Objective To investigate the application value of tenofovir alafenamide fumarate (TAF) in elderly patients with chronic hepatitis B (CHB) and its influence on bones and kidneys. Methods A total of 36 CHB patients, aged ≥60 years, who received TAF antiviral therapy in Qingdao Municipal Hospital, The Affiliated Hospital of Qingdao University, Qingdao Sixth People's Hospital, Chengyang People's Hospital, and Jimo People's Hospital from June 2021 to October 2022 were enrolled in this study, and all patients received TAF (25 mg/d) antiviral therapy. Related data were collected at baseline and weeks 24 and 48 of treatment, including virological indicators, biochemical parameters, urinary protein electrophoresis indices, transient elastography (FibroScan), and bone mineral density. Virological indicators included high-sensitivity HBV DNA quantification; biochemical parameters included total bilirubin, direct bilirubin (DBil), indirect bilirubin (IBil), alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, total bile acid (TBA), glucose, blood urea nitrogen, creatinine, estimated glomerular filtration rate, and cystatin C (Cys C); urinary protein electrophoresis indices included urinary β2 microglobulin (β2-MG), urinary retinol (URBP), and urinary α1 microspherin (α1-MG). The paired t -test was used for comparison of normally distributed continuous data before and after treatment, and the Wilcoxon signed-rank test was used for comparison of non-normally distributed continuous data before and after treatment; the chi-square test or the Fisher's exact test was used for comparison of categorical data. Results A total of 36 CHB patients completed 24 weeks of follow-up. The complete virological response rate after 24 weeks of treatment was higher than that at baseline [83.3% (30/36) vs 77.8% (28/36), χ 2 =0.36, P =0.55], and there were significant reductions in DBil ( t =-2.42, P =0.02) and Cys C ( t =-4.34, P < 0.001) from baseline to week 24. A total of 18 CHB patients completed 48 weeks of follow-up. The complete virological response rate after 48 weeks of treatment was higher than that at baseline (94.4% vs 77.8%, χ 2 =2.22, P =0.34), and there were significant increases in IBil ( t =2.43, P =0.03), TBA ( Z =-2.24, P =0.03), and bone mineral density T score of lumbar vertebra ( t =2.92, P = 0.01) and femoral neck ( t =2.42, P =0.03) and a significant reduction in liver stiffness measurement ( t =-2.31, P =0.03). There were no significant changes in β2-MG, URBP, and α1-MG after treatment (all P > 0.05). Conclusion TAF has a good antiviral effect in CHB patients aged ≥60 years and can help more CHB patients achieve complete virological response, without causing damage to the kidney, and it can also improve bone mineral density and liver fibrosis degree.

PURPOSE: Breast cancer is the most commonly occurring cancer among women worldwide, and therefore, improved approaches for its early detection are urgently needed. As microRNAs (miRNAs) are increasingly recognized as critical regulators in tumorigenesis and possess excellent stability in plasma, this study focused on using miRNAs to develop a method for identifying noninvasive biomarkers. METHODS: To discover critical candidates, differential expression analysis was performed on tissue-originated miRNA profiles of 409 early breast cancer patients and 87 healthy controls from The Cancer Genome Atlas database. We selected candidates from the differentially expressed miRNAs and then evaluated every possible molecular signature formed by the candidates. The best signature was validated in independent serum samples from 113 early breast cancer patients and 47 healthy controls using reverse transcription quantitative real-time polymerase chain reaction. RESULTS: The miRNA candidates in our method were revealed to be associated with breast cancer according to previous studies and showed potential as useful biomarkers. When validated in independent serum samples, the area under curve of the final miRNA signature (miR-21-3p, miR-21-5p, and miR-99a-5p) was 0.895. Diagnostic sensitivity and specificity were 97.9% and 73.5%, respectively. CONCLUSION: The present study established a novel and effective method to identify biomarkers for early breast cancer. And the method, is also suitable for other cancer types. Furthermore, a combination of three miRNAs was identified as a prospective biomarker for breast cancer early detection.
Area Under Curve ; Biomarkers ; Biomarkers, Tumor ; Breast Neoplasms* ; Breast* ; Carcinogenesis ; Data Mining ; Early Detection of Cancer ; Female ; Genome ; Humans ; Methods ; MicroRNAs* ; Plasma ; Prospective Studies ; Real-Time Polymerase Chain Reaction ; Reverse Transcription ; Sensitivity and Specificity

OBJECTIVE:To measure and analysis the related costs of drug-induced liver injury (D1LI) from different decision makers,and to provide reference for reducing related costs of DILI,improving medical insurance system and realizing effective health resource distribution.METHODS:In retrospective study,60 cured or recovered DILI inpatieuts were randomly selected as subjects from medical record management system of 4 hospitals in Henan province during Jun.2014-Jun.2015.Demographic character istic,clinical characteristic and related cost of DILI were analyzed retrospectively and the cost structure was also analyzed from different decison makers (patient,society,medical insurance payer).RESULTS:The total direct medical cost of 60 cases was 584 113.05 yuan,and total direct non-medical cost was 31 093.15 yuan and total indirect cost was 169 379.95 yuan.The total cost of DILI of fered by patients was 616 296.38 yuan;the total cost of DILI offered by society was 784 586.15 yuan;the total cost of DILI offered by medical insurance was 168 289.77 yuan.CONCLUSIONS:DILI results in serious economic damage for patients and society,deserving attracting extensive attention worldwide.The study provide reference for reducing patient's medical burden and improving medical insurance system,and contribute to optimize medical resource distribution.

Objective To investigate the clinical significance of combined heart and lung ultrasound in patients with severe left heart failure and pulmonary hypertension. Methods From March 2016 to June 2017, 75 patients with grade Ⅲ and Ⅳ heart failure and dyspnea were enrolled in Qingdao Municipal Hospital Affiliated to Qingdao University. Thirty-three patients had normal pulmonary artery pressure (normal pulmonary arterial pressure group), 25 patients had mild pulmonary hypertension (mild pulmonary hypertension group), and 17 patients had moderate to severe pulmonary hypertension (moderate to severe pulmonary hypertension group). The patient′s plasma B-type natriuretic peptide (BNP) was measured. Left ventricular diameter (LVD), right ventricular diameter (RVD), and left ventricular ejection fraction (LVEF) were measured by echocardiography. The patient′s lungs were observed by lung ultrasonography, and its number was recorded. One-way analysis of variance was used to compare the differences of LVD, RVD, and LVEF in three groups of patients with severe left heart failure. Further comparison between groups was performed using LSD-t test. Kruskal-wallis H test was used to compare the plasma BNP concentration and B-line number in three groups of patients with severe left heart failure. The Mann-Whitney U test was used to further compare the groups. The receiver operating characteristic (ROC) curve of pulmonary hypertension diagnosed by plasma BNP concentration and B line number in patients with severe left heart failure were drwan. Results The concentrations of BNP in patients with normal pulmonary arterial pressure, mild pulmonary hypertension, and moderate to severe pulmonary hypertension were 890 (614, 1516), 1460 (1245, 1950), and 2660 (1670, 3279) ng/L, respectively. The number of B line was 12 (9, 16), 17 (14, 18), 26 (20, 28), and the RVD was (22.1±1.7), (24.9±2.0), (26.3±2.8) mm, respectively. The number of B-line and RVD in the moderate-severe pulmonary hypertension group were both lager than those in the mild pulmonary hypertension group, and the number of B-line and RVD in the mild pulmonary hypertension group were both lager than those in the normal pulmonary artery pressure group. There was significant difference between any two groups (BNP concentration: U=210.500, P < 0.05; U=47.000, 73.000, both P < 0.001;B line number:U=189.000,P < 0.05;U=38.5000,64.000,both P < 0.001;RVD:t=0.553, 0.623, both P<0.001; t=0.656, P<0.05). There was no significant difference in LVD and LVEF between the three groups of patients. The ROC curve showed that the optimal threshold for the diagnosis of pulmonary hypertension in patients with severe left heart failure with BNP concentration was 1225 ng/L. The sensitivity was 85.7%,the specificity was 69.7%,the area under the curve was 0.814,and the 95% CI was 0.717 to 0.911. The optimal threshold for diagnosis of pulmonary hypertension in patients with severe left heart failure was B line number 14, the sensitivity was 88.1%, specificity was 66.7%, the area under the curve was 0.836, and 95%CI was 0.747 to 0.925.Conclusion Patients with severe left heart failure at different pulmonary artery pressure levels have different B-line findings, and the number of B-line increases with the severity of pulmonary hypertension, which warrants further study and application.

OBJECTIVE:To provide reference for standardized management of skin test of cephalosporin injection in our hos-pital. METHODS:In retrospective analysis,skin test of 8 kinds of cephalosporin [cefotaxime(1.0 g),cefotaxime(0.5 g),cefoti-am (1.0 g),cefotiam (0.5 g),ceftazidime (0.5 g),cefminox (0.5 g),cefminox (1.0 g),ceftriaxone (1.0 g)] and the cost of skin test, related cost of allergic reaction induced by cephalosporin injection were analyzed statistically during Sept. 1st, 2015-Aug. 31th,2016. The cost of skin test of cephalosporin injection was compared with allergic reaction cost reduced by skin test. RESULTS:The positive rate of 100330 patients who used above 8 kinds of cephalosporin injections was 6.27%;the rate of skin test was 82.49%;the direct cost of skin test was 3434411.72 yuan;the indirect cost was 141985.12 yuan;the cost of pa-tient was 3162901.44 yuan;the cost of medical insurance was 259096.28 yuan;the cost of the whole society was 3576396.84 yuan. From the perspective of the whole society,the cost of skin test of cephalosporin injections was(447049.61±247395.07)yuan, and allergic reaction cost reduced by skin test was (316075.48 ± 260600.49)yuan. The cost of skin test was significantly higher than allergic reaction cost reduced by skin test,with statistical significance(P<0.05). CONCLUSIONS:Skin test of cephalosporin injection is low in positive rate,has high expense. The government standardizes the management of skin test of cephalosporin injec-tion and reduces the economic burden of patients under the premise of ensuring the safety of drug use.

Objective: To explore the application value of real-time adenosine stress 3-dimensional echocardiography (3D-ASE) for diagnosing the patients with of coronary artery disease (CAD).
Methods: A total of 46 suspicious CAD patients were studied by 3D-ASE analysis. There were 26 male and 20 female patients from (38-73) years of age at the mean of (63.3 ± 7.2) years. Adenosine stress echocardiography was performed by infusing the agent at 140 ug/(kg?min) in 6 minutes. The changes of segmental ventricular wall motion, electrocardiogram (ECG), clinical symptoms, blood pressure and heart rate were recorded. Positive 3D-ASE result was deifned by the time of left ventricular segment minimum contraction volume gradually extending. Coronary angiograph (CAG) was conducted at 2 weeks after 3D-ASE, positive CAG ifnding was conifrmed by at least one of three main branches with the stenosis≥50%.
Results: There were 29/46 patients with positive CAG findings, 26 with positive 3D-ASE presentations and 8 with positive adenosines tress ECG. CAG showed that 48 coronary branches were positive and 90 were negative;3D-ASE indicated that 40 coronary branches were positive and 98 were negative. For 3D-ASE diagnosed coronary lesions, the overall sensitivity was 89.6%(26/29), speciifcity 76.5%(13/17), accuracy 84.8%(39/46). There were 36 branch lesions conifrmed by both CAG and 3D-ASE. For 3D-ASE determined coronary lesions, the sensitivity was 75%(36/48), speciifcity 95.6%(86/90), accuracy 88.4%(122/138). For 3D-ASE found single, double and three vessels diseases, the sensitivities were 60%(9/15), 88.9%(8/9) and 100%(5/5) respectively. The e occurrence rate of 3D-ASE side effect was 52.2%, there were usually slight symptoms without severe adverse reaction.
Conclusion: 3D-ASE has the high sensitivity and speciifcity in CAD diagnosis, it is an non-invasive examination with slight side effect, and therefore, has an important application value in clinical practice.

We observed the effect of vibration parameters on lumbar spine under different vibration conditions using finite element analysis method in our laboratory. In this study, the CT-images of L1-L5 segments were obtained. All images were used to develop 3D geometrical model using the Mimics10. 01 (Materialise, Belgium). Then it was modified using Geomagic Studio12. 0 (Raindrop Geomagic Inc. USA). Finite element (FE) mesh model was generated by Hypermesh11. 0 (Altair Engineering, Inc. USA) and Abaqus. Abaqus was used to calculate the stress distribution of L1-L5 under different vibration conditions. It was found that in a vibration cycle, tensile stress was occurred on lumbar vertebra mainly. Stress distributed evenly and stress concentration occurred on the left rear side of the upper endplate. The stress had no obvious changes under different frequencies, but the stress was higher when amplitude was greater. In conclusion, frequency and amplitude parameters have little effect on the stress distribution in vertebra. The stress magnitude is positively correlated with the amplitude.
Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Lumbar Vertebrae ; physiology ; Vibration

This article was aimed to study the action of antigout effects of compoundWeifu. Through the acute gouty arthritis models of rabbits and rats induced by micro-crystal sodium urate (MSU). The histopathological changes of synovial tissues among rabbits were observed. And the contents of TNF-α, IL-1β, IL-6 in rabbit serum were determined. The swelling degree of the rats’ feet and the content of prostaglandin E2 (PGE2) from the inflammatory exudate foot induced by MSU were also determined. The antigout effects of compoundWeifu were observed. The results showed that the grade of the vascular congestion, swelling and inflammatory cell infiltration in synovial tissues in the high-dose and medium-dose CompoundWeifu group had significantly improved (P <0.05). And the levels of TNF-α, IL-1β, IL-6 in serum were significantly decreased (P< 0.05, orP < 0.01). It can obviously reduce the swelling degree induced by MSU, and the level of PGE2 in the inflammatory exudate foot (P< 0.05, orP < 0.01). It was concluded that CompoundWeifu had obvious antigout effects in the study.

This study was aimed to estimate the effect of different ProDisc-C arthroplasty designs after it was implanted to C5-C6 cervicalspine. Finite element (FE) model of intact C5-C6 segments including the vertebrae and disc was developed and validated. Ball-and-socket artificial disc prosthesis model (ProDisc-C, Synthes) was implanted into the validated FE model and the curvature of the ProDisc-C prosthesis was varied. All models were loaded with compressed force 74 N and the pure moment of 1.8 Nm along flexion-extension and bilateral bending and axial torsion separately. The results indicated that the variation in the curvature of ball and socket configuration would influence the range of motion in flexion/extension, while there were not apparently differences under other conditions of loads. The method increasing the curvature will solve the stress concentration of the polyethylene, but it will also bring adverse outcomes, such as facet joint force increasing and ligament tension increasing. Therefore, the design of artificial discs should be considered comprehensively to reserve the range of motion as well as to avoid the adverse problems, so as not to affect the long-term clinical results.
Arthroplasty ; Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Intervertebral Disc ; Pressure ; Prostheses and Implants ; Range of Motion, Articular ; Spine ; Zygapophyseal Joint

Objective To investigate the hepatitis B virus (HBV) infection status quo among childbearing age women to provide the theoretical basis for adopting the effective intervention ,treatment and blocking measures in pre-pregnant women .Methods The enzyme-linked immunosorbent assay (ELISA) and the time-resolved fluorometric immunoassay were adopted to detect HbsAg in 68 682 children bearing age women ,including outpatient and hospitalized patients ,in this hospital from February 2012 to September 2013 .The detect results were analyzed according to the age ,place of residence and medical departments .Results Among 68 682 children bearing age women ,3 260 cases were found positive for HbsAg with the HBsAg positive rate of 4 .70% .The statistically significant differences in the HBV infection positive rate existed among different age groups ,the positive rates in the age groups of 16- <20 years ,20 - < 25 years ,25 - < 30 years ,30 - < 35 years ,35 - < 40 years ,40 - < 45 years and 45 - < 50 years were 3 .83% ,4 .89% ,4 .96% ,4 .91% ,4 .18% ,4 .40% and 4 .18% respectively ,the differences among them had statistical significance (χ2 =15 .76 ,P=0 .015) ,in which the age 25- <30 years group had the highest HBV infection rate .At the same time the signifi-cant differences in the geographical distribution and medical departments existed .The HBV infection positive rate in rural area was significantly higher than that in city with statistical difference (χ2 =27 .47 ,P<0 .05) ,and the HBV infection positive rate in the outpatient departments was higher than that in the inpatient departments with statistical difference (χ2 =46 .88 ,P<0 .05) .Conclu-sion Children bearing women at 20-34 years old show the highest HBV infection rate .The HBV screening and the works of pre-vention and treatment during this age period should be strengthened ,which conduces to discover the HBV infection positive patients in time and prevent the mother-to-fetus transmission .