Abstract: Objective To explore the influencing factors of serum HBeAg loss in patients with chronic hepatitis B (CHB) and and provide evidence for effective treatment of CHB. Methods A follow-up cohort of HBeAg-positive CHB patients was established in the the Infectious Diseases Outpatient Clinic of hospital. Regular follow-up and laboratory test indicators were collected to analyze the changes of serum HBeAg in HBeAg-positive CHB patients during the follow-up period. The subjects were divided into the case group (serum HBeAg loss) and the control group (serum HBeAg not loss) according to whether serum HBeAg loss occurred. The baseline data characteristics of the two groups were analyzed and compared, and the influencing factors of serum HBeAg loss were analyzed by Cox univariate and multivariate regression. Results A total of 634 HBeAg-positive CHB patients were enrolled, with a total follow-up of 2 570.01 person-years. Among them, 237 cases of serum HBeAg loss occurred, with the mean follow-up time of 40.92 months, and the rate of HBeAg loss was 9.22/100 person-years. There were significant differences in HBV family history, antiviral therapy, baseline WBC, PLT, ALT, AST, T˗Bil, GGT, AFP, quantitative HBsAg and quantitative HBeAg between serum HBeAg loss group and serum HBeAg not loss group (P<0.05). Cox regression analysis showed that family history of HBV (HR 0.68, 95％CI:0.50-0.92, P=0.012), ALT (HR2.06, 95％CI:1.52-2.79, P<0.001), quantitative HBsAg (HR 0.68, 95％CI:0.48-0.95, P=0.024), quantitative HBeAg (HR 0.48, 95％CI:0.31-0.74, P=0.001) were independent influencing factors for HBeAg loss in HBeAg-positive CHB patients. Conclusions HBeAg-positive CHB patients without family history of HBV, initial ALT≥80 U/L, quantitative HBsAg<1 000 IU/ml, quantitative HBeAg<1 000 C.O.I are more likely to have serum HBeAg loss.

OBJECTIVETo investigate the therapeautic effect of damage control orthopaedics (DCO) applicated to thoracolumbar burst fracture complicated with severe polytrauma.

METHODSTwenty-one patients with severe polytrama including 15 males and 6 females with an average age of 40-years-old ranging from 20 to 60 years, were treated by immediate fluid resuscitation and emergency simple operation so as to control the bleeding and contamination. According to Frankel grade of spinal nerves function, 3 cases were grade A, 3 were grade B, 9 were grade C, 6 were grade D. Ten cases were performed to open abdominal operation, 6 cases underwent closed negative pressure drainage thorough chest, 2 cases with lung rupture were treated by repairing operation. During operation, 9 cases were treated with by external fixation and 5 cases were skeletal traction or external fixation with plaster support for extremities fractures. After emergency operation, the patients were transported into surgical intensive care unit (SICU), and corrected the hypothermia, acidosis and coagulation. The definitive thoracolumbar operation was performed between 5 to 7 days as soon as the vital signs became stable.

RESULTSAmong 21 cases, trauma hemorrhagic shock was corrected rapidly in 18 cases and 3 cases died in 4 to 26 hours. The survival rate was about 85.7% (18/21). Eighteen patients were followed up for 6 to 14 months with an average of 10 months. According to Frankel grading, 3 cases were grade A, 2 cases were grade B, 3 cases were grade C, 3 cases were grade D, 7 cases were grade E.

CONCLUSIONIt may increase the therapy achievement rate excellently and decrease the disabled rate that performing damage control orthopaedics (DCO) timely, relifing the compression on the spinal cord and re-establishing the stability of spinal column as early as possible.

Adult ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Multiple Trauma ; etiology ; surgery ; Orthopedic Procedures ; Spinal Fractures ; complications ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Young Adult

OBJECTIVETo explore the clinical effects of delayed open reduction and locking compressing plate (LCP) plus bone-grafting in medullary cavity for the distal comminuted fractures of tibia.

METHODSTwenty-nine patients with the distal comminuted fractures of tibia were treated between March 2006 and September 2008, including 19 males and 10 females, ranging in age from 27 to 58 years with an average of 42.5 years. From wounded to hospital, the time was from 2 to 4 hours. According to AO classification, type 43-A1 were in 3 cases, type A5 in 12 cases, type A3 in 9 cases and type 43-C1 in 5 cases. Among them, there were 11 cases with open fracture (type Gustilo I in 5 cases, type Gustilo II in 6 cases) and 18 cases with closed fracture. Calcaneal traction was done in earlier stage (plaster external fixation in 5 cases), keeping the nagative liquid balance and electrolyte balance and improving the microcirculation. After the swolen limbs relieved markedly in 8 to 12 days,operating was done by open reduction and LCP internal fixation plus bone-grafting with own ilium in medullary cavity. Functional exercise was undergone in earlier stage and the wounded limbs loading weight on 10 to12 weeks after operation when the X-ray revealed the callus formed markedly.

RESULTSThe incision healed well without severe complication. All patients were followed up for from 6 to 14 months with an average of 12 months. All cases obtained bone union. According to the Mazur's evaluation standard, the results were excellent in 25 cases, good in 3 cases, and fair in 1 case.

CONCLUSIONThe above treatment can reduce the damage of periosteum and medullary cavity, shorten the time of bone healing and decrease the rate of bone nounion markedly. The internal fixation was reliable and less complacation after surgery, but it is very important for the right preoperation assessment to soft tissue injuries and the good operation timing choice.

Adult ; Bone Plates ; Bone Transplantation ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Tibial Fractures ; diagnostic imaging ; physiopathology ; surgery ; therapy ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome

Fluorescence intraoperative cholangiography (IOC) is a potential alternative for identifying anatomical variation and preventing iatrogenic bile duct injuries by using the near-infrared probe indocyanine green (ICG).However,the dynamic process and mechanism of fluorescenceIOC have not been elucidated in previous publications.Herein,the optical properties of the complex of ICG and bile,dynamic fluorescence cholangiography and iatrogenic bile duct injuries were investigated.The emission spectrum of ICG in bile peaked at 844 nm and ICG had higher tissue penetration.Extrahepatic bile ducts could fluoresce 2 min after intravenous injection,and the fluorescence intensity reached a peak at 8 min.Inaddition,biliary dynamics were observed owing to ICG excretion from the bile ducts into the duodenum.Quantitative analysis indicated that ICG-guided fluorescence IOC possessed a high signal to noise ratio compared to the surrounding peripheral tissue and the portal vein.Fluorescence IOC was based on rapid uptake of circulating ICG in plasma by hepatic cells,excretion of ICG into the bile and then its interaction with protein molecules in the bile.Moreover,fluorescence IOC was sensitive to detect bile duct ligation and acute bile duct perforation using ICG in rat models.All of the results indicated that fluorescence IOC using ICG is a valid alternative for the cholangiography of extrahepatic bile ducts and has potential for measurement of biliary dynamics.

OBJECTIVETo use a mathematical model and computer simulation to study transmission dynamics and control of schistosomiasis in mountainous regions of Sichuan.

METHODSBased on studies of schistosomiasis japonica transmission in 20 villages in mountainous regions of Sichuan, a mathematical model was developed to characterize the impact of local environmental factors on transmission intensity. The model integrated site-specific factors and was calibrated to field epidemiological data from 3 subset villages. The dichotomic method was then used to predict different control measures.

RESULTSThe study showed high variations in prevalence of infection and infection intensity across villages, ranging between 3%-73%, 0.1-100 epg (eggs per gram stool), respectively. Important factors including occupation of local residents, exposure to contaminated water, microclimatic characteristics were integrated in the model. The predictions of dichotomic models showed that continuing chemotherapy (coverage between 50%-60%) could reduce infection intensities to 30%-80%, but could not change local transmission potential; therefore, the termination of chemotherapy would be followed by bouncing back of transmission. Sustaining targeted environmental interventions through snail and parasite oval control at certain coverage (30%-50%, respectively) could reduce the transmission to relatively stable levels. The model predictions showed that an integrated control (e.g., including both chemotherapy and environmental interventions) could suppress the transmission to an undetectable level even interruption of transmission between 5-10 years.

CONCLUSIONThe study demonstrated the feasibility of using a dynamic model, calibrated to local data, to gain insights into complicated processes underlying the transmission and informing site-specific control strategies.

Adolescent ; Adult ; Animals ; Child ; Child, Preschool ; China ; Environment ; Humans ; Middle Aged ; Models, Theoretical ; Schistosoma japonicum ; Schistosomiasis japonica ; epidemiology ; prevention & control ; transmission ; Snails ; parasitology

OBJECTIVETo explore the eukaryotic expression of arresten in CHO cells and to investigate its basic biological activities.

METHODSCHO cells were divided into three groups: transfected pSecTag-arresten group, transfected pSecTag group and control group without transfection. PSecTag-arresten was transfected into CHO cells by Lipofectamine 2000 method. The arresten mRNA in CHO cells was assayed by RT-PCR. The protein expression of arresten gene was examined by Western-Blot. The cells expressing arresten were screened out by Zeocin. The effect of arresten on huvec cell migration and anchoring to three-dimensional vascular structures was measured.

RESULTSThe result of RT-PCR and Western-blot showed that arresten gene has been successfully transfected into CHO cells and expressed in those cells. Arrssten inhibited huvec cell migration and anchoring to three-dimensional vascular structures.

CONCLUSIONCHO cells expressing arresten have been obtained successfully. Arresten can inhibit huvec cell migration and anchoring to three-dimensional vascular structures, indicating that it might be one of its anti-angiogenetic approaches.

Angiogenesis Inhibitors ; biosynthesis ; genetics ; pharmacology ; Animals ; Blotting, Western ; CHO Cells ; Cell Line ; Cell Movement ; drug effects ; Cells, Cultured ; Collagen Type IV ; biosynthesis ; genetics ; pharmacology ; Cricetinae ; Cricetulus ; Endothelial Cells ; cytology ; drug effects ; physiology ; Humans ; Neovascularization, Physiologic ; drug effects ; RNA, Messenger ; biosynthesis ; genetics ; Recombinant Proteins ; biosynthesis ; genetics ; pharmacology ; Reverse Transcriptase Polymerase Chain Reaction ; Transfection

Objective To study the distribution of CYP3A4 activity in 260 middle-aged gynaecologic surgical patients. Methods Midazolam (MDZ) is used as a probe of eytoehrome P450 3A4 (CYP3A4) activity by a single-point blood measurement. CYP3 A4 activity was measured by plasma ratio of 1'-hydroxymidazolam and midazolam using LC/ MS. Result The mean value of CYP3A4 activity in 260 middle-aged gynaecologic patients (aged 30-50 years) measured was 0. 46 ±0. 14 and 95% confidence interval for mean was 0. 43-0. 48. The range for normal value is 0. 18-0. 73. Conclution CYP3A4 activity is mormal distribution observed in gynaecologic patients. CYP3A4 activity variation has a little effect on the metabolism of commonly used drugs after surgery that are substrates for this enzyme.

This study was aimed to establish a model for detecting the donor chimerism rate following the multi-donor hematopoietic stem cell transplantations, and simplify its calculation method. Patients with hematologic disease receiving allogeneic hematopoietic stem cell transplantation including single-donor and multi-donor were selected in this study and the donor cell chimerism rates were detected, using STR-PCR combined with capillary electrophoresis. The results indicated that the peaks of the sister alleles coming from the same individual were confirmed to have the approximate areas and can be replaced each other in the situation of mixed chimerism. In the calculation model, the value between reference chimerism and approximate chimerism have no significant difference using the hypothetical peak areas, and the result was confirmed to be accepted basing on typical measurement error between sister alleles (5% - 20%). It is concluded that the areas of share peaks can be replaced by non-share peaks and this conclusion can be used to calculate the double-donor CHM (DD-CHM)(%). Compared to the D alleles, R alleles show more strategic importance because it can lead to more accurate result and allowed simplifying the arithmetic calculations for DD-CHM(%).
Alleles ; Electrophoresis, Capillary ; Hematopoietic Stem Cell Transplantation ; Humans ; Polymerase Chain Reaction ; Postoperative Period ; Tissue Donors ; Transplantation Chimera ; genetics ; Transplantation, Homologous

OBJECTIVETo evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), and to compare the prognosis between patients of different ages.

METHODSThe hospitalization and follow-up data of 81 AAA patients treated by EVAR from May 2005 to May 2011 were retrospectively analyzed. All the patients were divided into advanced age group (age ≥ 75 years, 24 cases) and relatively young group (age < 75 years, 57 cases). General conditions, comorbidity, procedure, in-hospital complications, and follow-up were compared between these two groups.

RESULTSAll covered stents were successfully deployed, a technical success rate of 91.4% (74/81) was achieved. There was no intraoperative death. In-hospital mortality was 1.2% (1/81). The follow-up rate was 91.4% (74/81), with a mean follow-up of 47.5 months. Twelve deaths were recorded during follow-up, 1, 2, 3, 4, and 5-year survival rates were 98.6%, 92.2%, 80.8%, 58.7%, and 44.1%, respectively. When compared with relatively young group, the advanced age group had a lower rate of abdominal pain as the major symptom, but a higher rates of renal diseases and coronary artery diseases. Furthermore, the advanced age group had a longer stay in intensive care unit and higher morbidity of endoleaks, and also tended to have increased rates of pulmonary infection and access site hematoma, while the other parameters were similar between the two groups.

CONCLUSIONSEVAR of AAA is less invasive, safe, and effective during short to mid-tern follow-up. The patients of advanced age suffer from higher rates of some complications, thus careful perioperative preparation and intensive monitor are mandatory for preventing or treating potential complications and improving prognosis for these patients.

Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal ; surgery ; Blood Vessel Prosthesis Implantation ; adverse effects ; methods ; Endoleak ; etiology ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Survival Rate ; Treatment Outcome