of human preadipocyte and to look for the changes of its expression in adipose tissue in obese subject, as well as to clarify the correlation between KCNQ1OT1 and obesity, and to provide clues for further understanding the role of lncRNA in the development of obesity.Methods:Quantitative PCR was used to detect the expression of KCNQ1OT1 in human preadipocyte at day 0, 1, 3, 5, 9, and 12 during differentiation program, quantitative PCR was also used to detect KCNQ1OT1 expression in white adipose tissue of obese and normal people, which related to PPIA internal reference gene. Pearson correlation analyses were used to explore the relationships of KCNQ1OT1 with body mass index, triglyceride, and total cholesterol.Results:During differentiation program, the relative expression of KCNQ1OT1 levels at day of 1, 3, 5, 9, and 12 were (25.89±3.10), (24.78±5.58), (15.53±2.11), (6.75±0.71), (4.81±0.84), which showed an upward trend compared with day 0. This difference was significant ( P<0.01), especially in the early stage of differentiation (day 1 and day 3). The relative expression of KCNQ1OT1 in visceral adipose tissue of obese subjects was 0.79±0.05, which was significantly higher than that of normal people ( P<0.01). KCNQ1OT1 was positively correlated with body mass index ( r=0.569, P<0.01), triacylglycerol content ( r=0.489, P<0.05), and total cholesterol content( r=0.591, P<0.01). Conclusion:KCNQ1OT1 expression level, which was up-regulated in adipose tissue from obese subjects, increased during the differentiation program of preadipocytes, and also positively correlated with body mass index and serum triglyceride content. These results suggest that KCNQ1OT1 may be an important regulator of human preadipocyte differentiation and a potential target for prevention and treatment of obesity.

Objective To retrospectively analyze the antimicrobial resistance phenotype and molecular typing characteristics of Salmonella (S.) typhi and S. paratyphi in Jiangsu province from 2012 to 2015. Methods The samples were collected from typhoid and paratyphoid patients in Jiangsu province. The biochemical identification and serotyping were carried out after isolation and culture. Kirby-Bauer (K-B) testing was used to detect the drug susceptibility of the strains. The molecular typing characteristics of S. typhi and S. paratyphi were analyzed by pulsed field gel electrophoresis (PFGE). Results The resistant rates of 134 S. typhi and S. paratyphi A strains to nalidixic acid were highest (61.2%and 86.7%), while the resistant rates to remaining antibiotics were less than 15.0%. Most of S. typhi and S. paratyphi A strains were resistant to only one antibiotic. Multidrug-resistant (MDR) strains of S. typhi and S. paratyphi A accounted for 2.6% and 13.3%respectively. The composition of the all-sensitive strains of S. typhi increased by 44.3%in 2015, at the same time, there were also MDR S. pa ra typhi A strains, which were resistant to 5 and 6 antibiotics. S. paratyphi A could be divided into eight molecular patterns by PFGE, showing that the similarity between the MDR strains and other strains was relatively low. The S. paratyphi A strains with same pattern were resistant to same antibiotics. S. typhi could be divided into 68 molecular patterns by PFGE, with large variability between different patterns. There was no corresponding relationship between the patterns and the drug resistance characteristics. Conclusions The overall antibiotic resistance of S. typhi and S. paratyphi A strains showed a decreasing trend, but the number ofantibiotics to which they were resistant increased. PFGE patterns of S. typhi showed diversity without correspondence to antibiotic characteristics. PFGE patterns of S. paratyphi A were less with correspondence to antibiotic characteristics. We should pay more attention to key patterns in key areas.

Objective: To analyze the epidemiological and molecular characteristics of norovirus outbreaks in schools in Xicheng District of Beijing from 2017 to 2022, so as to provide evidence for the prevention and control of norovirus outbreaks in schools. Methods: Data of norovirus outbreaks in schools in Xicheng District, Beijing during 2017 to 2022 were collected and analyzed by descriptive epidemiological methods. Realtime PCR was used to detect the nucleic acid of group GⅠand GⅡnorovirus, the positive norovirus nucleic acid samples were sent to Beijing Center for Disease Control and Prevention for molecular typing. Results: From 2017 to 2022, 185 norovirus outbreaks were reported in schools in Xicheng District, including 166 cluster outbreaks and 19 outbreaks. A total of 2 044 cases were reported, with a total attack rate of 13.92%. There were two peaks in the outbreak time, which were from March to June after the spring semester and from October to December after autumn semester. Primary schools were the most common place of occurrence (101 cases), followed by nursery institutions (68 cases) and secondary schools (16 cases). There were statistically significant differences in the incidence rates among different sites(12.37%, 22.78%, 8.47%, χ2=263.34, P<0.01). There were significant differences in the incidence of vomiting, diarrhea, nausea and stomachache among different students (χ2=263.33, 90.58, 20.42, 30.29, P<0.01). Vomiting was the main symptom in primary school and nursery school children (96.41%, 98.28%), and the diarrhea rate was higher in middle school students (68.22%). The outbreaks were mainly caused by type GⅡ norovirus. The genotype from 2017 to 2021 showed the characteristics of diversity, mainly GⅡ.2[P16], but there was no significant advantage for the GⅡ.2 [P16] during 2019 to 2021. Conclusions The norovirus outbreak in schools in Xicheng district of Beijing from 2017 to 2022 are mainly caused by GⅡ type genome. The main genotype is GⅡ.2[P16]. Norovirus infection mainly occurred in primary schools and kindergartens. For the vulnerable populations, it is necessary to improve the capacity to early identification, student infectious disease management, active infection control and prevention measures, and pathogen surveillance and sporadic case monitoring.

Objective:To evaluate the efficacy of compatibility of different opioids for postoperative patient-controlled intravenous analgesia (PCIA) in the patients undergoing gastrointestinal surgery.Methods:A total of 6 556 patients undergoing PCIA after gastrointestinal surgery in the first affiliated Hospital of Air Force military Medical University from May 2018 to March 2022 were retrospectively collected and divided into sufentanil plus nalbuphine group (SN group), hydromorphine plus nalbuphine group (HN group) and sufentanil group (S group). In SN, HN and S groups, the PCIA solutions contained sufentanil 100 μg+ nalbuphine 40 mg, hydromorphone 10 mg+ nalbuphine 40 mg, sufentanil 200 μg, respectively, in 100 ml of normal saline, and the PCA pump was set up with a background infusion at a rate of 1 ml/h, bolus dose 0.5 ml, and lockout interval 10 min.The demographic data, the number of patients with insufficient analgesia at rest and during activity (visual analog scale score≥4) at 24 and 48 h after operation, adverse reactions, time to first flatus and first postoperative off-bed time were collected.Results:Compared with S group, the incidence of insufficient analgesia at rest and during activity, dizziness, nausea and vomiting, effective pressing times of PCA and consumption of drugs in the analgesic pump were significantly decreased at 24 and 48 h after operation in HN group and SN group, the incidence of drowsiness was decreased at 24 h after operation, and the time to first flatus and first postoperative off-bed time were shortened in HN group, and the incidence of somnolence was increased at 48 h after operation in SN group ( P<0.05). Compared with SN group, the incidence of insufficient analgesia at rest at 24 and 48 h after operation was significantly increased, the incidence of insufficient analgesia during activity, dizziness, nausea and vomiting, effective pressing times of PCA and consumption of drugs in the analgesic pump were decreased, the incidence of drowsiness was increased at 24 h after operation, the incidence of somnolence was decreased at 48 h after operation, and the time to first flatus and first postoperative off-bed time were shortened in HN group ( P<0.05). Conclusions:Hydromorphine mixed with nalbuphine provides better efficacy than sufentanil mixed with nalbuphine and sufentanil and is helpful in shortening the recovery time of gastrointestinal function when used for postoperative PCIA in the patients undergoing gastrointestinal surgery.

Objective To investigate the epidemiological characteristics of viral diarrhea in children under 5 years old during 2015-2018 in Xicheng District of Beijing, and to provide evidence for prevention and control of viral diarrhea. Methods Fecal specimens from patients under 5 years old were collected from the outpatient clinic of the Children's Diarrhea Surveillance Sentinel Hospital in Xicheng District, Beijing from 2015 to 2018. Real-time fluorescence PCR was used to detect group A rotavirus (RVA), norovirus (NV), and adenovirus (AdV), Astrovirus (AstV). Results A total of 972 fecal specimens were collected, 142 were tested positive for RVA (14.61%), 136 were tested positive for NV (13.99%), 67 were tested positive for AdV (6.89%), and 49 were tested positive for AstV (5.04%). Mix-infection was found in 46 cases, which accounted for 4.73%. The detection rates of the 4 viruses in children under 2 years old were 80.28%, 77.94%, 83.58%, and 87.75%, respectively. Conclusion Rotavirus and norovirus were the main pathogens of viral diarrhea in children in Beijing Xicheng District from 2015-2018, and iinfants under 2 years old were the high-risk group. The peak incidence was in winter.

Objective To investigate the epidemiological chatacteristics and genotypes of parechovirus A (PeV-A) from children with acute diarrhea in Beijing in 2021. Methods Fecal samples were randomly collected from outpatient children under 60 months with acute diarrhea in a sentinel hospital in Beijing from January to December of 2021. RNA was extracted and detected for PeV-A by real-time RT-PCR. Nested RT-PCR was performed to amplify the VP3/VP1 conjunction region. PeV-A genotypes were determined based on sequencing and NCBI BLAST. Group A rotavirus, norovirus, enteric adenovirus, astrovirus and sapovirus were also detected for co-infection analysis. Phylogenetic and statistical analyses were performed using bioinformatics and statistical software. Results Of the 198 stool samples, 11 were positive for PeV-A, with a detection rate of 5.56% (11/198). Among them, 2 cases were co-infected with enteric adenovirus. 81.82% (9/11) of PeV-A infected cases were under 24 months. The highest detection rate was observed in fall, which was 12.50% (7/56). 90.91%（10/11）of PeV-A infection occurred in summer and fall. Among the 11 PeV-A isolates, 9 were sequenced successfully, of which 7 belonged to PeV-A1B genotype and 2 belonged to PeV-A3 genotype. Conclusion PeV-A1B and PeV-A3 are identified in children with acute gastroenteritis in Beijing in 2021. Infants and young children under 2 years old are the high-risk population for PeV-A infection. Most infections occur in summer and fall.