Objective:To learn about physicians’ concepts and commonly employed method in hyaluronic acid injection and provide reference data for the standardization of pain management.Methods:This study was a cross-sectional study. Convenient sampling method was used to distribute questionnaires to cosmetic injectors and patients experienced with hyaluronic acid injections to collect data on their views of pain associated with hyaluronic acid injections. The physician portion was collected offline from June 15 to July 20, 2022, and the patient portion was collected from November 14, 2022, to December 6, 2022, via the Questionnaire Star platform. The physician questionnaire consisted of 17 questions, question types included single choice, multiple choice and essay questions. The patient questionnaire consisted of 6 questions, question types included single choice and multiple choice. Relevant data were analyzed using SPSS 22.0 software for descriptive statistics, and data were presented in the form of cases and percentages (%).Results:Sixty-two physician questionnaires and 123 patient questionnaires were collected. 42 (67.74%) physicians observed from their daily practice that more than 50% of their patients were very concerned about pain during injection; 101 (82.11%) patients scored ≥5 out of 10 for concern about impending pain prior to hyaluronic acid filler injection. At the time of treatment, 48 (77.42%) physicians advised patients to choose a lidocaine-containing hyaluronic acid filler for reasons including a significant reduction in injection pain (53 cases, 85.48%) and patient comfort with the treatment experience (59 cases, 95.16%). 60 (48.78%) patients were willing to choose an anesthesia-containing product at the time of injection, but the price of the anesthesia-containing product influenced the patient’ s choice (55 cases 44.72%) .Conclusions:Pain from cosmetic injectable treatments is an important issue to both physicians and patients. Lidocaine-containing hyaluronic acid is recognized by physicians and patients for its analgesic effect and high safety profile. There is no perfect solution for pain in cosmetic injection treatment, and multidisciplinary collaboration may be needed to solve the problem.

Objective:To learn about physicians’ concepts and commonly employed method in hyaluronic acid injection and provide reference data for the standardization of pain management.Methods:This study was a cross-sectional study. Convenient sampling method was used to distribute questionnaires to cosmetic injectors from plastic surgery department of public hospitals or medical beauty institutions and patients experienced with hyaluronic acid injections to collect data on their views of pain associated with hyaluronic acid injections. The physician portion was collected offline from June 15 to July 20, 2022, and the patient portion was collected from November 14 to December 6, 2022, via the Questionnaire Star platform. The physician questionnaire consisted of 17 questions, question types included single choice, multiple choice and essay questions. The patient questionnaire consisted of 6 questions, question types included single choice and multiple choice. Relevant data were analyzed using SPSS 22.0 software for descriptive statistics, and data were presented in the form of cases(%).Results:Sixty-two physician questionnaires and 123 patient questionnaires were collected. 42 (67.74%) physicians observed from their daily practice that more than 50% of their patients were very concerned about pain during injection; 101 (82.11%) patients scored ≥5 out of 10 for concern about impending pain prior to hyaluronic acid filler injection. At the time of treatment, 48 (77.42%) physicians advised patients to choose a lidocaine-containing hyaluronic acid filler for reasons including a significant reduction in injection pain (53 cases, 85.48%) and patient comfort with the treatment experience (59 cases, 95.16%). 60 (48.78%) patients were willing to choose an anesthesia-containing product at the time of injection, but the price of the anesthesia-containing product influenced the patient’s choice (55 cases, 44.72%).Conclusion:Pain from cosmetic injectable treatments is an important issue to both physicians and patients. Lidocaine-containing hyaluronic acid is recognized by physicians and patients for its analgesic effect and high safety profile. There is no perfect solution for pain in cosmetic injection treatment, and multidisciplinary collaboration may be needed to solve the problem.

Objective:To learn about physicians’ concepts and commonly employed method in hyaluronic acid injection and provide reference data for the standardization of pain management.Methods:This study was a cross-sectional study. Convenient sampling method was used to distribute questionnaires to cosmetic injectors and patients experienced with hyaluronic acid injections to collect data on their views of pain associated with hyaluronic acid injections. The physician portion was collected offline from June 15 to July 20, 2022, and the patient portion was collected from November 14, 2022, to December 6, 2022, via the Questionnaire Star platform. The physician questionnaire consisted of 17 questions, question types included single choice, multiple choice and essay questions. The patient questionnaire consisted of 6 questions, question types included single choice and multiple choice. Relevant data were analyzed using SPSS 22.0 software for descriptive statistics, and data were presented in the form of cases and percentages (%).Results:Sixty-two physician questionnaires and 123 patient questionnaires were collected. 42 (67.74%) physicians observed from their daily practice that more than 50% of their patients were very concerned about pain during injection; 101 (82.11%) patients scored ≥5 out of 10 for concern about impending pain prior to hyaluronic acid filler injection. At the time of treatment, 48 (77.42%) physicians advised patients to choose a lidocaine-containing hyaluronic acid filler for reasons including a significant reduction in injection pain (53 cases, 85.48%) and patient comfort with the treatment experience (59 cases, 95.16%). 60 (48.78%) patients were willing to choose an anesthesia-containing product at the time of injection, but the price of the anesthesia-containing product influenced the patient’ s choice (55 cases 44.72%) .Conclusions:Pain from cosmetic injectable treatments is an important issue to both physicians and patients. Lidocaine-containing hyaluronic acid is recognized by physicians and patients for its analgesic effect and high safety profile. There is no perfect solution for pain in cosmetic injection treatment, and multidisciplinary collaboration may be needed to solve the problem.

Objective:To learn about physicians’ concepts and commonly employed method in hyaluronic acid injection and provide reference data for the standardization of pain management.Methods:This study was a cross-sectional study. Convenient sampling method was used to distribute questionnaires to cosmetic injectors from plastic surgery department of public hospitals or medical beauty institutions and patients experienced with hyaluronic acid injections to collect data on their views of pain associated with hyaluronic acid injections. The physician portion was collected offline from June 15 to July 20, 2022, and the patient portion was collected from November 14 to December 6, 2022, via the Questionnaire Star platform. The physician questionnaire consisted of 17 questions, question types included single choice, multiple choice and essay questions. The patient questionnaire consisted of 6 questions, question types included single choice and multiple choice. Relevant data were analyzed using SPSS 22.0 software for descriptive statistics, and data were presented in the form of cases(%).Results:Sixty-two physician questionnaires and 123 patient questionnaires were collected. 42 (67.74%) physicians observed from their daily practice that more than 50% of their patients were very concerned about pain during injection; 101 (82.11%) patients scored ≥5 out of 10 for concern about impending pain prior to hyaluronic acid filler injection. At the time of treatment, 48 (77.42%) physicians advised patients to choose a lidocaine-containing hyaluronic acid filler for reasons including a significant reduction in injection pain (53 cases, 85.48%) and patient comfort with the treatment experience (59 cases, 95.16%). 60 (48.78%) patients were willing to choose an anesthesia-containing product at the time of injection, but the price of the anesthesia-containing product influenced the patient’s choice (55 cases, 44.72%).Conclusion:Pain from cosmetic injectable treatments is an important issue to both physicians and patients. Lidocaine-containing hyaluronic acid is recognized by physicians and patients for its analgesic effect and high safety profile. There is no perfect solution for pain in cosmetic injection treatment, and multidisciplinary collaboration may be needed to solve the problem.

Objective To investigate liver inflammation and fibrosis in patients with chronic HBV infection with a low viral load. Methods Among the HBsAg-positive patients who attended Ganzhou Fifth People's Hospital from April 2019 to June 2022, 41 patients with 20 IU/mL < HBV DNA < 2 000 IU/mL were selected and underwent the examinations of blood biochemistry, liver stiffness measurement (LSM), and liver biopsy to clarify liver inflammation and fibrosis. Liver inflammation was analyzed according to HBV DNA, alanine aminotransferase (ALT), LSM, and age. The chi-square test was used for comparison of categorical data between groups. Results Among the 41 patients, 15 (36.59%) had liver inflammation grade ≥G2 and/or liver fibrosis stage ≥S2. Among these 15 patients, 11 (73.33%) had an HBV DNA level of > 200-2 000 IU/mL and 4 (26.67%) had an HBV DNA level of 20-200 IU/mL; the patients with G2 liver inflammation accounted for 73.33% (11/15), and those with S2 liver fibrosis accounted for 46.67% (7/15); the patients with ALT ≤30 U/L accounted for 46.67% (7/15); the patients aged ≥30 years accounted for 86.66% (13/15); the patients with LSM > 17 kPa accounted for 6.67% (1/15), those with an LSM value of 12.4-17 kPa accounted for 46.67% (7/15), and those with an LSM value of 9.4-12.4 kPa accounted for 33.33% (5/15). Conclusion Patients with chronic HBV infection and low-level viremia have a relatively high risk of progression of inflammation and fibrosis. ALT level cannot be used as a basis for antiviral therapy in HBV-infected people with a low viral load. LSM based on transient elastography can be used as a noninvasive test to screen for CHB patients with a low viral load, and antiviral therapy should be considered when HBV-infected patients with a low viral load have an age of > 30 years and an LSM value of > 9.4 kPa persistently.

Objective To investigate the possible influence of long-term antiviral therapy with entecavir on renal function in patients with chronic hepatitis B (CHB) and the sensitive indicators for early identification of renal injury. Methods A cross-sectional real-world study was conducted for the clinical data of 125 CHB patients treated with entecavir for more than 1 year (treatment group) and 44 patients with chronic HBV infection who did not receive antiviral therapy (control group), including the changes in serum creatinine (SCr), estimated glomerular filtration rate (eGFR), and the levels of urinary α1 microglobulin (α1-MG), β2 microglobulin (β2-MG), and N-acetyl-β-D-glucosaminidase (NAG). The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The Logistic regression analysis was used to investigate independent influencing factors for abnormal urinary α1-MG, β2-MG, and NAG in the treatment group. Results There were no significant differences in SCr and eGFR between the treatment group and the control group ( t =0.999 and -1.259, P > 0.05), and both indices were within the normal range in these two groups. The treatment group had significantly higher abnormal rates of urinary α1-MG and β2-MG than the control group (47.2%/42.4% vs 13.6%/13.6%, χ 2 =15.693 and 12.567, both P < 0.001), and compared with the control group, the treatment group had a significantly higher proportion of patients with α1-MG or β2-MG > 2×upper limit of normal (18.4%/21.6% vs 2.3%/4.5%, both P < 0.05); however, there were no significant differences between the treatment group and the control group in the abnormal rate of urinary NAG (8.0% vs 6.8%, P > 0.05) and the proportion of patients with urinary NAG > 2×upper limit of normal (8.8% vs 6.8%, P > 0.05). Compared with the control group, the treatment group had a significantly higher proportion of patients with abnormalities in two or more indicators for renal tubular injury (33.6% vs 11.4%, χ 2 =8.519, P < 0.05), while there was no significant difference between the two groups in the proportion of patients with abnormalities in one indicator (16.0% vs 11.4%, P > 0.05). Conclusion Long-term treatment of CHB with entecavir may be associated with the risk of renal tubular dysfunction, and abnormalities in more than two indicators for renal injury may help to identify renal tubular dysfunction in patients, so as to adjust related treatment in time.

Objective:To explore the significance of triggering receptor expressed on myeloid cells-2 (TREM-2) prognostic evaluation so as to provide novel biological markers in clinical practice for patients with hepatitis B virus-related acute-on-chronic liver failure ( HBV-ACLF).Methods:The research subjects of this study were divided into an experimental group and a control group. Fifty HBV-ACLF cases admitted to the Department of Infectious Diseases of the First Affiliated Hospital of Nanchang University from January 1, 2019 to December 31, 2019 were selected as the experimental group. Patients were divided into survival and death groups according to the actual prognosis at discharge (self-discharge and dead patients were considered death groups, and all enrolled patients were hospitalized for more than 28 days). Twenty-five healthy subjects were chosen as the control group. Peripheral venous blood was collected from the experimental group and the control group. Plasma and peripheral blood mononuclear cells (PBMC) were isolated. The concentrations of TREM-2, interleukin (IL)-6, and IL-8 were detected in the plasma. TREM-2 mRNA expression was detected in PBMC. A single blood sample was collected from the control group, whereas five blood samples were dynamically collected from the experimental group on the day of admittance and at 7, 14, 21, and 28 days after treatment commenced. Simultaneously, upon admission, the relevant clinical indicators of HBV-ACLF patients were monitored, including the liver function test: alanine aminotransferase, aspartate aminotransferase, total bilirubin, albumin, coagulation function test: international normalized ratio, prothrombin time, and other indicators. Measurement data were expressed as mean±standard deviation (x±s). Count data were compared and analyzed using the χ 2 test. The intra-group factor mean was compared using a repeated measures ANOVA. The means were analyzed by t-tests between the two groups. Bivariate correlation analysis was used to analyze the correlation between the two variables. The value of TREM-2 as a diagnostic marker was analyzed using the receiver operating characteristic (ROC) curve. Results:The mRNA expression of TREM-2 in the PBMC of HBV-ACLF patients showed a gradually increasing trend at various time points and was significantly higher in the survival group than that of the control group at 28 days ( P < 0.01), while the death group showed a gradually weakening trend at various time points and was significantly lower than the control group at 28 days ( P < 0.01). (1) The levels of TREM-2 in the plasma of HBV-ACLF patients generally showed a gradually increasing trend at various time points in the survival group. The levels on the day of admission and 7, 14, 21, and 28 days after the initiation of treatment were (1.49±0.85), (1.62±0.58), (1.95±0.69), (2.33±0.71), and (2.00±0.67) ng/ml, respectively. The expression of TREM-2 in the death group showed a gradually weakening trend at various time points. The levels on the day of admission and 7, 14, 21, and 28 days after initiation of treatment were (1.40±0.73), (1.59±0.79), (1.56±0.80), (1.05±0.49), and (0.81±0.21) ng/ml, respectively. The survival group's various detection time points were higher than those of the death group, and the difference was statistically significant. The plasma level of TREM-2 in the healthy control group was (1.25±0.35) ng/ml. (2) The concentrations of IL-6 and IL-8 in the plasma of HBV-ACLF patients showed a gradually decreasing trend at various time points in the survival group. The levels on the day of admission and 7, 14, 21, and 28 days after initiation of treatment were (46.70±26.31), (33.98±20.28), (19.07±10.24), (14.76±7.84), (9.12±7.65) and (108.29±47.07), (93.85±26.53), (79.27±34.63), (56.72 ±18.30), (37.81±13.88) pg/ml, respectively. However, its concentration in the death group fluctuated within a relatively high range. The levels on the day of admission and 7, 14, 21, and 28 days after the initiation of treatment were (41.94±24.19), (36.99±19.78), (34.30±20.62), (34.14±14.52), (36.64±23.61) and (104.65±50.16), (112.98±45.03), (118.43±45.00), (111.67±40.44), (109.55±27.54) pg/ml, respectively. (3) Bivariate correlation analysis results indicated that the plasma TREM-2 content was negatively correlated with the plasma levels of pro-inflammatory cytokines IL-6 and IL-8 ( r = -0.224, P = 0.025; r = - 0.223, P = 0.026). ROC curve analysis showed that the mRNA levels of TREM-2 in PBMCs at various time points for prognostic evaluation of HBV-ACLF patients were 1d=0.667, 7d=0.757, 14d=0.979, 21d=0.986, and 28d= 0.993. The areas under the ROC curve of the TREM-2 content in the plasma at various time points were 1d=0.522, 7d=0.571, 14d=0.658, 21d=0.927, and 28d=0.994. Conclusion:TREM-2 mRNA expression in PBMC and TREM-2 content in plasma have a significant relationship to the prognosis of HBV-ACLF patients and may inhibit the liver inflammatory response by regulating the secretion of pro-inflammatory cytokines IL-6 and IL-8. Dynamic monitoring of TREM-2 expression in peripheral blood is favorable for evaluating the prognostic condition of HBV-ACLF patients.

Objective To investigate the difference in the prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) caused by hepatitis recurrence after withdrawal of nucleos(t)ide analogues (NUC) and possible causes in HBeAg-positive versus HBeAg-negative chronic hepatitis B (CHB) patients. Methods A total of 108 CHB patients with HBV-ACLF caused by withdrawal of NUC who were admitted to The First Affiliated Hospital of Nanchang University from January 2017 to December 2018 were enrolled, and according to HBeAg status, these patients were divided into HBeAg-positive group with 57 patients and HBeAg-negative group with 51 patients. The two groups were compared in terms of sex, age, clinical manifestation, signs, levels of total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, prothrombin time, activated partial thromboplastin time, prothrombin time/international normalized ratio, and HBV DNA quantification on admission, complications (including hepatic encephalopathy, hepatorenal syndrome, and spontaneous bacterial peritonitis), and prognosis of HBV-ACLF. In addition, 48 CHB patients with continuous NUC antiviral therapy for > 2 years and HBV DNA < 20 IU/mL were enrolled, and the serum level of HBV pgRNA was measured to investigate the possible causes of the difference in the prognosis of HBV-ACLF between the patients with different HBeAg statuses. The two-independent-samples t test was used for comparison of normally distributed continuous data between two groups, and the Kruskal-Wallis H 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. Results For the 108 patients with HBV-ACLF caused by drug withdrawal and recurrence, the HBeAg-positive group had an improvement rate of 49.1% and the HBeAg-negative group had an improvement rate of 74.5%. The HBeAg-negative group had a significantly higher improvement rate than the HBeAg-positive group ( χ 2 =2.811, P =0.006). The HBeAg-positive group had a significantly higher level of HBV DNA than the HBeAg-negative group on admission ( t =-3.138, P =0.002). For the 48 CHB patients who achieved virologic response after long-term antiviral therapy, the HBeAg-positive group had a significantly higher HBV pgRNA load than the HBeAg-negative group ( H =2.814, P =0.049). Conclusion Compared with the HBeAg-positive CHB patients, HBeAg-negative CHB patients have a significantly better improvement rate of HBV-ACLF caused by hepatitis recurrence after withdrawal of NUC antiviral therapy. The difference in baseline HBV pgRNA level may be associated with the difference in the prognosis of HBV-ACLF in patients with different HBeAg statuses.

Objective:To investigate the predictive value of serum soluble urokinase-type plasminogen activator receptor (suPAR) combined with alpha-fetoprotein (AFP) and model for end-stage liver disease (MELD) score in short-term prognosis assessment of patients with chronic hepatitis B (CHB) related acute-on-chronic liver failure (ACLF).Methods:From January 2018 to May 2020, 66 patients with CHB related ACLF from Fuzhou First People′s Hospital were enrolled. After 90 days of follow-up, the patients with CHB related ACLF were divided into death group and survival group according to the outcome. Meanwhile, 30 patients with CHB were enrolled by simple random sampling method. The differences of serum suPAR in patients with CHB related ACLF and patients with CHB were analyzed. The values of suPAR, AFP and MELD score were compared between death group and survival group in patients with CHB related ACLF. The predictive value of suPAR, AFP, MELD score, Child-Turcotte Pugh score (CTP score) and suPAR combined with AFP and MELD score in the short-term prognosis of patients with CHB related ACLF were analyzed by area under the receiver operator characteristic curve (AUROC). Data were analyzed by two independent sample t test or non-parametric test. Results:The serum suPAR level of patients with CHB related ACLF was (9.6±0.8) ln ng/L, which was higher than that of patients with CHB ((8.0±0.3) ln ng/L). The difference was statistically significant ( t=14.533, P<0.01). The suPAR and MELD score of patients with CHB related ACLF in the death group were (9.9±0.7) ln ng/L and 29.6 (7.1) points, respectively, which were higher than those in the survival group ((9.4±0.7) ln ng/L and 21.0 (5.0) points, respectively). The AFP level in the death group was 45.9 (108.1) μg/L, which was lower than that in the survival group (209.3 (187.1) μg/L). There were significant differences in suPAR ( t=2.895, P=0.005), MELD score ( Z=4.708, P<0.01) and AFP ( Z=3.051, P<0.01) between the death group and the survival group. AUROC of suPAR (0.741, P=0.001), AFP (0.724, P=0.002) and MELD score (0.885, P<0.01) had predictive value for death in patients with CHB related ACLF. The sensitivities of suPAR, AFP, MELD score, CTP score and suPAR combined with AFP and MELD score were 84.6%, 73.1%, 88.5%, 96.2% and 84.6%, respectively, and the specificities were 75.0%, 72.5%, 70.0%, 52.5% and 92.5%, respectively. The AUROC of suPAR combined with AFP and MELD score was 0.871 ( P<0.01), which was higher than that of CTP score (0.793, P<0.01). Conclusions:Serum suPAR is increased in patients with CHB related ACLF. SuPAR combined with AFP and MELD score could apply in the prognostic value for patients with CHB related ACLF.

Objective:To study the relationship between serum HBV pgRNA and antigen status in patients with chronic hepatitis B treated with long-term nucleotide analogues, and to elucidate the reason and possible mechanism of high relapse rate in antiviral therapy of nucleotide analogues in chronic hepatitis B.Methods:94 patients with chronic hepatitis B who had been treated with long-term antiviral therapy with nucleotide analogues (more than 2 years) were divided into 5 groups according to their HBeAg and HBsAg levels: e antigen positive group(group1), e antigen negative and HBsAg > 1 500 IU/L group(group2), e antigen negative and 100 IU/L< HBsAg < 1 500 IU/L group(group3), e antigen negative and HBsAg < 100 IU/L group(group4), e antigen negative and HBsAg negative group(group5). The level and detection rate of HBVpgRNA in different antigen states groups were analyzed and compared. In addition, in order to exclude the influence of other factors on the results of this study. The study was divided into groups according to age, gender and treatment time.Results:The detection rate of HBVpgRNA was 95.0% in patients with e antigen positive, while 43.2% in patients with e antigen seroconversion, which was significantly lower than that in patients with e antigen positive ( P < 0.05). The detection rate of serum HBVpgRNA was 95.0% in e antigen positive group, 75.0% in group 2, 65.0% in e antigen negative with group 3, 15.0% in group 4 and 0% in group 5. Among them, group 1, group 2 and group 3 was significantly higher than that in group 4 and group 5. There was significant difference between the two groups ( P < 0.05). However, there was no difference in the positive rate of serum HBV pgRNA among group 1, group 2 and group 3 ( P > 0.05). Similarly, there was no difference in the positive rate of serum HBV pgRNA between group 4 and group 5 ( P > 0.05). Moreover, the detection rate of serum HBV pgRNA was not correlated with age, gender and treatment time of nucleotide analogues ( P > 0.05). Conclusion:There is a significant correlation between the serological antigen status and the presence of HBV pgRNA in chronic hepatitis B after long-term treatment of nucleotide analogues. The persistence of HBV pgRNA is closely related to the low seroconversion rate of e antigen and the high level of HBsAg. HBV pgRNA can be used as one of the biomarkers to judge the transcription activity and replication status of HBV cccDNA in liver.