目的探究乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者接受人工肝治疗后PLT计数的变化趋势和影响因素。方法选取2018年1月—2021年11月在中山大学附属第三医院住院接受血浆置换治疗(n=102)和双重血浆分子吸附系统联合低剂量血浆置换(n=50)...目的探究乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者接受人工肝治疗后PLT计数的变化趋势和影响因素。方法选取2018年1月—2021年11月在中山大学附属第三医院住院接受血浆置换治疗(n=102)和双重血浆分子吸附系统联合低剂量血浆置换(n=50)的152例HBV-ACLF患者,分析患者的临床资料和实验室指标。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验,计数资料两组间比较采用χ^(2)检验;采用logisitic多因素分析影响人工肝治疗后PLT>50×10^(9)/L的危险因素,采用ROC曲线分析基线PLT计数对人工肝治疗后PLT>50×10^(9)/L的预测价值。结果纳入患者以中年男性为主,70例(46.1%)患者在入院时合并肝硬化,114例(75.0%)患者接受3次人工肝治疗,基线PLT>50×10^(9)/L患者占比为88%。总体患者人工肝治疗后PLT计数较基线水平显著下降(79.5±47.7 vs 112.5±64.1,t=4.965,P<0.001),治疗后1周PLT计数升高至基线水平(97.2±50.7 vs 112.5±64.1,t=1.787,P=0.075)。进一步比较人工肝治疗后1周PLT计数较基线的变化量,发现肝硬化组PLT下降幅度显著高于非肝硬化组(U=1986.5,P=0.026),而在不同人工肝术式、治疗次数(3~5次)之间无显著差异(P值均>0.05)。通过logisitic多因素分析发现,合并肝硬化(OR=3.097,95%CI:1.255~7.645,P=0.014)和基线PLT>50×10^(9)/L(OR=0.019,95%CI:0.002~0.154,P<0.001)是影响人工肝治疗后PLT>50×10^(9)/L的独立危险因素。对基线PLT计数进行ROC曲线分析,发现基线PLT>80.5×10^(9)/L是影响治疗后PLT>50×10^(9)/L的最佳截断值,ROC曲线下面积为0.818。结论人工肝治疗对PLT的影响是暂时性的,但肝硬化患者的PLT生长能力弱于非肝硬化患者;基线PLT>80.5×10^(9)/L是降低人工肝治疗后出血风险的最佳界值。展开更多
Rhenium diselenide(ReSe_(2))has gathered much attention due to its low symmetry of lattice structure,which makes it possess in-plane anisotropic optical,electrical as well as excitonic properties and further enables R...Rhenium diselenide(ReSe_(2))has gathered much attention due to its low symmetry of lattice structure,which makes it possess in-plane anisotropic optical,electrical as well as excitonic properties and further enables ReSe_(2)have an important application in optoelectronic devices.Here,we report the thickness-dependent exciton relaxation dynamics of mechanically exfoliated few-layer ReSe_(2)flakes by using time-resolved pump–probe transient transmission spectroscopies.The results reveal two thickness-dependent relaxation processes of the excitons.The fast one correlates with the exciton formation(i.e.,the conversion of hot carriers to excitons),while the slow one is attributed to the exciton recombination dominated by defect-assisted exciton trapping besides photon emission channel.The decrease of scattering probability caused by defects leads to the increase of fast lifetime with thickness,and the increase of slow lifetime with thickness is related to the trap-mediated exciton depopulation induced by surface defects.Polarization-dependent transient spectroscopy indicates the isotropic exciton dynamics in the two-dimensional(2D)plane.These results are insightful for better understanding of excitonic dynamics of ReSe_(2)materials and its application in future optoelectronic and electronic devices.展开更多
目的观察核苷类药物(nucleoside analogues,NAs)治疗后病毒学应答不佳的慢性乙型肝炎(chronic hepatitis B,CHB)患者换用替诺福韦(Tenofovir,TDF)的疗效和安全性。方法本研究经筛选后纳入108例患者,分为恩替卡韦(Entecavir,ETV)治疗后继...目的观察核苷类药物(nucleoside analogues,NAs)治疗后病毒学应答不佳的慢性乙型肝炎(chronic hepatitis B,CHB)患者换用替诺福韦(Tenofovir,TDF)的疗效和安全性。方法本研究经筛选后纳入108例患者,分为恩替卡韦(Entecavir,ETV)治疗后继续ETV治疗组(ETV to ETV组)(32例)、ETV治疗后换用TDF组(ETV to TDF组)(30例)和非ETV的NAs治疗后换用TDF组(Non-ETV to TDF组)(46例)。观察各组在基线前后各个随访点HBV DNA累计不可检测率、HBV DNA定量等病毒学指标,丙氨酸氨基转移酶、血清肌酐等生化指标的差异。结果ETV to TDF组与ETV to ETV组相比,第24周HBV DNA定量对数为2.0(2.0~2.0)IU/mL vs.2.0(2.0~2.5)IU/mL(P=0.034);第24周HBV DNA累计不可检测率为83.3%vs.56.3%,差异有统计学意义(χ^(2)=5.34,P=0.021),ETV to TDF组明显优于ETV to ETV组;两组之间的总体的HBV DNA不可检测耗时分布的差异不具有统计学意义(χ^(2)=2.366,P=0.124),但HBV DNA不可检测耗时平均值两组分别为(24.8±3.57)和(36.4±5.35)周。ETV to TDF组与Non-ETV to TDF组相比,24和48周的HBV DNA累计不可检测率分别为83.3%vs.82.8%(P=0.935)和90%vs.93.5%(P=0.675),差异均无统计学意义。换药前ETV疗程在48~96周内在换用TDF后HBV DNA转阴时间之间差异无统计学意义(P=0.270)。所有随访患者均未发生病毒学突破。所有随访患者均未发生严重的不良反应,如横纹肌溶解等。结论换用TDF治疗其他核苷类药物初治后病毒学应答不佳的患者是一种疗效好,安全性高的治疗方法。换用TDF治疗可能在一定程度上比继续ETV治疗更快促进ETV应答不佳患者的HBV DNA阴转。ETV疗程在48至96周内可能并不会影响后续换用TDF疗效。展开更多
文摘目的探究乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者接受人工肝治疗后PLT计数的变化趋势和影响因素。方法选取2018年1月—2021年11月在中山大学附属第三医院住院接受血浆置换治疗(n=102)和双重血浆分子吸附系统联合低剂量血浆置换(n=50)的152例HBV-ACLF患者,分析患者的临床资料和实验室指标。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验,计数资料两组间比较采用χ^(2)检验;采用logisitic多因素分析影响人工肝治疗后PLT>50×10^(9)/L的危险因素,采用ROC曲线分析基线PLT计数对人工肝治疗后PLT>50×10^(9)/L的预测价值。结果纳入患者以中年男性为主,70例(46.1%)患者在入院时合并肝硬化,114例(75.0%)患者接受3次人工肝治疗,基线PLT>50×10^(9)/L患者占比为88%。总体患者人工肝治疗后PLT计数较基线水平显著下降(79.5±47.7 vs 112.5±64.1,t=4.965,P<0.001),治疗后1周PLT计数升高至基线水平(97.2±50.7 vs 112.5±64.1,t=1.787,P=0.075)。进一步比较人工肝治疗后1周PLT计数较基线的变化量,发现肝硬化组PLT下降幅度显著高于非肝硬化组(U=1986.5,P=0.026),而在不同人工肝术式、治疗次数(3~5次)之间无显著差异(P值均>0.05)。通过logisitic多因素分析发现,合并肝硬化(OR=3.097,95%CI:1.255~7.645,P=0.014)和基线PLT>50×10^(9)/L(OR=0.019,95%CI:0.002~0.154,P<0.001)是影响人工肝治疗后PLT>50×10^(9)/L的独立危险因素。对基线PLT计数进行ROC曲线分析,发现基线PLT>80.5×10^(9)/L是影响治疗后PLT>50×10^(9)/L的最佳截断值,ROC曲线下面积为0.818。结论人工肝治疗对PLT的影响是暂时性的,但肝硬化患者的PLT生长能力弱于非肝硬化患者;基线PLT>80.5×10^(9)/L是降低人工肝治疗后出血风险的最佳界值。
基金Project supported by the National Natural Science Foundation of China(Grant Nos.12074202,12174207,and 11974190)the Natural Science Foundation of Tianjin City(Grant Nos.20JCQNJC00020 and 22JCYBJC00390)。
文摘Rhenium diselenide(ReSe_(2))has gathered much attention due to its low symmetry of lattice structure,which makes it possess in-plane anisotropic optical,electrical as well as excitonic properties and further enables ReSe_(2)have an important application in optoelectronic devices.Here,we report the thickness-dependent exciton relaxation dynamics of mechanically exfoliated few-layer ReSe_(2)flakes by using time-resolved pump–probe transient transmission spectroscopies.The results reveal two thickness-dependent relaxation processes of the excitons.The fast one correlates with the exciton formation(i.e.,the conversion of hot carriers to excitons),while the slow one is attributed to the exciton recombination dominated by defect-assisted exciton trapping besides photon emission channel.The decrease of scattering probability caused by defects leads to the increase of fast lifetime with thickness,and the increase of slow lifetime with thickness is related to the trap-mediated exciton depopulation induced by surface defects.Polarization-dependent transient spectroscopy indicates the isotropic exciton dynamics in the two-dimensional(2D)plane.These results are insightful for better understanding of excitonic dynamics of ReSe_(2)materials and its application in future optoelectronic and electronic devices.
文摘目的观察核苷类药物(nucleoside analogues,NAs)治疗后病毒学应答不佳的慢性乙型肝炎(chronic hepatitis B,CHB)患者换用替诺福韦(Tenofovir,TDF)的疗效和安全性。方法本研究经筛选后纳入108例患者,分为恩替卡韦(Entecavir,ETV)治疗后继续ETV治疗组(ETV to ETV组)(32例)、ETV治疗后换用TDF组(ETV to TDF组)(30例)和非ETV的NAs治疗后换用TDF组(Non-ETV to TDF组)(46例)。观察各组在基线前后各个随访点HBV DNA累计不可检测率、HBV DNA定量等病毒学指标,丙氨酸氨基转移酶、血清肌酐等生化指标的差异。结果ETV to TDF组与ETV to ETV组相比,第24周HBV DNA定量对数为2.0(2.0~2.0)IU/mL vs.2.0(2.0~2.5)IU/mL(P=0.034);第24周HBV DNA累计不可检测率为83.3%vs.56.3%,差异有统计学意义(χ^(2)=5.34,P=0.021),ETV to TDF组明显优于ETV to ETV组;两组之间的总体的HBV DNA不可检测耗时分布的差异不具有统计学意义(χ^(2)=2.366,P=0.124),但HBV DNA不可检测耗时平均值两组分别为(24.8±3.57)和(36.4±5.35)周。ETV to TDF组与Non-ETV to TDF组相比,24和48周的HBV DNA累计不可检测率分别为83.3%vs.82.8%(P=0.935)和90%vs.93.5%(P=0.675),差异均无统计学意义。换药前ETV疗程在48~96周内在换用TDF后HBV DNA转阴时间之间差异无统计学意义(P=0.270)。所有随访患者均未发生病毒学突破。所有随访患者均未发生严重的不良反应,如横纹肌溶解等。结论换用TDF治疗其他核苷类药物初治后病毒学应答不佳的患者是一种疗效好,安全性高的治疗方法。换用TDF治疗可能在一定程度上比继续ETV治疗更快促进ETV应答不佳患者的HBV DNA阴转。ETV疗程在48至96周内可能并不会影响后续换用TDF疗效。
