ObjectiveTo investigate the features of serum HBV RNA in different stages of the natural history of chronic hepatitis B virus （HBV） infection without antiviral treatment， as well as its correlation with serum HBV DNA and HBsAg. MethodsA total of 306 treatment-naïve patients with chronic HBV infection who attended Department of Infections Diseases and Hepatoloty， the Second Hospital of Shandong University from January 2023 to June 2024 were divided into six groups based on the different stages of natural history， i.e.， HBeAg-positive chronic HBV infection group with 29 patients， HBeAg-positive chronic hepatitis B （CHB） group with 107 patients， HBeAg-negative chronic HBV infection group with 18 patients， HBeAg-negative CHB group with 60 patients， HBeAg-positive indeterminate-phase chronic HBV infection group with 7 patients， and HBeAg-negative indeterminate-phase chronic HBV infection group with 85 patients. Real-time isothermal RNA amplification was used to measure serum high-sensitivity HBV RNA. The Kruskal-Wallis H test was used for comparison between multiple groups of continuous data， while the Mann-Whitney U test was used for comparison between two groups. The Spearman method was used to investigate the correlation of HBV RNA with HBV DNA and HBsAg. ResultsThe HBeAg-positive chronic HBV infection group showed the highest level of serum HBV RNA ［7.5 （7.4‍ ‍—‍ ‍7.9） log₁₀ copies/mL］， followed by the HBeAg-positive CHB group ［7.4 （6.4‍ ‍—‍ ‍7.9） log₁₀ copies/mL］， the HBeAg-negative CHB group ［4.5 （3.0‍ ‍—‍ ‍5.7） log₁₀ copies/mL］， and the HBeAg-negative chronic HBV infection group ［1.0 （1.0‍ ‍—‍ ‍2.0） log₁₀ copies/mL］； the HBeAg-positive indeterminate-phase chronic HBV infection group had a serum HBV RNA level of 3.9 （3.7‍ ‍—‍ ‍5.7） log₁₀ copies/mL， and the HBeAg-negative indeterminate-phase chronic HBV infection group had a serum HBV RNA level of 2.0 （1.0‍ ‍—‍ ‍3.0） log₁₀ copies/mL； there was a significant difference in serum HBV RNA level between the six groups （H=830.770， P<0.001）. There was a significant difference in HBV RNA level between the HBeAg-positive chronic HBV infection group and all the other groups except the HBeAg-positive CHB group （all P<0.001）. In the 306 patients with HBV infection， HBV RNA was strongly correlated with HBV DNA （r=0.92， P<0.001） and was moderately correlated with HBsAg （r=0.67， P<0.001）. The correlation between serum HBV RNA and HBsAg in HBeAg-positive patients （r=0.61， P<0.001） was stronger than that in HBeAg-negative patients （r=0.31， P<0.001）. For the patients with HBeAg-positive chronic HBV infection， the male patients with ALT>30 U/L and the female patients with ALT>19 U/L had a significantly lower serum HBV RNA level than the male patients with ALT≤30 U/L and the female patients with ALT≤19 U/L （P<0.001）， and there was no significant difference in serum HBV RNA level between the latter group of patients and the HBeAg-positive CHB group （P>0.05）. ConclusionIn patients with chronic HBV infection who do not receive antiviral therapy， there is a difference in serum HBV RNA level in different stages of natural history， and serum HBV RNA level has the strongest correlation with HBV DNA and a relatively weak correlation with HBsAg. In patients with HBeAg-positive chronic HBV infection， serum HBV RNA level in male patients with ALT>30 U/L and female patients with ALT>19 U/L are in the transition stage between HBeAg-positive chronic HBV infection and HBeAg-positive CHB.

The intestinal flora and gut barrier function are of great significance for gut function and human health. When the intestinal flora is disrupted and the gut barrier structure is disrupted, it can lead to bacterial translocation, endotoxin influx into the bloodstream, and the production of pro-inflammatory factors, leading to various tissue damage in the body. Tongfu method in TCM can affect the intestinal environment by regulating intestinal permeability and immune response, restoring normal intestinal movement, and regulating the structure and metabolites of intestinal flora, thereby maintaining intestinal homeostasis and body health. The research on regulating intestinal flora and improving intestinal barrier function by Tongfu method can provide reference for further research on the relationship between TCM and intestinal microecology, and provide ideas for clinical treatment.

The purpose of this study was to investigate the damage mechanism of pathogenic E.coli on mouse brain microvascular endothelial cells(BMEC cells)and mouse alveolar macrophages(MH-S cells),as well as the lung and brain of healthy mice.In this study,BMEC cells and MH-S cells were infected with pathogenic E.coli strains,and cell morphological changes were observed.Plate counting method was used to detect the adhesion and invasion ability of the strains to cells and the number of bacteria in the lungs and brains of mice.RT-qPCR was used to detect the ex-pression of TNF-α,IL-1β and IL-6 genes in cells and mouse organs at different time periods.West-ern blot was used to detect the expression of p-NF-κB,p-JAK2 and p-STAT3 proteins related to inflammation in cells and mouse organs after infection.The results showed that the cell culture medium of the infection group was turbid,the cell vision became dark and blurred,some cells shrank and died,and more fragments were produced.The adhesion rate and invasion rate of BMEC cells at 3 h were significantly lower than those at 6 h(P＜0.050),and the adhesion rate and inva-sion rate of MH-S cells at 3 h were significantly higher than those at 6 h(P＜0.010).Infected mice had a large area of swelling and bleeding in the brain,and the lungs had different degrees of swell-ing and bleeding.The bacterial load in the brain and lung was the highest at 12 h.Compared with the control group,the mRNA expression levels of IL-1β,IL-6 and TNF-α in the infection group were significantly increased at 3 h and 6 h(P＜0.050),and the mRNA expression levels of inflam-matory factors in BMEC cells and MH-S cells were the highest at 6 and 3 h,respectively.The mR-NA expression of inflammatory factors in the brain and lung of infected mice showed a trend of in-creasing first and then decreasing with time,with the highest expression at 12 h after infection.The expression levels of p-NF-κB protein in BMEC cells,MH-S cells,lung and brain tissues of mice in the infection group were significantly higher than those in the control group(P＜0.001),and the expression levels of p-JAK2 protein and p-STAT3 protein were significantly lower than those in the control group(P＜0.050).The above results showed that pathogenic E.coli could adhere and invade BMEC cells and MH-S cells,colonize in lung and brain tissues of mice,promote the expres-sion of NF-κB protein in cells and tissues,inhibit the expression of JAK2 protein and STAT3 pro-tein,and then stimulate cells and tissues to produce inflammatory response.

Objective:To analyse the clinical presentation and pathogenic gene mutations of a family diagnosed with primary familial brain calcification (PFBC).Methods:A pedigree with primary familial brain calcification was recruited. The clinical data of the proband who was admitted to the Affiliated Hospital of Guizhou Medical University in March 2020 and the family members were collected. The DNA sequence of myogenesis regulating glycosidase (MYORG) gene was detected by Sanger sequencing in the proband and some available family members.Results:The proband is a male, 30 years old. There was only one patient of PFBC in this family. The first symptom of the proband was vagueness of speech, and gradually extrapyramidal symptoms such as slow and flexible movement and advanced cognitive impairment appeared. The brain CT of the proband and his second brother showed extensive symmetrical calcifications, mainly located in the bilateral cerebellar hemispheres, basal ganglia and thalamus. A homozygous mutation in the exon 2 of the MYORG gene [c.1967T>C(p.I656T)] was identified in the proband and an asymptomatic patient. The heterozygous mutation of MYORG gene was also detected in four healthy family members.Conclusions:All patients with homozygous mutations of MYORG gene showed calcification in CT scan, and most of the lesions were located in basal ganglia, cerebellum, subcortical white matter and thalamus. Compared with the patients with autosomal dominant gene mutation, the patients with MYORG gene mutation had more extensive intracranial calcification lesions, and the pontocerebellar lesions were more common. The most common symptoms of MYORG gene mutation patients were dyskinesia, mainly tremor paralysis and unclear speech.

Purpose: The goal of this study was to describe the current status of oncology nurses' behaviors toward end of life (EOL) care in China and to explore the factors associated with oncology nurses’ behaviors toward EOL care. Methods: A cross-sectional design was applied and a convenience sample of 1038 oncology nurses from 22 grade A hospitals were recruited into this study. A general social demographic data questionnaire was administered, and the Chinese version of Nurses’ Behaviors of Caring for Dying Patients Scale was used to assess nurse behavior toward EOL care. The total score ranges from 40 to 200 points. Data were analyzed with SPSS 26.0 software. Results: Chinese oncology nurses' average score of holistic EOL care behaviors was 2.97 ± 0.59. Oncology nurses provide physical care most (3.81 ± 0.76), followed by family care (3.02 ± 0.86), and spiritual care (2.37 ± 0.67). Multiple regression analysis showed that a higher frequency of sharing EOL care experience with colleagues, in-service palliative care education, higher level of head nurse support for EOL patient care, more cases of EOL care, higher working position, and nurse's perceived high level of support were positively associated with behavior toward EOL care. These six factors explained 16.2% of the total variance. Conclusions The results may help provide a basis for converting behavior for EOL care among oncology nurses and design interventions to better improve quality of life for EOL patients with cancer in China.

Objective:To translate Lnych Syndrome Self-Concept Scale into Chinese and test its reliability and validity.Methods:After translation, back translation and cultural adjustment, the Chinese version of Lynch Syndrome Self-Concept Scale was formed. From November 2018 to February 2019, the convenient sampling method was adopted to select 119 patients with Lynch syndrome in a ClassⅢ Grade A tumor specialist hospital in Guangzhou for investigation, and the reliability and validity of the Chinese version of the scale were calculated. The reliability of the scale was expressed by Cronbach's α coefficient and split-half reliability; the content validity of the scale was expressed by content validity index ( CVI); the construct validity of the scale was analyzed by exploratory factor analysis. Results:Cronbach's α coefficient of internal consistency of the Chinese version of Lynch Syndrome Self-Concept Scale was 0.944, the split-half reliability was 0.922, and the scale-level content validity index ( S- CVI) in the content validity was 0.980. In construct validity, three common factors were extracted by exploratory factor analysis, which represented stigma vulnerability dimension, gastrointestinal anxiety dimension and two positive problems of inxstigma vulnerability dimension, which explained respectively 49.392%, 9.875% and 8.007% of the total variation and cumulatively explained 67.274% of the total variation. Conclusions:Chinese version of Lynch Syndrome Self-Concept Scale has good reliability and validity. It is suitable for conducting surveys among Chinese patients with Lynch syndrome and it is used to determine the effects of genetic counseling and genetic testing on related self-cognition. At the same time, it is of reference significance for development of tools to measure the genes of hereditary tumor syndromes in Chinese population and the genetic influence on patients.

Objective: To explore the feasibility and clinical effect of single bundle anatomic intrathecal reconstruction of proximal injury of anterior cruciate ligament (ACL) using dissociate peroneus longus tendon combined with semitendinosus tendon. Methods: From January 2015 to September 2016, a total of 24 patients with proximal injury of ACL, confirmed by arthroscopy, were admitted to the sports medicine department of our hospital. The ACL was completely ruptured from the proximal footprint and the tibial side residual remained intact. There were 19 males and 5 females; 16 cases on the right side and 8 cases on the left side. The mean age was 27.88±7.13 years old; The interval between injury and surgery was 14.83±9.09 d; The dissociate peroneus longus tendon and semitendinosus tendonfrom the injured extremity were folded in half, then braided and trimmed into ACL graft for use. The ACL remnant was preserved and the graft was pulled through the stump for single bundle anatomic intrathecal reconstruction. The ACL graft was fixed with Endobutton on the femoral side and interference screw on the tibial side. The results of Lachman test, Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) subjective scores of knee before operation and at final visit were recorded to evaluate the stability and function of the knee. Visual analogue score (VAS) was used to record the changes of pain at the site where the peroneal longus tendon was harvested. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores were recorded before injury and at the final visit to assess the effect of ankle function after peroneal longus tendon resection. Results: The diameter of the ACL graft made of dissociate peroneus longus tendon and semitendinosus tendon is 8.88±0.30 mm. All patients were followed up at the outpatient clinic, with an average of 34.38±5.40 months, and no serious complications such as rerupture and joint infection were found. There were 16 grade B, 6 grade C and 2 grade D for preoperative Lachman test, none with hard end point. At last vist, there were 23 cases of grade A and 1 grade B, all with hard end points for Lachman test. At the preoperative and final visit, the Lysholm scores of the knee joint were 35.20±11.92 and 94.29±2.92 (t=23.850, P=0.000). Tegner scores were 3.46±0.93 and 8.04±1.00 (t=16.653, P=0.000). The subjective IKDC scores of knee joint were 47.63±13.06 and 91.71±3.75 (t=15.972, P=0.000). At the final visit, all the indicators of the knee were improved compared with those before surgery, and the difference was statistically significant.The AOFAS scores before injury and at the final visit were 98.83 (2.78) and 98.17 (4.01), respectively, with no statistically significant difference (t=1.850, P=0.076) . The VAS scores for the harvest of theperoneus longus tendon were 4.50±1.41, 0.54±0.65 and 0.29±0.55 immediately and 6 months after the operation and at the last visit.There was statistically significant difference between the scores immediately and 6 months after the operation (t=14.900, P=0.001).There was statistically significant differences between the scores at 6 months after the operation and the final visit (t=2.770, P=0.011). Conclusion Single bundle anatomic intrathecal reconstruction of proximal injury of ACL using dissociate peroneus longus tendon and semitendinosus tendon is feasible with good clinical effect.

Objective: To investigate the effect of Kamistad gel on oral ulcer healing and the expression of tumor necrosis factor α (TNF-α), interleukin 6 (IL-6) and epidermal growth factor (EGF) after oral administration in ulcer tissue of rats and to provide animal experimental data for the clinical application of Kamistad gel. Methods: The oral ulcer rat model was established by chemical cauterization. The rats were randomly divided into four groups: Kamistad group (Kamistad gel), befuxin group (befuxin gel), lidocaine group (lidocaine cream), blank control group (normal saline), with 12 rats in each group. The ulcer area of the rats in each group was measured before and 1, 3 and 5 days after treatment; at 1 day after treatment, the duration of swabbing behavior within 3 minutes of intraoral capsaicin infusion was recorded to evaluate the degree of pain; the ulcer tissue was collected at 5 days after treatment, and the histopathological changes were observed by HE staining, the expression of TNF-α, IL-6 and EGF in the ulcer tissue was detected by immunohistochemistry and ELISA. Results: At 1 day after treatment, the duration of mouth wiping induced by capsaicin was significantly shorter in the Kamistad group than in the blank control and befuxin groups (P < 0.05), but there was no significant difference between the Kamistad and lidocaine groups (P >0.05). At 5 days after treatment, the ulcer area was significantly smaller in the Kamistad group than in the blank control and lidocaine groups (P < 0.05), and there was no significant difference between the Kamistad and befuxin groups (P >0.05). At 5 days after treatment, H&E staining of the oral ulcer tissue sections showed significantly reduced levels of inflammatory cells and significantly proliferated fibroblasts and better epithelial hyperplasia in the Kamistad group compared with those in the lidocaine and blank control groups, and there were no differences between the Kamistad and befuxin groups. At 5 days after treatment, the expression levels of TNF-α, IL-6 and EGF in the ulcer tissue of rats in each group were significantly different (P < 0.05). Compared with the blank control and lidocaine groups, the expression of TNF-α and IL-6 was significantly decreased and the expression of EGF was significantly increased in the Kamistad group (P < 0.05); there were no significant differences in the expression of the above three factors between the Kamistad and befuxin groups (P > 0.05). Conclusion Kamistad gel exhibited anti-inflammatory, analgesic and healing effects on experimental oral ulcers.

Objective To explore the curative effects of unilateral Orthofix external fixation in the treatment of tibial defects.Methods From June 2012 to February 2016,we treated 19 patients with tibial defects using unilateral Orthofix external fixation.They were 14 men and 5 women,aged from 26 to 79 years (mean,43.0 years).The right tibia was involved in 12 cases and the left tibia in 7.The soft tissue defects averaged 6.4 cm × 3.7 cm.The mean bone defect before bone transport was 8.9 cm in length.The anteroposterior and lateral X-ray films of the affected tibia were taken regularly after surgery.Edwards tibial fracture scores were used to evaluate the functional recovery and complications of the affected limb at final follow-ups.Results All the patients were followed up for 10 to 40 months (average,18.5 months).Bone union time ranged from 4 to 16 months (average,9.0 months).Lengths of bone transport ranged from 6 to 10 cm (average,7.8 cm).All the bone defects were reconstructed.According to the Edwards scoring at the final follow-ups,10 cases were rated as excellent,6 as good and 3 as poor.Complications were observed in 4 cases,giving a complication rate of 21.1％.Conclusion Unilateral Orthofix external fixation and bone transport can lead to preferable curative effects in the management of tibial defects.