Hepatitis In China Research Articles

Analysis on morbidity and mortality of viral hepatitis in China, 2004-2013

To understand the incidence and death patterns of viral hepatitis in China and provide evidence for the prevention and control of viral hepatitis. The analysis was conducted on the incidence and death data of viral hepatitis published by National Health and Family Planning Commission during 2004-2013. The incidences of viral hepatitis in Guizhou,Yunnan, Tibet, Gansu, Qinghai,Ningxia and Xinjiang provinces (autonomous region) were high. The major forms were hepatitis B (80.63/100 000) and hepatitis C (9.68/100 000), accounting for 80.90% and 9.25% of the total reported viral hepatitis cases respectively. The incidences of hepatitis A and unidentified hepatitis decreased and the incidence of hepatitis B, C and E increased during this period. During the 10 years, 10 008 deaths caused by viral hepatitis were reported (1 001 deaths per year). The reported deaths caused by hepatitis A, hepatitis E and unidentified hepatitis decreased during this period. The reported deaths caused by hepatitis B were in a downward trend, but the constituent in total cases remained high. The reported deaths caused by hepatitis C were in an upward trend. During 2004-2013, the overall incidence of viral hepatitis showed no downward trend in China. The incidence of hepatitis B remained high, and the incidence of hepatitis C showed an obvious upward trend. The overall death rate and case fatality rate of viral hepatitis showed a downward trend, but hepatitis B remained the main cause of viral hepatitis related death, and the death caused by hepatitis C was in increase. Hepatitis B and hepatitis C are the major targets in the prevention and treatment of viral hepatitis in China, and the 7 western provinces (autonomous region) with high incidences are the key regions of the prevention and control.

Validation of an LC-MS/MS method for quantitative analysis of the 5 bioactive components of Wuzhi capsule in human plasma samples.

Wuzhi capsule (WZC) is an ethanol extract from the ripe fruit of Schisandra sphenanthera in traditional Chinese medicine that has long been used to treat viral and drug-induced hepatitis in China. The principal active components in WZC are Schisandra lignans. The clinical pharmacokinetics of these components in the form of an oral WZC preparation is unknown. To optimize the WZC dosage and develop WZC-related combination therapies, it is necessary to conduct a comprehensive pharmacokinetic study of the Schisandra lignans. A method was developed for simultaneous quantification of multiple bioactive lignans in WZC in human plasma through liquid-liquid extraction followed by multiple reaction monitoring liquid chromatography/tandem mass spectrometry with positive-mode electrospray ionization. The 5 bioactive constituents were separated by isocratic elution using a mobile phase consisting of acetonitrile, methanol, and 0.1% aqueous formic acid at a flow rate of 0.3 mL/min. The total run time was 3.5 minutes. All analytes showed good linearity over a wide concentration range with a lower limit of quantification at 0.5 ng/mL. Using this method, we determined the 5 bioactive lignans in WZC from human plasma simultaneously and performed a pharmacokinetic study on the Schisandra lignans in healthy volunteers. Owing to simplicity, quickness, high sensitivity, and selectivity, and a sufficient lower limit of detection of the new liquid chromatography/tandem mass spectrometry method, it may be used as a routine technique for clinical monitoring of WZC, and for understanding interactions between herbal and conventional drug therapies.

English

The alcohol-extraction-water-precipitation fraction of Swertia mussotii Franch. (SME-d) had been proved to be hepatoprotective without toxicity in previous report. In this article, high performance liquid chromatography (HPLC), rat experiment and P450 model tests were employed for studying the pharmacology characteristics of SME-d. The results showed that the contents of sweroside, swertiamarin, mangiferin, gentiopicroside, and isoorientin were 0.24, 3.96, 12.30, 13.53, 16.85 mg/g in SME-d, respectively. SME-d could reduce the CCl4-induced exaltation of alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), total bile acid (TBA) significantly in rat, and the protective activity showed dose-dependent in 0.9 and 1.8 g/kg body weight (BW). The hepatoprotective activity of SME-d was different to positive drug bifendate, which only did on ALT value significantly. Bifendate could inhibit 66.17 ± 2.12% of CYP3A4 activity, while SME-d showed 99.0 ± 0.267% reductions on CYP1A2. The different medicinal characteristics of SME-d to bifendate, which are used widely to cure hepatitis in china, can give more choices for hepatitis. Key words: Swertia mussotii Franch, the alcohol-extraction-water-precipitation fraction, pharmacology characteristic, hepatoprotective activity.

Review of hepatitis B surveillance in China: Improving information to frame future directions in prevention and control

BackgroundAs the WHO verified that China reached the target of 1% prevalence of chronic hepatitis B infection among children targeted by universal hepatitis B immunization of newborns, the country considered new options for hepatitis B prevention and control. We reviewed hepatitis B surveillance in the broader context of viral hepatitis surveillance to propose recommendations to improve the system. MethodsWe described surveillance for viral hepatitis in China with a specific focus on hepatitis B. We assessed critical attributes of the system, including data quality, predictive positive value and usefulness. ResultsWhile remarkable progress in hepatitis B immunization of infants and children has likely almost eliminated transmission in younger age groups, reported rates of hepatitis B increased steadily in China between 1990 and 2008, probably because of a failure to distinguish acute from chronic infections. Elements that prevented a clearer separation between acute and chronic cases included (1) missed opportunity to report cases accurately among clinicians, (2) low availability and use of tests to detect IgM against the hepatitis B core antigen (IgM anti-HBc) and (3) lack of systems to sort, manage and analyze surveillance data. ConclusionsTo improve hepatitis B surveillance, China may consider (1) training clinicians to diagnose acute cases and to use IgM anti-HBc to confirm them, (2) improving access and use of validated IgM anti-HBc tests and (3) developing data management and analysis techniques that sort out acute from chronic cases.

The emerging importance of autoimmune hepatitis in China

Autoimmune hepatitis (AIH) is a chronic inflammation of the liver caused by an abnormal autoimmune reaction against hepatocytes. The pathogenesis of AIH involves a loss of tolerance to hepatic self antigens in a susceptible host. The diagnosis is based on histological abnormalities, and characteristic clinical and biochemical findings, which include abnormal levels of serum globulins, and the presence of one or more characteristic autoantibodies such as ANA, SMA, and anti-SLA. Interface hepatitis with abundant plasma cells in the infiltrate is characteristic histological features of AIH. Although the prevalence data are scare, AIH has emerging as major course of non-viral chronic hepatitis in China. More and more liver centers launch liver biopsy and serum autoantibody detection regularly. Alertness and awareness of hepatologists and histologic physicians on histologic features of AIH contributes to more and more AIH patients diagnosed in our clinics who were considered as cryptogenic chronic hepatitis previously. The simplified criteria have high sensitivity and specificity for diagnosis of AIH in Chinese patients. The revised original criteria have the complementary role to avoid the false negative diagnosis in atypical AIH patients. Immunosuppressive treatment can attenuate hepatic inflammation, revert fibrosis, and eventually improve the patient’s prognosis and life quality. Corticosteroids, either alone or in combination with azathioprine, are the standard treatment of choice for AIH. Most Chinese patients with AIH show a good response to immunosuppressive treatment, although patients with late-stage or severe disease are less likely to achieve remission. Liver transplantation is the last choice for AIH patients with decompensated end-stage disease. Transfer of regulatory immune cells such as regulatory T cells may become a potential therapy in the near future.

Era of Vaccination Heralds a Decline in Incidence of Hepatitis A in High- Risk Groups in China

Hepatitis A was ranked first among all of the different types of viral hepatitis in China, which occurred an average of 500,000 cases annually during the 1980's. A live attenuated hepatitis A vaccine was applied in preventing of the disease in 1992, large scale used in vaccination program in 1995, and incorporated in the Expanded Program of Immunization in 2008 in China. The objective of this study was to determine whether, and to what extent, the decline in the incidence of hepatitis A in China was the result of hepatitis A (HA) vaccination. Official documents and longitudinal serological follow-up studies were reviewed to compare the incidence of HA before and after the introduction of the vaccine. National trends in the incidence of HA in China saw rates decrease by 92.7% in 2009, compared to the levels seen in 1992. A mass vaccination program was carried out in 3-18 year old children (Wuhan City, China), and its protective efficacy was 85.4%. In a mass vaccination program of an entire population (Shenshi County, China), the annual HA incidence decreased from 359.7/100,000 to 17.7/100,000 (almost 20.3 times). There was a significant relationship found between vaccine coverage and the incidence of HA, the correlation of the negative regression was significant at the 1% (Kendall rank correlation, significant level P < 0.05). In summary, this study highlights the important role of implementing a vaccination program in decreasing the incidence of HA, and the large protective efficacy of such a strategy, as demonstrated in China.

Era of Vaccination Heralds a Decline in Incidence of Hepatitis A in High-Risk Groups in China

Background: Hepatitis A was ranked first among all of the different types of viral hepatitis in China, which occurred an average of 500,000 cases annually during the 1980s. A live attenuated hepatitis A vaccine was applied in preventing of the disease in 1992, large scale used in vaccination program in 1995, and incorporated in the Expanded Program of Immunization in 2008 in China. Objective: The objective of this study was to determine whether, and to what extent, the decline in the incidence of hepatitis A in China was the result of hepatitis A (HA) vaccination. Materials and Methods: Official documents and longitudinal serological follow-up studies were reviewed to compare the incidence of HA before and after the introduction of the vaccine. Results: National trends in the incidence of HA in China saw rates decrease by 92.7% in 2009, compared to the levels seen in 1992. A mass vaccination program was carried out in 3-18 year old children (Wuhan City, China), and its protective efficacy was 85.4%. In a mass vaccination program of an entire population (Shenshi County, China), the annual HA incidence decreased from 359.7/100,000 to 17.7/100,000 (almost 20.3 times). There was a significant relationship found between vaccine coverage and the incidence of HA, the correlation of the negative regression was significant at the 1% (Kendall rank correlation, significant level P < 0.05). Conclusions: In summary, this study highlights the important role of implementing a vaccination program in decreasing the incidence of HA, and the large protective efficacy of such a strategy, as demonstrated in China

Protective effects of oleanolic acid on cerebral ischemic damage in vivo and H2O2-induced injury in vitro

Context: Oleanolic acid (OA), a triterpenoid compound, exists in many plants. It has numerous bioactivities and has been used to treat hepatitis in China. However, few studies have reported its effect on the central nervous system, especially in ischemic stroke.Objective: To explore the protective effects of OA on cerebral ischemic injury for the first time.Materials and methods: Survival time was tested in mice injured by bilateral common carotid artery ligation (BCCAL). Neurological function, infarct area, cerebral edema, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and malondialdehyde (MDA) were estimated in rats operated by middle cerebral artery occlusion (MCAO). Cell survival, lactate dehydrogenase (LDH), SOD, reduced glutathione (GSH), MDA, mitochondrial membrane potential (MMP) and succinic dehydrogenase (SDH) were detected in H2O2-injured PC12 cells.Results: Pre-administration with OA significantly prolonged survival time in mice at 50 and 25 mg/kg, alleviated neurological function, infarct area and cerebral edema, increased SOD and GSH-Px activities and decreased MDA level in rats at 25 and 12.5 mg/kg. Pre-treatment with OA at 10 and 1 μM remarkably improved cell survival, enhanced SOD activity and GSH content, reduced LDH and MDA levels and reversed the lowering of MMP and SDH activity.Discussion and conclusion: These results demonstrate that oleanolic acid effectively alleviates cerebral ischemic damage in vivo and oxidative injury in vitro, which may be in part due to the modulation of endogenous antioxidants and the improvement of mitochondrial function. Oleanolic acid may be a potential medicine for attenuating ischemic stroke.

Oleanolic acid nanosuspensions: preparation, in-vitro characterization and enhanced hepatoprotective effect

Oleanolic acid is a naturally derived triterpene used clinically in the treatment of hepatitis in China, but its poor solubility often leads to poor bioavailability. In the present study, oleanolic acid nanosuspensions were prepared by the nanoprecipitation method and then systematically characterized. The average particle size of the obtained nanosuspensions was 284.9 nm, with a polydispersity index of 0.216. Transmission electron microscopy and atomic force microscopy showed that the drug existed as spherical or near-spherical nanoparticles in the nanosuspensions. Differential scanning calorimetry and X-ray diffraction studies indicated that oleanolic acid was present in an amorphous state in the lyophilized nanosuspensions. At 25 degrees C, the saturation solubility of oleanolic acid was increased by about 6 times after nanoation (25.72 microg mL(-1) vs 4.37 microg mL(-1)). In the in-vitro drug release experiments, the lyophilized nanosuspensions showed a faster drug dissolution rate than that of the coarse drug powder (approx. 90% vs 15% during the first 20 min), and nearly 95% of the oleanolic acid was released by 120 min. As evidenced by the lower serum alanine aminotransferase activity and liver malondialdehyde content, pre-treatment with oleanolic acid nanosuspensions significantly enhanced the hepatoprotective effect of oleanolic acid against carbon tetrachloride-induced liver injury.

Antitumor Activity of the Aqueous Extract from Sedum sarmentosum Bunge In Vitro

Sedum sarmentosum Bunge, a Chinese herb, is mainly used for the treatment of chronic viral hepatitis in China, The aim of this work was to examine the cytotoxic activity of S. sarmentosum (aqueous extract, AE) against a human hepatoma cell line (HepG2) in culture. Cell-proliferation ability was determined by the MTT method. Cell-cycle changes and earlier period apoptotic rate of HepG2 cells were detected by flow cytometry. Apoptosis of cultured HepG2 cells induced by AE were observed with a classic laddering pattern on agarose gel electrophoresis. The mRNA levels of Bcl-2 and vascular endothelial growth factor (VEGF) were determined by reverse-transcriptase polymerase chain reaction. The protein expressions of Bcl-2, VEGF, and p-STAT3 were valued by immunocytochemistry. The application of AE to the HepG2 cell culture caused a significant, dose-dependent inhibition of cancer cell growth. It was found that the AE treatment induced apoptosis of the cancer cells, although no changes were found after AE treatment for 48 hours in the HepG2 cell cycle. The mRNA and protein expressions of Bcl-2 and VEGF and the protein level of p-STAT3 were significantly decreased after the AE treatment for 48 hours. This study suggests that AE of S. sarmentosum has potential in preventing and inhibiting effects on hepatocellular carcinoma, which is associated with apoptosis of the cancer cells.

Diammonium Glycyrrhizinate protects against trinitrobenzene sulfonic acid‐induced colitis in rats

Glycyrrhizinate is the major active component of licorice root extract, an ancient medicinal plant with various pharmacological activates. Diammonium Glycyrrhizinate (DG) has long been used to treat hepatitis in China. Recently, it has been reported that DG could reduce acetic acid‐induced inflammatory injury in a rat ulcerative colitis (UC). However, whether DG has anti‐inflammatory effect in other UC models remains unknown. The aim of the present study is to examine the protective effects of DG on trinitrobenzene sulfonic acid (TNBS)‐induced UC in rats.Methods: Sprague‐Dawley rats were randomly assigned into five groups: 1) normal control; 2) TNBS; 3) TNBS+DG (2 mg/kg); 4) TNBS+DG (10 mg/kg); 5) TNBS+DG (50 mg/kg); 5) TNBS+ sulfasalazine (SASP, 225mg/kg). After induction of UC with TNBS, DG or SASP was rectally administrated daily for 8 days, the normal control and TNBS groups were administrated with the same volume of saline. Colonic inflammation was evaluated by disease activity index, histological changes, and myeloperoxidase (MPO) activity. Radioimmunoassay was used to measure TNF‐a and IL‐1b levels in the serum.Results: DG not only significantly inhibited TNBS‐induced increase of MPO, TNF‐α and IL‐1β, but also prevented TNBS‐induced colonic injury.Conclusions: TNBS‐induced colitis was reliable rat UC model. Rectal administration of DG could effectively prevent TNBS‐induced inflammatory injury.

Bicyclic Polyketide Lactones from Chinese Medicinal Ants, Polyrhacis lamellidens

Two new bicyclic polyketide lactones, polyrhacitides A ( 1) and B ( 2), were isolated from Chinese medicinal ants, Polyrhacis lamellidens, which have been used as an effective therapeutic agent to treat rheumatoid arthritis and hepatitis in China. Their absolute structures were elucidated on the basis of spectroscopic analyses and chemical evidence. The occurrence of polyketides with similar structures in plants of the Lamiaceae, Lauraceae, and Staphyleaceae indicates their significance in the study of chemical ecology.

Improve laboratory test for viral hepatitis in China

提高实验室诊断水平对于病毒性肝炎的有效防治具有十分重要的作用.通过优化常规病毒性肝炎实验室诊断技术,使检测灵敏度、稳定性等方面达到国际水准.运用分子生物学、蛋白组学、代谢组学等平台,研发新型、快速、联合、多样化的病毒性肝炎实验诊断技术.同时,按照循证医学要求,提高实验室数据的利用效率,切实改进我国病毒性肝炎的实验室诊断水平。

Hepatoprotective and antioxidative effects of total phenolics from Laggera pterodonta on chemical-induced injury in primary cultured neonatal rat hepatocytes

Although Laggera pterodonta as a folk medicine has been widely used for several centuries to ameliorate some inflammatory ailments as hepatitis in China, there have been no studies of the hepatoprotective and antioxidative effects of this plant. In this paper, the hepatoprotective effect of total phenolics from L. pterodonta (TPLP) against CCI 4-, d-GalN-, TAA-, and t-BHP-induced injury was examined in primary cultured neonatal rat hepatocytes. TPLP inhibited the cellular leakage of two enzymes, hepatocyte ASAT and ALAT, caused by these chemicals and improved cell viability. Moreover, TPLP afforded much stronger protection than the reference drug silibinin. Meanwhile, DPPH and superoxide radicals scavenging activities of TPLP were also determined. The present investigation is the first to report chemical-induced injury model in primary cultured neonatal rat hepatocytes and provide evidence for the hepatoprotective and antioxidative effects of L. pterodonta. Neutralizing reactive oxygen species by nonenzymatic mechanisms may be one of main mechanisms of TPLP against chemical-induced hepatocyte injury. Furthermore, The total phenolic content of L. pterodonta and its main component type were quantified, and its principle components isochlorogenic acids were isolated and authenticated. These data support the folkloric uses of L. pterodonta in the treatment of hepatitis.

Formation of lignans in plant cell culture of Schisandra chinensis

The fruit of Schisandra chinensis, a woody liana, has been used for centuries in traditional Chinese medicine. The fruit is prescribed for the treatment of hepatitis in China. The active principles are lignans with unusual structures derived from dibenzo[a,c]cyclooctadiene. These lignans have been shown to possess a broad range of biological activities. Recently, it has been found that lignan gamma-schizandin strongly inhibits P-glycoprotein, the overexpression of which is the most frequent cause for cancer multidrug resistance. S. chinensis cultures derived from immature zygotic embryos were developed on Murashige and Skoog and VW5 medium. Embryogenic cultures were established on the medium containing thidiazuron, 2,4-dichlorophenoxyacetic acid and benzylaminopurine. An analytical method based on HPLC-UV was used for the determination of six lignans in plant cell cultures. Our previous results showed that the concentration of lignans in plant cell cultures was mostly lower than that in fruit and leaves. We also detected the lignans in liquid culture media, but the amount of lignans inside the cells was substantially higher. In order to release the lignans stored within the cells, we explored the cultivation of five cell lines with neutral polymeric resin, Amberlite XAD2. We found that the addition of Amberlite XAD2 not only notably enlarged portions of extracellular lignans, but also greatly enhanced the production of lignan deoxyschizandrin, whereas the formation of other lignans was increased only moderately (less than 5fold). Importantly, Amberlite XAD-2 did not reduce the growth of cell cultures. Deoxyschizandrin adsorbed on the polymeric resin can be easily recovered and purified without destruction of the cells.

Molecular detection and sequence analysis of a new hepatitis E virus isolate from Pakistan

Sporadic and epidemic acute viral hepatitis E in many developing countries is caused by hepatitis E virus (HEV). The HEV genome has been classified into three major genotypes. However, extensive diversity has been noted among HEV isolates from patients with acute hepatitis in China and Taiwan. Some reports indicated that multiple genotypes of HEV could cocirculate in the same area; even distinct genotypes of HEV could exist in the same patient. Pakistan is a highly endemic area for hepatitis E. So far only two Pakistan HEV isolates Sar-55 (87-Pakistan-A) and Abb-2B (88-Pakistan-2B) have been characterized, and the nucleotide sequences of these two HEV isolates show only 90% homology. In this study, a third HEV isolate from Pakistan (87-Pakistan-B) is reported. The sequences of a 438-bp fragment from ORF-2 and a 259-bp fragment from the ORF-1-3 region of this new HEV isolate were obtained and sequenced. The sequence analysis showed that this new HEV isolate was very closely related to the Sar-55 but different from the Abb-2B HEV isolate. These results indicated that the Sar-55 (87-Pakistan-A) genotype is the main endemic HEV strain in the Sargodha area. These data will be useful for HEV epidemiological studies, diagnosis and vaccine development.

Artificial Liver Support System in China: A Review Over the Last 30 Years

Severe viral hepatitis with high mortality is the most common cause of liver failure in China. Treatment of severe viral hepatitis by hemoperfusion was initially adopted in the late 1970s and early 1980s. Following 10 years of development in China, a plasma exchange (PE)-centered artificial liver support system (ALSS), principally dependent on PE technology was developed. Based on the condition and symptoms of each patient, PE was given alone, or combined with hemodialysis, hemofiltration, hemodiafiltration, hemoperfusion, or plasma perfusion. In the late 1990s, training courses for ALSS were developed, and ALSS began to be carried out across China. Guidelines for artificial liver therapy were formulated and published by the Artificial Liver and Liver Failure Group of the Chinese Society of Infection. In recent years, new methods have been attempted, including small pore-size plasma separators, a molecular adsorbent-based recirculating system (MARS), and a continuous albumin purification system (CAPS). According to a retrospective analysis published in 2004, ALSS therapy significantly (P < 0.001) improved the survival rate of patients with severe hepatitis compared with patients who received only medicines (43.4%, 157/362 vs. 15.4%, 55/358 in chronic patients and 78.9%, 30/38 vs. 11.9%, 5/42 in acute and subacute patients). Furthermore, ALSS has also proved valuable as a bridge to liver transplantation in the treatment of patients with end-stage severe hepatitis in China. More recently, ALSS has been used in the treatment of drug-induced liver failure, acute fatty liver during pregnancy, and other difficult-to-treat disorders in China.

Mechanism of protective action of bicyclol against CCl4‐induced liver injury in mice

Bicyclol is a novel synthetic drug for the treatment of chronic viral hepatitis in China. This paper reports the protective action of bicyclol against experimental liver injury in mice and its mechanism of action. Oral administration of bicyclol markedly reduced the elevated serum transaminases (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)) and the hepatic morphologic changes induced by CCl(4) in mice. Mechanistic studies demonstrated that bicyclol significantly inhibited CCl(4)-induced lipid peroxidation of liver microsomes and (14)CCl(4) covalent binding to microsomal lipids and proteins in vitro, and decreased the level of the trichloromethyl free radical (*CCl(3)) generated from CCl(4) metabolism by NADPH-reduced liver microsomes. On the other hand, bicyclol neither directly inhibited the activity of ALT or AST in vitro nor affected hepatic ALT protein content in mice. These results suggest that bicyclol has remarkable hepatoprotective effects and its mechanism of action may be related to a decrease in free radical-induced damage to hepatocytes.

Relationship between clinical and pathologic findings in patients with chronic liver diseases

To explore the relationship between clinical findings of patients with chronic liver diseases and the pathologic grading and staging of liver tissues. The inflammatory activity and fibrosis of consecutive liver biopsies from 200 patients were determined according to the diagnosis criteria of chronic hepatitis in China established in 1995. A comparative analysis was carried out for 200 patients with chronic liver diseases by comparing their clinical manifestations, serum biochemical markers with the grading and staging of liver tissues. It was revealed that age, index of clinical symptoms and physical signs were obviously relevant to the pathologic grading and staging of liver tissues (P<0.05). Blood platelet, red blood cells, aspartate aminotransferase (AST), N-terminal procollagen III (PIII NP) were apparently correlated with the degree of inflammation. PGA (prothrombin time, GGT, apoprotein A1) index, PGAA (PGA+delta2-macroglobulin) index, albumin and albumin/globulin were relevant to both inflammation and fibrosis. Hyaluronic acid (HA) was an accurate variable for the severity of hepatic inflammation and fibrosis. The combination of serum markers for fibrosis could increase the diagnostic accuracy. It was notable that viral replication markers were not relevant to the degree of inflammation and fibrosis. There is a good correlation between clinical findings and the pathologic grading and staging of liver tissues, which may give aid to the noninvasive diagnosis of liver fibrosis.

Risk of medical sharps injuries among Chinese nurses

The risk of occupational exposure to bloodborne pathogens is a serious problem for Chinese health care workers. China has one of the highest rates of hepatitis B virus (HBV) infection in the world, with almost 58% of the population demonstrating serologic evidence of past or present hepatitis B infection. 1 Yao GB Importance of perinatal versus horizontal transmission of hepatitis B virus infection in China. Gut. 1996; 38: S39-S42 Crossref PubMed Scopus (106) Google Scholar , 2 Clayton S Yang H Guan J Lin Z Wang R Hepatitis B control in China: knowledge and practices among village doctors. Am J Public Health. 1993; 83: 12 Crossref Scopus (17) Google Scholar , 3 Viral hepatitis in China: seroepidemiological survey in Chinese population (Part One), 1992-1995. Bureau of Public Health of People's Republic of China, Beijing, China1997 Google Scholar This proportion reaches more than 76% in Hunan Province. 3 Viral hepatitis in China: seroepidemiological survey in Chinese population (Part One), 1992-1995. Bureau of Public Health of People's Republic of China, Beijing, China1997 Google Scholar Hepatitis C virus is also present, with a prevalence of 3.2% for the total Chinese population and 4% in Hunan. 3 Viral hepatitis in China: seroepidemiological survey in Chinese population (Part One), 1992-1995. Bureau of Public Health of People's Republic of China, Beijing, China1997 Google Scholar In addition, the prevalence of HIV is rising. All of these bloodborne pathogens represent a significant health risk to medical personnel. 4 Chen X He J Wu H A sero-epidemiological and behavior factors study of HIV, HCV, HBV, and syphilis infection among commercial blood donors. Practical Prev Med. 1999; 6: 174-176 Google Scholar