Objective:To analyze the effect of different hepatitis B virus DNA (HBV DNA) loading on liver function in patients with hepatitis B-related hepatocellular carcinoma (HCC).Methods:From February 2017 to August 2018, 78 patients with HCC who underwent radical hepatectomy in the Second Affiliated Hospital of Guangxi University of Science and Technology were enrolled retrospectively.According to the difference of preoperative serum HBV DNA load, there were 30 cases in the high copy group and 48 cases in the low copy group.The positive rates of HBV DNA load in patients with hepatocellular carcinoma were compared 3 days before operation, 7 days and 6 months after operation.Repeated measurement ANOVA was used to observe the liver function of the two groups 3 days before operation, 7 days and 6 months after operation, and the adverse reactions of the two groups were compared.Results:There was no significant difference in the positive rate of HBV DNA load between 3 days before operation, 7 days after operation and 6 months after operation ( P>0.05). The levels of alanine aminotransferase in high copy group were (60.25±28.22), (201.35±69.12), (250.52±74.76) U/L 3 days before operation, 7 days and 6 months after operation, and those in low copy group were (57.24±20.83), (144.50±49.25), (200.21±51.66) U/L.The results of repeated measurement ANOVA showed that Fintra-group=20.429, P<0.01, Finter-group=7.119, P<0.01, Finteraction=27.547, P<0.01.There were significant differences between 7 days, 6 months and 3 days before operation (all P<0.01), between 7 days and 6 months after operation (all P<0.05), and between 7 days and 6 months after operation (all P<0.05). The aspartate aminotransferase levels were (53.14±24.23), (300.30±63.85), (352.36±60.38) U/L in the high copy group 3 days before operation, 7 days and 6 months after operation, and (57.74±23.13), (232.56±53.08), (254.56±58.78) U/L in the low copy group.The results of repeated measurement ANOVA showed that Fintra-group=41.476, P<0.01, Finter-group=50.211, P<0.01, Finteraction=8.736, P<0.01.The difference between 7 days and 6 months after operation and 3 days before operation within the group was statistically significant (all P<0.01). The difference between 7 days after operation and 6 months after operation was statistically significant (all P<0.05). There were statistically significant differences between the groups at 7 days and 6 months after operation (all P<0.05). The plasma albumin of high copy group was (38.13±13.14), (24.22±8.56), (20.31±5.37) g/L 3 days before operation, 7 days and 6 months after operation, and that of low copy group was (37.93±12.54), (29.77±9.32), (25.32±6.43) g/L.The results of repeated measurement ANOVA showed that Fintra-group=12.836, P<0.01, Finter-group=3.608, P<0.05, Finteraction=16.444, P<0.01.There were significant differences between 7 days, 6 months and 3 days before operation (all P<0.01), between 7 days and 6 months after operation (all P<0.05), and between 7 days and 6 months after operation (all P<0.05). The total bilirubin of high copy group was (27.56±6.12), (37.78±9.45), and (46.56±10.22)% at 3 days before surgery, 7 days and 6 months after surgery, and that of low copy group was (25.82±6.38), (31.11±8.65), (38.26±9.23)%, respectively.The results of repeated measurement ANOVA showed that Fintra-group=10.281, P<0.01, Finter-group=8.832, P<0.01, Finteraction=19.114, P<0.01.There were significant differences between 7 days, 6 months and 3 days before operation (all P<0.01), between 7 days and 6 months after operation (all P<0.05), and between 7 days and 6 months after operation (all P<0.05). In addition, the recovery time of liver function in the high copy group was (13.22±2.21) d, and that in the low copy group was (10.34±2.53) d. The difference between the two groups was statistically significant ( t=5.128, P<0.01). The incidence of adverse reactions was 46.67% (14/30) in the high copy group and 16.67% (8/48) in the low copy group, and the difference was statistically significant ( P=0.008). Conclusion:There was no significant change of HBV DNA load in HCC patients before and after operation, while the recovery ability of liver function in HCC patients with high copy HBV DNA was significantly reduced, the incidence of adverse reactions was higher, and the prognosis was poor.

Objective To assess the clinical value of systemic vascular resistance index (SVRI) combined with serum procalcitonin (PCT) and sequential organ failure assessment (SOFA) score in the early diagnosis of sepsis. Methods A retrospective study was conducted. The data of critical patients admitted to Department of Critical Care Medicine of the Third People's Hospital of Hechi from November 2013 to April 2016 were enrolled. The clinical data were recorded as follows: gender, age, infection site, SOFA score, serum PCT level (enzyme linked fluorescence analysis) within 1 hour after intensive care unit (ICU) admission, hemodynamics parameters, including mean arterial pressure (MAP), central venous pressure (CVP), cardiac index (CI), SVRI, global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), which were monitored by pulse indicator continuous cardiac output (PiCCO) after ICU admission. The patients were divided into sepsis and non-sepsis groups according to the diagnostic criteria of sepsis. Septic patients were divided into low SVRI group, normal SVRI group, and high SVRI group according to SVRI normal value (170-240 kPa·s·L-1·m-2), and the differences in parameters among the three groups were compared. The correlations between SVRI and various parameters were analyzed by using Pearson correlation analysis. The receiver operating characteristic curve (ROC) was plotted to evaluate the diagnostic efficiency of each parameter. Results Totally 103 critical patients were enrolled, 55 in sepsis group, and 48 in non-sepsis group. Compared with non-sepsis group, SVRI in septic group was significantly lowered (kPa·s·L-1·m-2: 146.56±45.17 vs. 188.04±56.27), and serum PCT was significantly increased (μg/L: 10.43±6.17比0.32±0.11) with statistically significant differences (both P < 0.05). In 55 sepsis patients, there were 21 in low SVRI group, 19 in normal SVRI group, and 15 in high SVRI group. There were no statistically significant differences in gender, age and infection site among the three groups, indicating that the baseline data among all groups was balanced with comparability. SOFA score, PCT, and CI in the low SVRI group were significantly higher than those of normal SVRI and high SVRI groups [SOFA: 10.57±2.89 vs. 5.73±2.28, 5.73±2.15, PCT (μg/L): 24.15±12.43 vs. 7.18±5.05, 7.39±4.38, CI (mL·s-1·m-2): 71.01±9.67 vs. 62.01±8.34, 62.51±8.67, all P < 0.05], but no significant difference was found between the normal SVRI group and high SVRI group. There was no statistically significant difference in MAP, CVP, EVLWI, and GEDVI among the three groups. It was shown by Pearson correlation analysis that SVRI was negatively correlated with PCT, SOFA score, and CI (r value was -0.622, -0.598, -0.398, all P = 0.000). It was shown by ROC curve that area under ROC curve (AUC) of PCT combined with SVRI for diagnosis of sepsis was higher than that of PCT or SVRI alone (0.943 vs. 0.911, 0.884). When the cut-off value of PCT was 3.79 μg/L, and cut-off value of SVRI was 156.81 kPa·s·L-1·m-2, the sensitivity and specificity were 94.6% and 92.3% respectively. Conclusions For sepsis patients, SVRI is related to PCT and SOFA score. Combined monitoring of PCT, SVRI, SOFA score can accurately reflect the severity of sepsis patients, guide diagnosis and treatment, and estimate prognosis. The efficacy of PCT combined with SVRI in the early diagnosis of sepsis is better than that of the two alone.

Objective To analyze the dynamic changes of immunoregulatory factors and tumor markers before and after chemotherapy in patients with advanced gastric cancer.Methods From October 2015 to February 2018,58 patients with chemotherapy AGC in our hospital were selected as gastric cancer group.According to the efficacy of chemotherapy they were divided into effective group, stable group and ineffective group.Meanwhile,30 healthy persons were selected as normal group.The immunoglobulins (IgA, IgG,IgM), T lymphocyte subsets ( CD3+, CD4+, CD8+, CD4+／CD8+) and related tumor markers ( CEA, CA199,CA242) were compared before and after chemotherapy.Results The levels of IgA((2.11±0.89) g／L),IgM((10.65±4.61) g／L),IgG((1.25±0.45) g／L),CD8+((28.12±3.56)%),CEA((40.33 ±16.24) μg／L),CA199((76.34±21.56) kU／L) and CA242((29.34±9.57)k U／L) in the gastric cancer group were significantly higher than those in the normal group IgA((0.93±0.36) g／L),IgM((6.46±3.59) g／L),IgG((0.65±0.32) g／L),CD8+(( 25.02± 4.78)%),CEA((1.81± 0.55) μg／L),CA199((7.51 ±2.67) kU／L),CA242((3.35±1.21) kU／L) (t＝6.958,3.600,6.495,3.435,12.952,17.370,14.773, P＜0.05),while CD3+(( 64.12± 5.12)%),CD4+(( 34.12 ± 4.10)%),CD4+／CD8+( 1.09 ± 0.28) were lower than the normal group (CD3+(71.23±7.14)%,CD4+( 39.78±5.20)%,CD4+／CD8+( 1.47±0.40)) (t＝5.376,5.592,5.192,P＜0.05).The total effective rate of AGC patients in gastric cancer group was 79.31 %(46／58),and the ineffective rate was 20.69%(12／58).IgA,IgG,IgM,and CD8+in the effective group were significantly lower than those before chemotherapy (t＝3.925,3.745,4.036,2.661,P＜0.05), while CD3+,CD4+, CD4+／CD8+ were significantly higher than before chemotherapy ( t＝3.520, 3.077, 3.218,P＜0.05).The subcellular level of protein and T lymphocytes was significantly better than that of stable group and ineffective group (P＜0.05).The levels of tumor markers CEA,CA199 and CA242 in the effective group and stable group were significantly lower than those before chemotherapy ( P＜0.05), and significantly lower than the ineffective group ( P＜0.05).Conclusion The levels of immunoglobulins, T lymphocyte subsets and tumor markers in patients with AGC have significant changes after chemotherapy,and their levels can guide the efficacy of chemotherapy.

Levothyroxine anaphylaxis is a rare yet severe adverse reaction to exogenous levothyroxine. While levothyroxine desensitization is commonly employed, its direct application in patients with severe shock poses considerable risks. Omalizumab may offer a potential adjunctive approach to induce tolerance to levothyroxine. We reported a case of a 30-year-old female with a history of thyroid papillary carcinoma who developed anaphylactic shock following oral administration of 50 μg levothyroxine daily after surgery. High serum level of immunoglobulin E (IgE 99.2 kU/L) and positive intradermal tests to all brands of levothyroxine available in China confirm a type Ⅰ hypersensitivity reaction. Several reports have proven the role of omalizumab in desensitization protocol in IgE-mediated diseases; therefore, she was pretreated with three courses of omalizumab (150 mg intradermal injection every four weeks). She then successfully completed oral levothyroxine desensitization and tolerated treatment dose of levothyroxine without experiencing allergic symptoms along with normalization of thyroid function. Further research is warranted to assess its potential as a standard treatment in difficult-to-treat levothyroxine hypersensitivity.