Objective: To investigate the value of serum hepcidin in assessment of liver inflammation activity among patients with chronic hepatitis B ( CHB ), so as to provide insights into the assessment of liver inflammation activity among CHB patients. Methods: A total of 79 CHB patients who were admitted to the Affiliated Hospital of Hangzhou Normal University were selected as the experimental group, while 40 healthy volunteers were randomly sampled as controls. Subjects'demographic data, liver function tests and iron metabolism parameters were collected from medical records, and serum hepcidin was measured using enzyme-linked immunosorbent assay ( ELISA ). In addition, ultrasound-guided liver biopsy was performed in CHB patients, and mild and moderate-to-severe CHB were classified according to liver inflammation activity and degree of liver fibrosis. Serum hepcidin levels were compared between the experimental and control groups and between patients with mild and moderate-to-severe CHB. The value of serum hepcidin in assessment of liver inflammation activity was examined among CHB patients using the receiver operating characteristic ( ROC ) curve analysis. Results: Subjects in the experimental group included 54 men ( 68.35% ) and had a mean age of ( 39.06±10.67 ) years, while the controls included 24 men (60.00%) and had a mean age of ( 42.43±11.44 ) years. Lower hepcidin levels were measured in the experimental group than in the control group [( 11.70±5.64 ) vs. ( 17.82±3.63 ) μg/L; P<0.05 ]. There were 54 patients with mild CHB ( 68.35% ) and 25 cases with moderate-to-severe CHB ( 31.65% ), and lower hepcidin levels were detected in patients with moderate-to-severe CHB than in those with mild CHB [ ( 6.92±2.21 ) vs. ( 13.95±5.36 ) μg/L; P<0.05 ]. The area under the ROC curve, optimal cut-off, sensitivity and specificity of serum hepcidin were 0.903 ( P<0.05 ), 10.365 μg/L, 100.0% and 72.2% for assessment of moderate-to-severe CHB, respectively. Conclusion Serum hepcidin is feasible to evaluate the liver inflammatory activity among patients with CHB.

Objective:To investigate the predictive value of procalcitonin (PCT) in the development of acute kidney injury (AKI) in patients after bee stings.Methods:A total of 105 bee stings patients admitted to Mianyang Central Hospital from May 2019 to August 2021 were enrolled and were divided into AKI group (37 cases) and non-AKI group (68 cases) according to the occurrence of AKI. Baseline demographic information [gender, age, body mass index (BMI), sting season, sting site, number of stings, underlying disease, clinical manifestations, and inflammatory factor levels] were collected and compared between the two groups. Logistic regression model was used to analyze the risk factors associated with the occurrence of AKI in bee stings patients. Pearson model was used to analyze the correlation between PCT and other indicators; the receiver operator characteristic curve (ROC curve) were drawn to analyze the predictive value of each indicator on the occurrence of AKI in bee stings patients.Results:There were significant differences in age, number of bee stings, and vomiting after admission between the two groups of patients. The levels of serum creatinine (SCr), PCT, interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP) were significantly higher in the AKI group than those in the non-AKI patients [SCr (μmol/L): 122.36±32.45 vs. 76.74±28.52, PCT (μg/L): 1.42±1.05 vs. 0.34±0.21, IL-6 (ng/L): 277.52±120.25 vs. 112.14±73.34, hs-CRP (mg/L): 7.64±3.26 vs. 3.01±2.13, all P < 0.05]. Serum PCT levels were positively correlated with serum SCr, IL-6, and hs-CRP levels in patients with AKI after bee stings ( r values of 0.486, 0.393, and 0.425, respectively; P = 0.002, 0.016, and 0.009, respectively). Multivariate Logistic analysis showed that age, SCr, PCT, IL-6, and hs-CRP were independent risk factors for AKI in patients with bee stings. The ROC curve analysis showed that the area under the ROC curve (AUC) of age, SCr, PCT, IL-6 and hs-CRP for predicting AKI in patients with bee stings were 0.622 [95% confidence interval (95% CI) was 0.516 to 0.727], 0.722 (95% CI was 0.601 to 0.843), 0.869 (95% CI was 0.781 to 0.958), 0.739 (95% CI was 0.627 to 0.851) and 0.799 (95% CI was 0.700 to 0.900), respectively. The best cut-off value of PCT was 0.742 μg/L, the sensitivity was 75.70% and the specificity was 90.50%. Conclusions:The serum PCT level was significantly elevated in patients with AKI after bee stings, which is an independent risk factor for AKI after bee stings. Serum PCT level has better predictive efficacy for AKI after bee stings and can be used as a valid biomarker for clinical prediction.

Chitinase AO-801 is a hydrolase secreted by Arthrobotrys oligospora during nematode feeding, while its role remained elusive. This study analyzed the molecular characteristics of recombinant chitinase of Arthrobotrys oligospora (reAO-801). AO-801 belongs to the typical glycoside hydrolase 18 family with conserved chitinase sequence and tertiary structure of (α/β)8 triose-phosphate isomerase (TIM) barrel. The molecular weight of reAO-801 was 42 kDa. reAO-801 effectively degraded colloidal and powdered chitin, egg lysate, and stage I larval lysate of Caenorhabditis elegans. The activity of reAO-801 reached its peak at 40˚C and pH values between 4-7. Enzyme activity was inhibited by Zn2+, Ca2+, and Fe3+, whereas Mg2+ and K+ potentiated its activity. In addition, urea, sodium dodecyl sulfate, and 2-mercaptoethanol significantly inhibited enzyme activity. reAO-801 showed complete nematicidal activity against C. elegans stage I larvae. reAO-801 broke down the C. elegans egg shells, causing them to die or die prematurely by hatching the eggs. It also invoked degradation of Haemonchus contortus eggs, resulting in apparent changes in the morphological structure. This study demonstrated the cytotoxic effect of reAO-801, which laid the foundation for further dissecting the mechanism of nematode infestation by A. oligospora.

Immune checkpoint inhibitor (ICI) has been emerged as a major breakthrough in tumor immunotherapy, but its unique mechanism of action has also led to a number of immune-related adverse events (irAE). Type 1 diabetes mellitus (T1DM) is one of the rarest irAEs. This paper reports a case of advanced malignant liver tumor-induced T1DM who received second-line anti-PD-1 therapy and showed initial symptoms of hyperosmolar coma and hyperglycemia. In addition, the relevant literature at home and abroad was collected and reviewed, and the clinical characteristics of T1DM induced by anti-PD-1 therapy were summarized with a view to achieve early detection, diagnosis and treatment.

Objective: To compare the clinical efficacy and safety of bortezomib, cyclophosphamide, dexamethasone (VCD) regimen and bortezomib dexamethasone (VD) regimen in the treatment of the patients with newly diagnosed multiple myeloma (NDMM). Methods: The clinical data of 73 patients with NDMM in Shanxi Dayi Hospital from January 2013 to January 2016 were retrospectively analyzed. According to the chemotherapy regimen, the patients were divided into VCD group (41 cases) and VD group (32 cases). The efficacy and adverse reactions of the two groups were evaluated. Results: The overall response rate of VCD group and VD group was 80.5% (33/41) and 78.1% (25/32) respectively, and the difference was not statistically significant (χ ²= 0.061, P= 0.804); and complete remission (CR) rate was 36.6% (15/41) and 15.6% (5/32) respectively, and the difference was statistically significant (χ ²= 3.970, P= 0.046); the median progression-free survival (PFS) was 27 months and 24 months respectively, and the median overall survival (OS) was 35 months and 33 months respectively, and the differences were not statistically significant (all P > 0.05). Most adverse reactions occurred in grade 1-2, in which peripheral polyneuropathy and thrombocytopenia were the most common. Peripheral neuritis was the most common finding among the adverse reactions of grade 3. The incidence of adverse reactions in both groups was not statistically significant (P > 0.05). Conclusions VCD and VD regimen could be recommended as a better induction therapy for NDMM patients. Compared with VD scheme, VCD scheme has a higher CR rate.

Objective To explore the 5,10-methylenetetrahydrofolate reductase (MTHFR) and 5-methyltetrahydro-folate-homocysteine methyltransferase reductase ( MTRR ) gene polymorphisms among the Han women in Zhangjiagang city .Methods A total of 4008 Han women were recruited .Their oral epithelial cells were collected to extract genome DNA in order to detect gene polymorphisms of MTHFR and MTRR using fluorescence quantitative PCR.Then the results were compared with those in other cities in China .Results The genotype frequencies of MTHFR C677T CC, CT and TT among Zhangjiagang women are 32.2%, 49.5%and 18.3%, respectively.The C allele frequency is 64.3%, T allele frequency is 35.7%.The genotype frequencies of MTHFR A1298 C AA, AC and CC are 68.7%,28.7% and 2.5%, respectively .The A allele frequency is 80.8%, C allele frequency is 19.2%.The genotype frequencies of MTRR A66 G AA, AG and GG are 54.4%, 38.5%and 7.1%, respectively . The A allele frequency is 76.3%, G allele frequency is 26.4%.Conclusions The MTHFR, MTRR polymorphism distribution of Han women in Zhangjiagang city is region specific.

Objective To explore the clinical effect of laparoscopy combined with choledochoscopy on choledocholithiasis.Methods Totally 134 elderly patients with choledocholithiasis were treated in our hospital from Jan 2013 to Dec 2014, who were randomly divided into observation group and control group (n=67 for each), treated with laparoscopy combined with choledochoscopy, and traditional surgery, respectively.The operation time, bleeding volume, exhaust time, in-hospital stay, complications and residual stones rate were compared between the two groups.Results The operation time was higher in observation group than in control group [(124.6±21.2) min vs.(94.7± 17.9) min, t=8.821, P＜0.001].The bleeding volume were less in observation group than in control group[(43.8±10.4) ml vs.(113.5±37.6) ml, t=14.624, P＜0.001].The exhaust time and in hospital time were decreased in observation group than in control group[(27.6 ±5.5) h vs.(43.4±8.1) h, (7.4±2.4) d vs.(10.3±2.8) d, t=13.209 and 6.437, P＜0.001 for both].The incidences of postoperative pain and other complications were lower in observation group than in control group [6.0％ vs.28.4％, 16.4％ vs.43.3％, x2=11.810and 11.547, P=0.001 for all].Conclusions The laparoscopy combined with choledochoscopy has advantages to minimize the surgical injury, reduce the bleeding volume and promote the postoperative recovery in treating choledocholithiasis in elderly patients.

Chronic constipation is a highly debilitating condition, affecting a significant proportion of the commu-nity. Rhei Radix et Rhizoma (rhubarb) is one of the important herbal drugs used in traditional Chinese medicine (TCM) for treating constipation which includes four groups of main active components such as free anthraquinone, conjunc-tive anthraquinone, rhubarb tannin, and rhubarb polysaccharides. However, which one is response for the laxative effect of rhubarb is unknown. Therefore, we proposed a strategy for the effect-guided quality control of TCM based on disease. The effective material for laxative effect of rhubarb was firstly screened based on the constipation model. And different production locations were investigated. Then, the processing was optimized to set up a quality control of rhubarb. It was found that the bioactive component was the conjunctive anthraquinone for the laxative effect. And the raw herb from Liangshan had the best quality compared with those from Pingwu and Beichuan in Sichuan Prov-ince, China. The extraction ethanol volumes to substrate ratio of 10.34, extraction time of 24.25 min and extraction number of 4 were the best conditions for the extraction of conjunctive anthraquinone. Under the optimized condi-tions, the maximum production was 5.455 mg·g-1. This extraction procedure was used as quality control of rhubarb in the treatment of constipation.

Objective To establish the procedural pain nursing care protocols to improve the management of perioperative pain in elderly patients after total knee replacement,as well as to relief postoperative pain,and promote the rehabilitation.Methods 82 patients were randomly divided into the control group (45 cases) and the intervention group (37 cases).The control group was controlled by usual care,and the intervention group was offered with the standardized pain nursing care.The scores for postoperative pain,the satisfaction for analgesia,the complications associated with analgesia and the injection rate of Dolantin at 24,48,72h postoperatively were compared between two groups.Results The score for postoperative pain at rest in the intervention group was significantly lower than that in the control group at 24 h postoperatively,but there was no statistical difference at 48 h and 72 h postoperatively.Pain scores during passive activity at 24,48h,and 72h postoperatively were significantly lower in the intervention group when compared with that of the control group.The rates of side effects at 24,48,72h postoperatively in the intervention group were significantly lower than those in the control group.The injection rate of Dolantin in the control group were significantly higher than that in the intervention group.The score for both analgesia and life satisfactory in the intervention group was significantly higher than that in the intervention group at 24,48,72h postoperatively.Conclusions Procedural pain nursing care can reduce the pestoperative pain,complications and the injection rate of Dolantin in patients after total knee replacement.It can also improve elderly patients' satisfaction of analgesia and promote early recovery of their joint function.

Objective To observe the bone density, serum osteoprotegerin (OPG) level,relevant parameters of bone metabolism and sex hormones in elderly men with osteoporosis before and after treatment with oral Fosamax for 3 years. Methods The serum OPG level was compared between 72 randomly selected elderly male patients with osteoporosis and age-matched healthy controls. The bone density, serum OPG level, sex hormones, serum calcium and phosphorus,parathyroid hormone (PTH), osteoealein and urine type Ⅰ collegen crosslinked N-telopeptides (NTX),urine calcium and cretinine were tested in all elderly male patients with osteoporosis before and after 3 years of oral Fosamax treatment. The role of OPG in anti-osteoporotic therapy was studied by comparison of the parameters tested during the course of treatment. Results The serum levels of OPG osteoealcin, PTH and urine NTX were obviously higher in elderly men with osteoporosis than in healthy controls [(10.56±2.56) pmol/L vs. (8.91±2.20) pmol/L, (9.544±4.40) g/L vs. (6.774±2.87)rig/L, (70.39±35.58) ng/L vs. (47.11±21.80) ng/L, (72.06±9.78) nmol/L vs. (63.36±14.61)nmol/L, all P<0.05]. After treatment with oral Fosamax , the bone density was significantly increased. However, serum levels of OPG[(8.23±2.96)pmol/L], osteocalcinE(6.18±2.27)μg/L],PTH[(40.46±14.43) ng/L] and urine NTX[(64.83±11.40) nmol/L] were significantly decreased after treatment (all P<0.05). Spearman analysis showed that the improvement of bone density after treatment was closely associated with serum OPG level. Conclusions Serum OPG level in elderly patients with osteoporosis is much higher than that in control group. The improvement in bone density after treatment is associated with the decrease in OPG level. Bone density and relevant parameters of bone metabolism can be improved in elderly male patients with osteoporosis by using oral Fosamax.