Objective:To analyze the clinical features of postpartum hepatitis flares in pregnant women with hepatitis B virus (HBV) infection.Methods:A retrospective study was conducted. Patients who met the enrollment criteria were included. Liver function and HBV virology tests were collected from pregnant women with chronic HBV infection at delivery, 6, 24, 36, and 48 weeks after delivery through the hospital information and test system. Additionally, antiviral therapy types and drug withdrawal times were collected. Statistical analysis was performed on all the resulting data.Results:A total of 533 pregnant women who met the inclusion criteria were included, with all patients aged (29.5±3.7) years old. A total of 408 cases received antiviral drugs during pregnancy to interrupt mother-to-child transmission. There was no significant difference in the levels of alanine aminotransferase (ALT, z ?=?-1.981, P ?=?0.048), aspartate aminotransferase (AST, z ?=?-3.956, P ?

Objective To investigate the onset of liver inflammation and related predictive factors in patients with HBeAg-positive chronic hepatitis B virus (HBV) infection who have normal alanine aminotransferase (ALT) and a high viral load. Methods A retrospective analysis was performed for the clinical data of 183 patients with HBeAg-positive chronic HBV infection who had normal ALT and a high viral load and were treated from October 2008 to May 2015, and according to the results of liver biopsy, they were divided into hepatitis group and non- hepatitis group. The t -test or Mann-Whitney U testwas used for comparison of normally distributed continuous data between groups, the chi-square test was used for comparison of categorical data. The predictive factors were analyzed by univariate binary logistic regression, the multivariate binary logistic regression was carried out by stepback method, and the cut-off values were analyzed by receiver operating characteristic curve (ROC) and Jordan index. Results There were 37 patients (20.2%) in the hepatitis group and 146 patients (79.8%) in the non-hepatitis group. Compared with the non-hepatitis group, the hepatitis group had a significantly lower proportion of male patients (45.9% vs 68.5%, χ 2 =6.508, P =0.011), a significantly higher level of aspartate aminotransferase [24 (21.25~35.55) U/L vs 21.2 (18.08~ 24.65) U/L, Z =-3.344, P =0.001], and a significantly lower log(HBsAg) value [4.4(4.28~4.49) vs 4.46(4.4~4.74), Z =-2.184, P =0.029]. Log(HBsAg) value was a predictive factor for hepatitis (odds ratio=0.077, P =0.017), and the cutoff value of HBsAg was 33884.4I U/mL. Conclusion Among the patients with HBeAg-positive chronic HBV infection who have normal ALT and a high viral load, 20.2% have liver inflammation, and HBsAg may be a predictive factor for liver inflammation.

Objective To compare clinical and pathological features between autoimmune hepatitis (AIH) patients with positive and negative autoantibodies, and to summarize the experience in diagnosis. Methods A retrospective analysis was performed for the patients who attended Beijing Ditan Hospital from January 2010 to August 2021 and were diagnosed with AIH by liver histopathology, and according to the presence or absence of autoantibodies, they were divided into positive autoantibody group and negative autoantibody group. The two groups were compared in terms of biochemical parameters, immunological features, histopathological features, disease stage, and clinical symptoms and signs. The t -test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data. Results A total of 110 patients were enrolled, among whom 78 (71%) had positive autoantibodies and 32 (29%) had negative autoantibodies. Anti-nuclear antibody (ANA), anti-mitochondrial antibody (AMA), and anti-smooth muscle antibody (ASMA) were the main autoantibodies detected, and of all 110 patients, 74 (67.27%) had positive ANA, 1 (0.91%) had positive AMA, 5 (4.55%) had positive ASMA, and 14 (12.73%) had positive anti-Ro-52 antibody. As for clinical and immunological features, compared with the positive autoantibody group, the negative autoantibody group had significantly lower incidence rates of jaundice of the skin and sclera (21.90% vs 50.00%, χ 2 =7.377, P =0.007) and poor appetite (18.80% vs 41.00%, χ 2 =4.979, P =0.026) and significantly lower median levels of direct bilirubin [7.30(4.05~12.10) μmol/L vs 16.80(6.48~69.75) μmol/L, Z =-2.304, P =0.021], IgG [16.40(13.15~18.05) g/L vs 20.30(16.00~27.15) g/L, Z =-2.715, P =0.007], and GLo [30.60(26.00~34.90) g/L vs 37.30(30.50~42.50) g/L, Z =-3.356, P =0.001]. In terms of liver histopathology, compared with the negative autoantibody group, the positive autoantibody group had a significantly higher proportion of patients with lymphocyte infiltration (91.03% vs 68.75%, χ 2 =6.997, P =0.008) and plasma cell infiltration (82.05% vs 50.00%, χ 2 =11.572, P =0.001); compared with the ANA-negative patients, the ANA-positive patients had significantly higher inflammation grade (G1-G4) (9.46%/16.22%/44.59%/29.73% vs 5.56%/27.78%/63.89%/2.78%, Z =-2.179, P =0.029) and fibrosis degree (S1-S4) (37.84%/25.68%/32.43%/4.05% vs 13.89%/41.67%/30.56%/13.89%, Z =-0.082, P =0.037). Conclusion Compared with AIH patients with positive autoantibodies, AIH patients with negative autoantibodies are mostly in the early stage of the disease and tend to have a low level of IgG, with a relatively high rate of missed diagnosis in clinical practice. Early and active liver biopsy is of particular importance.

Objective:To study the predictors of postpartum hepatitis in pregnant women with chronic HBV infection.Methods:In this retrospective study, liver function and hepatitis B virology tests of pregnant women with chronic HBV infection at delivery and within 48 weeks were collected from the clinical medical system after the enrollment of eligible patients. Statistical analysis was performed on the obtained data.Results:A total of 533 pregnant women meeting the criteria were enrolled, and the average age of all patients was 29.5±3.7. A total of 408 pregnant women took antiviral drugs during pregnancy for prevention of mother-to-child transmission; 231 patients developed hepatitis within 1 year after delivery. There were significant differences in alanine transaminase (ALT), aspartate transaminase (AST), HBV DNA during delivery, hepatitis B e antigen (HBeAg) during delivery and baseline HBeAg between patients with and without hepatitis. Multivariate binary logistic regression analysis showed that HBeAg ( OR=0.19, 0.074-0.473; P<0.001), ALT ( OR=1.05, 1.021-1.071; P<0.001), albumin ( OR=0.91, 0.833-0.995; P=0.038), platelet ( OR=0.995, 0.992-0.999; P=0.01), neutrophils ( OR=0.98, 0.973-0.995; P=0.004) had significant difference. Conclusions:Baseline HBeAg and ALT are powerful predictors of postpartum hepatitis in pregnant women with chronic HBV infection.

The functional cure of hepatitis B means that patients have good clinical outcomes, which is the ideal endpoint of hepatitis B antiviral treatment. Whether chronic hepatitis B patients can achieve functional cure is related to the nature of the virus itself, such as virus species, virus replication and expression of related proteins, on the other hand, it is also related to the host body's immunity, including innate immunity and specific immunity. Immune factors play a vital role in the functional cure of hepatitis B. Antiviral drugs, including interferon, often play an antiviral role by regulating immunity. This paper reviews the relationship between hepatitis B and functional cure from the perspective of immunity, in order to provide the basis for the clinical pursuit of functional cure, hoping to provide guidance for clinical practice.

Objective:To investigate the distribution characteristics and related factors of HBsAb in infants born to women with chronic hepatitis B virus (HBV) infection.Methods:A total of 605 infants born to women with chronic HBV infection who met the requirements for inclusion were selected as the subjects. Information about the mother′s previous HBV infection, biochemical indicators during pregnancy, pregnancy complications, information about delivery, and hepatitis B test result after birth were collected. HBsAg and HBsAb at the age of 1 year were determined, and HBsAg and HBsAb at the age of 7 months were retrospectively collected. The factors influencing HBsAb in infants were analyzed by ordered logistic regression.Results:In 605 infants, the infection rate was about 1%. Among them, 6 infants were positive for HBsAg and HBV DNA at 7 months and 1 year of age. Uninfected infants were divided into groups according to HBsAb titers. The result showed that there were significant differences in prothrombin activity (PTA) ( χ2=11.17, P=0.01), positive rate of HBeAg ( χ2=7.87, P=0.049) and HBsAg positive rate at birth ( χ2=10.52, P=0.02) among different groups. Multivariate ordered Logistic regression analysis showed that HBsAg negative at birth was an independent protective factor for HBsAb at 7 months of age ( OR=1.564, 95% CI 1.092-2.239, P=0.015). Logistic regression analysis of HBsAb at 1 year of age showed maternal gestational diabetes mellitus ( OR=1.578, 95% CI 1.126-2.210, P=0.008), infant enhanced immunization ( OR=81.207, 95% CI 31.202-211.352, P < 0.001) and antibody level at 7 months of age ( OR=42.123, 95% CI 22.824-77.739, P < 0.001) were independently associated with HBsAb at 1 year of age. Conclusions:HBsAg negative in venous blood at birth was an independent protective factor for HBsAb at 7 months of age, and enhanced immunization was an independent protective factor for HBsAb at 1 year of age.

Objective To explore the application value of multiphase dynamic contrast-enhanced MRI (MDCE-MRI) in the early chemoradiation efficacy in cervical cancer.Methods Twenty-one patients with cervical cancer received chemoradiation.Routine MR scan and MDCE-MRI scan were examined at different stages, including pre-treatment, 15 days,1 month and 2 months after treatment.According to volume change of the tumor after treatment, the cases were mainly divided into complete remission(CR), partial remission (PR).The correlation between volume change of cancer after treatment and the time-signal intensity curve (TIC),mean time to enhancement(MTE),time to peak(TTP),maximum slope of increase(MSI),maximum slope of decrease(MSD), negative enhancement integral (NEI) were analysed.Results After system chemoradiation for 2 months,4 of enrolled patients got complete remission and 17 partial remission.The reduction rate of the tumor diameter was negatively correlated to MSI values(r=-0.877,P<0.05) and positively related with NEI (r=0.819,P<0.05) before the treatment.15 days after the treatment, the diminished rate of the tumor diameter had active relation with change of TTP(r=0.765,P<0.05) and NEI(r=0.775,P<0.05).It indicated that MSI and NEI values before cervical cancer chemoradiation and the variation of TTP and NEI after treatment for 15 days could help predict the variation tendency of cancer diameter.Chemoradiation and therapy 1 month later,for all the parameters'' AUC values,the change rate of NEI were the largest one.When the critical value was not less than 96.46%, the sensitivity was 82.4%, specificity was 75%.TIC curve of type Ⅰ increased, type Ⅲ decreased to disappear gradually.Conclusion MDCE-MRI can be used to predict the efficacy of chemoradiation in cervical cancer patients, of which the MSI, TTP and NEI are more sensitive.

Objective To explore the effects of baicalin on the expression of TAFI,NF-κB,and ACE2 in the atherosclerotic rats and discuss the anti-atherosclerosis mechanisms of baicalin.Methods The subjects were healthy male Wistar rats.The rats were divided into sham operation group,model group,baicalin high dose group (1 50 mg·kg-1 ·d-1 )and baicalin low dose group (100 mg·kg-1 ·d-1 ).Plasma TAFI activity were detected with enzymatic assays.The expression of NF-κB and ACE2 were detec-ted with immunohistochemical staining.Results Compared with sham group,the rest groups of TAFI and ACE2 activity were sig-nificantly higher (P <0.05),and the expression of NF-κB,had significant decreased (P <0.05).Compared with the model group, the level of TAFI and ACE2 in baicalin drug group was significantly lower than the model group (P <0.05),and the expression of NF-κB,had significant increased.Conclusion Baicalin can reduce TAFI and ACE2 level,and upregulate the expression of NF-κB to play its role in anti atherosclerosis.

Objective To investigate the safety of intraoperative electron radiation therapy (IOERT) for stage Ⅰ hepatocellular carcinoma (HCC) by a cohort study.Methods From November 2010 to May 2012,16 patients who were pathologically diagnosed with stage Ⅰ HCC underwent IOERT after radical resection.With a cohort study,87 patients with stage Ⅰ HCC who underwent radical resection alone during the same period were qualified,and according to tumor size (＞ 5 cm and ≤ 5 cm) and resection margin (close margin and negative margin),32 of 87 patients made up the control group.The intraoperative and postoperative adverse events,liver function parameters,coagulogram,and routine blood parameters,as well as IOERT-related adverse reactions,were evaluated.Independent-samples t test was used for analyzing the differences between groups.Results Compared with the control group,the IOERT group had a significantly longer operative time ((275.4 ± 71.55) min vs.(184.7 ± 64.74) min,P =0.000),a slightly higher incidence of intraoperative adverse events (18.75％ vs.6.25％,P=1.000),a slightly lower incidence of operative complications (12.50％ vs.28.12％,P =0.460),and a lower perioperative mortality (0 vs.6％,P =0.440).Liver function parameters showed no significant differences between the two groups (P ＞ 0.05).There were no significant differences between the two groups in postoperative time to grade 1 or normal liver function parameters,median length of postoperative hospital stay,length of hospital stay in the surgical department,time to incision healing,and level of incision healing (P ＞ 0.05).During follow-up,no radiation hepatitis was found in the IOERT group.Conclusions As an adjuvant therapy after radical resection for early HCC,IOERT has no significant side effects on postoperative recovery and liver function,and an intraoperative dose of 15-16 Gy is safe.

Objective The aim of this study is to evaluate the feasibility of using orthogonal kilo voltage fluoroscopic imaging(OKVFI)for setup correction in image guided radiotherapy of the liver.Methods After positioned the patients with liver cancer implanted with silver rings on the accelerator equipped with kilo voltage X-ray volume imaging(XVI),averaged OKVFI and cone beam CT(CBCT) volumetric images were acquired.A total of 90 datasets of averaged OKVFI and 90 datasets of volumetric images for 10 patients were obtained.The couch shifts obtained by the matching between OKVFI and digitally reconstructed radiograph were compared tu those achieved by the registration between CBCT and 4D reference average CT.On the comparison of the two different matching metheds.the Pearson coefficient was used to analyzed the correlation and Bland-Altman analysis to discern the consistence.Results The Pearson coefficient of correlation for the patient position shifts were R2=0.821.0.771 and 0.909 in the left-right (LR),anterior-posterior(AP)and superior-inferior(SI)directions respectively.95% CI were-2.30 -1.53(LR),-2.06-3.01(AP)and-2.69-1.53(SI)respectively.Within a±3 mm tolerance were 97.78%.95.56%and 96.67%respectively.Conclusions OKVFI has hish correlation and consistence with CBCT image on the setup correction.It is feasible to implement position correction with OKVFI in clinic practice.