He Jie Tang in the treatment of chronic hepatitis B patients

AIM： To explore the effect of He .lie Tang （decoction for medication） on serum levels of T lymphocyte subsets, NK cell activity and cytokines in chronic hepatitis B patients. METHODS： Eighty-five patients with chronic hepatitis B were divided randomly into two groups. Fifty patients in group I were treated with He .lie Tang （HIT） and 35 patients in group II were treated with combined medication. The levels of T-lymphocyte subsets （CD^3＋, CD^4＋, CD^8＋）, NK cell activity, cytokines （TNF-α, IL-8, sIL-2R） were observed before and after the treatment. Another 20 normal persons served as group 3. RESULTS： The level of CD^4＋ cells and NK cell activity were lower, whereas the level of CD^8＋ cells in patients was higher than that in normal persons （t = 2.685, 3.172, and 2.754 respectively; P〈0.01）. The levels of TNF-α, IL-8, and sIL-2R in chronic hepatitis B patients were higher than those in normal persons （t = 3.526, 3.170, and 2.876 respectively; P〈0.01）. After 6 months of treatment, ALT, AST, and TB levels in the two groups were obviously decreased （t = 3.421, 3.106, and 2.857 respectively; P〈0.01）. The level of CD^4＋ cells and NK cell activity were increased whereas the level of CD^8＋ cells decreased （t = 2.179, 2.423, and 2.677 respectively; P〈0.05） in group I. The levels of TNF-α, IL-8, and sIL- 2R in group I were decreased significantly after the treatment （t = 2.611, 2.275, and 2.480 respectively; P〈0.05） but had no significant difference in groupII after the treatment （t = 1.906, 1.833, and 2.029 respectively; P〉0.05）. The total effective rate had no significant difference between the two groups （X^2 = 2.882, P〉0.05） but the markedly effective rate was significantly different between the two groups （X^2 = 5.340, P〈0.05）. CONCLUSION： HIT is effective in treating chronic hepatitis B. HIT seems to exert its effect by improving the cellular immune function and decreasing inflammatory cytokines in chronic hepatitis B patients. The function of HIT in protecting liver function in the process of eliminating virus needs to be further studied.

Influence of lactulose on interventional therapy for HCC patients with hepatocirrhosis and hypersplenism

Objective: To investigate the influence of lactulose on immunity of hepatocellular carcinoma(HCC) patients with hepatocirrhosis and hypersplenism after double-interventional therapies. Methods: A total of 40 HCC patients with hepatocirrhosis and hypersplenism, hospitalized during January 2013 to June 2014, were enrolled and randomized into control group and observation group. Both groups received partial splenic embolization combined with transcatheter arterial chemoembolization. Besides, observation group orally took lactulose 30 m L/d. Four days before interventional therapies and at day 1, 3, 7 and 14 after therapies, fasting venous blood was collected to detect white blood cell count, red blood cell count(RBC), and platelet count(PLT). Four days before therapies and at day 7 and 14 after therapies, the levels of alanine aminotransferase, aspartate transaminase, total bilirubin, malondialdehyde, super-oxide dismutase(SOD), IFN-α, and IL-4 as well as the distribution of T cell subsets in peripheral blood were tested. Complications were observed after interventional therapies. Results: Before interventional therapies the levels of white blood cell count, PLT and RBC in both groups showed no difference, while after interventional therapies the levels of PLT and RBC in both groups showed an increasing tendency(P<0.05). At day 14 after interventional therapies, the level of blood cell as well as that of SOD, IFN-α and IL-4 in serum were significantly higher than that before therapies; meanwhile, the levels of alanine aminotransferase and total bilirubin of observation group after therapies were significantly lower than before and control group(P<0.05), the levels of CD4+/CD8+, SOD and IFN-α were all higher than before and control group(P<0.05). Conclusions: Oral administration of lactulose could adjust the imbalance of oxidation system/antioxidant system in HCC patients with hepatocirrhosis and hypersplenism after interventional therapies, and improve the antitumor immunity and prognosis.

Respiratory Support in Severely or CriticallyⅢICU Patients With COVID-19 in Wuhan,China

Summary:This case series aimed to describe the clinical characteristics of severely or critically ill patients with COVID-19 and compare the clinical characteristics of patients who received invasive respiratory support with those of patients who received noninvasive respiratory support.We included all confirmed severe or critical illness cases of COVID-19 admitted to the Intensive Care Unit(ICU)of Zhongnan Hospital of Wuhan University,a COVID-19-designated hospital,from January 8 to March 12,2020.Cases were analyzed for cpidemiological,demographic,clinical,APACHE II,SOFA,radiological features and laboratory data.Outcomes of all patients were followed up as of March 12,2020.This newly emerging virus had caused 55 confirmed severe or critical illness cases in ICU of a COVID-19-designated hospital.Most of the infected patients were men;more than half had underlying diseases,including hypertension,coronary artery disease and diabetes.The median age was 63 years old.Common symptoms at onset of ilness were fever,fatigue and dry cough.Five(9.1%)hospitalized patients were presumed to have been infected in the hospital,and 4(7.3%)health care workers were infected in their work.Of the 55 confirmed severe or critical ilncss cases,10(18.2%)patients died during the follow-up period as of March 12 with the median follow-up period of 28 days(interquartile range 1635).Nine patients received VV-ECMO for severe respiratory failure and 4(44.4%)patients died.Moreover,28 patients received invasive respiratory support and 14(50.0%)patients died.In this single-center study,55 severely or critically ill ICU patients were confirmed to have COVID-19 in Wuhan and the overall mortality was 29.1%。Totally 28(50.9%)of severely or critically ill ICU patients received invasive respiratory support and 14(50.0%)died during the follow-up period.

The rat eustachian tube:Anatomical, histological, and radiological features

Purpose: This study investigated the anatomical and histological characteristics of the rat Eustachian tube(E-tube)and the feasibility of Eustachian tubography in a rat model.Materials and methods: Fifteen male Wistar rats were used in this study, and the bilateral E-tubes of each rat were examined. Ten E-tubes were used for anatomical studies, another ten for histological analysis, and the other ten for Eustachian tubography. Five rats were euthanized and decapitated, and ten E-tubes were dissected to describe the anatomy of the E-tube. Ten E-tube specimens obtained from five other rats were sectioned to investigate Etube histology. Eustachian tubography was performed on the bilateral E-tubes of the other five rats using the trans-tympanic approach.Results: The rat E-tubes consisted of bony and membranous parts. Cartilage and bone tissue covered only the bony part. The E-tubes’ mean diameter and overall length were 2.97 mm and 4.96 mm, respectively. The tympanic orifices’ mean diameter was 1.21 mm. The epithelium of E-tubes was mainly composed of pseudostratified ciliated and goblet cells. Eustachian tubography was successfully performed on both sides of the E-tube for each rat.The technical success rate was 100%, the average running time was 4.9 min, and no procedure-related complications occurred. On tubography images, the E-tube, tympanic cavity, and nasopharynx could be identified because of the visualization of bony landmarks.Conclusion: In this study, we described the anatomical and histological features of rat E-tubes. With the aid of these findings, E-tube angiography was successfully performed using a transtympanic approach. These results will facilitate further investigation of E-tube dysfunction.

Association between gestational anemia in different trimesters and neonatal outcomes:a retrospective longitudinal cohort study

Background Previous studies investigated the association between gestational anemia and neonatal outcomes.However,few studies explored whether the effects of gestational anemia could be eliminated by subsequent correction of anemia in the later stages of pregnancy.This study aimed to investigate the relationship between anemia in different trimesters and neonatal outcomes.Methods The study was conducted in Shanghai,China,with a sample of 46,578 pregnant women who delivered between January 1,2016 and July 1,2019.A multivariable logistic regression model was adopted to analyse the associations between maternal anemia and neonatal outcomes.Results The incidence of gestational anemia was 30.2%,including 4.4%in the first trimester,9.6%in the second trimester,and 16.2%in the third trimester.Only 24.5%(507/2066)of anemia that occurred in the first trimester and 29.6%(1320/4457)that occurred in the second trimester could be corrected in the later stages of pregnancy.Anemia occurring in the first trimester was associated with small for gestational age[odds ratio(OR)1.46;95%confidence interval(CI)1.20-1.78]and with fetal distress(OR 1.23;95%CI 1.08-1.40).Anemia corrected in the first trimester also was associated with a higher risk of small for gestational age.Conclusions Gestational anemia is a public health problem in China impacting neonatal health.Anemia in pregnancy could be corrected in only about a quarter of the women.Anemia in the first trimester,whether corrected or not,still led to lower birth weight;therefore,the prevention of anemia prior to pregnancy is important.

Long interpregnancy interval and adverse perinatal outcomes: a retrospective cohort study

We conducted a retrospective cohort study of 9,552 women experiencing their second delivery between 2014 and 2016 at the International Peace Maternity and Child Health Hospital to investigate the association between the interpregnancy interval(IPI)and adverse perinatal outcomes. With the 12–23-mon IPI as the reference category, logistic regression analyzes were used to examine associations between different IPIs(<12, 12–23, 24–59, 60–119, and ≥120 mon) and perinatal outcomes(gestational diabetes mellitus, premature membrane rupture, gestational hypertension, preterm birth, low birth weight, and macrosomia).Compared with the 12–23-mon IPI category, women with longer IPIs had a higher risk of adverse perinatal outcomes, and those with an IPI ≥120 mon had the highest risk of gestational diabetes mellitus and premature membrane rupture(adjusted odds ratio(OR) 1.76, 95% confidence interval(CI) 1.32–2.35 and adjusted OR 2.03, 95% CI 1.53–2.67, respectively). These results indicate that a longer IPI is associated with a higher risk of adverse perinatal outcomes and an IPI of ≥120 mon appears to be independently associated with a higher risk of gestational diabetes mellitus and premature membrane rupture.

Clinical Features and Neuroimaging Findings in Patients with Cerebral Fat Embolism

INTRODUCTIONCerebral fat embolism （CFE） is a rare but potentially lethal disease that is usually complicated by long bone fracture, which can develop over 12-72 h. Since the main fbrm of treatment for CFE is supportive, early diagnosis, prevention, and appropriate treatment can reduce mortality and the development of complications. However, due to symptom heterogeneity and imprecise diagnostic methods, CFE may be masked by other clinical conditions that make early detection challenging. Given its low incidence, most clinical studies of CFE are single cases or small case series. To characterize the features of CFE, clinical manifestations, laboratory examinations, and neuroimaging data were evaluated in a large sample of patients with CFE.