Application of Intelligent Equipment on Novel Coronavirus Pneumonia Designated Hospital

Objective: To explore the application of intelligent equipment in non-negative pressure isolation ward for COVID-2019 patients. Method: From February 1 to March 17, 2020, intelligent equipment, such as communication interaction system, intelligent disinfection robot, delivering robot, were used in non- negative pressure isolation ward of COVID-2019. With the help of communication interaction system to supervise the implementation of infection prevention and control, and observe the incorrect situation of pee use and personal behavior before and after the implementation. The disinfection robot and meal delivery robot were used in ward disinfection and life nursing combined with nursing practice. Result: Through the supervision of communication interaction system, the frequency of pee use and personal behavior was reduced. The frequency of bad articles before and after improvement was wearing protective clothing (2.80%/0.84%), taking off protective clothing (5.87%/0.84%), personal behavior observation (8.38%/1.90%), P < 0.01. The robot disinfected and delivered medicine for 912.5 h, saving 225 shifts of nursing staff. Conclusion: Intelligent equipment is a good option for infection control in isolation ward of COVID-2019. It can not only reduce the workload of health workers, but also the cross-infection.

Reduction in Intrahepatic cccDNA and Integration of HBV in Chronic Hepatitis B Patients with a Functional Cure

Background and Aims:Functional cure(FC)is characterized by the clearance of the hepatitis B surface antigen from the serum of patients with chronic hepatitis B(CHB).However,the level of intrahepatic covalently closed circular DNA(cccDNA)and hepatitis B virus(HBV)integration remains unclear.We conducted this study to determine them and reveal their value in the treatment of CHB.Methods:There were two sessions to elucidate the changes in intrahepatic cccDNA and HBV integration after antiviral therapy.In the first session,116 patients were enrolled and divided into FC,non-functional cure(NFC),and CHB groups,including 48 patients with functionally cured CHB,27 with CHB without functional cure after antiviral treatment,and 41 with treatment-naïve CHB.Patients were tested for both intrahepatic cccDNA and other viral markers.All patients in the FC group were followed up for at least 24 weeks to observe relapse.In the second session,another ten patients were included for in-depth whole-genome sequencing to analyze HBV integration.Results:Thirteen patients in the FC group were negative for intrahepatic cccDNA.Intrahepatic cccDNA was much higher in the CHB group compared with the FC group.Seven patients had HBsAg seroreversion,including two with virological relapse.Integration of HBV was detected in one(33.3%)functionally cured patients and in seven(100%)with CHB.28.0%of the HBV breakpoints were assigned in the 1,500 nt to 1,900 nt range of the HBV genome.Conclusions:After achieving an FC,the rate of intrahepatic cccDNA and HBV integration was significantly reduced in patients with CHB.For those patients who cleared intrahepatic cccDNA,the chances of developing virological relapse were even lower.

Progress on clinical prognosis assessment in liver failure

Liver failure is a group of clinical syndromes with a mortality rate of>50%.The accurate evaluation of severity in patients with liver failure has been a meaningful and hot topic in clinical research and an important guide for liver transplantation.Numerous prognosis studies have emerged in recent years with high accuracy and adequate validity.Nonetheless,different models utilize distinct parameters and have unequal efficiencies,leading to a specific value and unique application situations for each model.This review focused on the progress in recent prognostic studies including the model for end-stage liver disease,sequential organ failure assessment and its derivative models,the Chinese Group on the Study of Severe Hepatitis B Acute-on-Chronic Liver Failure,the Tongji prognostic predictor model,and other emerging prognostic models and predictors.This review aims to assist clinicians understand the framework of recent models and choose the appropriate model and treatment.

A novel nomogram based on routine clinical indicators for screening for Wilson's disease

Background and aims:There is currently no single model for predicting Wilson's disease(WD).We aimed to create a nomogram using daily clinical parameters to improve the accuracy of WD diagnosis in patients with abnormal liver function.Methods:Between July 2016 and December 2020,we identified 90 WD patients with abnormal liver function who had homozygous or compound heterozygous mutations in the ATP7B gene.The control group included 128 patients with similar liver function but no WD during the same time period.To create a nomogram,we screened potential predictive variables using the least absolute shrinkage and selection operator model and multivariate logistic regression.Results:We developed a nomogram for screening for WD based on six predictive factors:serum copper,direct bilirubin,uric acid,cholinesterase,prealbumin,and reticulocyte percentage.In the training cohort,the area under curve(AUC)of the nomogram reached 0.967(95%confidence interval(CI)0.946e0.988),while the area under the precision-recall curve was 0.961.Based on the optimal cutpoint of 213.55,our nomogram performed well,with a sensitivity of 96%and a specificity of 87%.In the validation cohort,the AUC of the nomogram was as high as 0.991(95%CI 0.970e1.000).Conclusions:We developed a nomogram that can predict the risk of WD prior to the detection of serum ceruloplasmin or urinary copper,greatly increasing screening efficiency for patients with abnormal liver function.

Clinical and Genetic Characteristics of Alagille Syndrome in Adults

Background and Aims:Alagille syndrome(AGS)is an autosomal dominant multisystem disorder caused by mutations in the JAG1 and NOTCH2 genes.AGS has been rarely reported in adult patients,mainly because its characteristics in adults are subtle.The study aimed to improve the understanding of adult AGS by a descriptive case series.Methods:Eight adults diagnosed with AGS at our hospital between June 2016 and June 2019 were included in the study.Clinical data,biochemical results,imaging results,liver histopathology,and genetic testing were analyzed.Results:Three female and five male patients with a median age of 24.5 years at the time of diagnosis were included in the analysis.The clinical manifestations were adult-onset(62.5%,5/8),cholestasis(50%,4/8),butterfly vertebrae(62.5%,5/8),systolic murmurs(12.5%,1/8),typical facies(12.5%,1/8),posterior embryotoxon,and renal abnormalities(0/8).Genetic sequencing showed that all patients had mutations,with four occurring in the JAG1 gene and four in the NOTCH2 gene.Six were substitution mutations,one was a deletion mutation,and one was a splicing mutation.Five had been previously reported;but the others,one JAG1 mutation and two NOTCH2 mutations were unique and are reported here for the first time.Conclusions:The clinical manifestations highlighted by the current diagnostic criteria for most adults with AGS are atypical.Those who do not meet the criteria but are highly suspicious of having AGS need further evaluation,especially genetic testing.

Functional cure of chronic hepatitis B: Efforts and prospects

Worldwide,more than 240 million people are chronically infected with hepatitis B virus(HBV),1 and more than 887,000 deaths in 2015 are due to HBV-related end-stage liver disease or hepatocellular carcinoma.China has the largest burden of HBV in the world,with approximately 70 million HBV carriers,of which 20e30 million are chronic hepatitis B(CHB)patients.2,3 As the development of medicine,the treatment goal of CHB is getting higher and higher.