Objective To evaluate the efficacy of telbivudine in HBeAg-positive chronic hepatitis B (CHB) patients by comparing the efficacy of initial telbivudine therapy in treatment-naive patients with sequential telbivudine therapy in patients with poor response to adefovir.Methods A total of 90 HBeAg-positive CHB patients were assigned to receive sequential telbivudine therapy following poor response to adefovir dipivoxil (n=45),or initial telbivudine therapy in antiviral treatment-naive patients (n=45).All patients were treated with telbivudine 600 mg daily for 104 weeks.The efficacy was evaluated in terms of liver function tests,serum HBV markers,HBV DNA and antiviral drug resistance.Results Telbivudine showed good overall efficacy after treatment for 104 weeks in terms of alanine aminotransferase normalization rate (91.1％),HBV DNA negative conversion rate (80.0％),HBeAg loss rate (57.8％),and HBeAg/HBeAb seroconversion rate (30.0％).The HBV DNA negative conversion rate in initial treatment group was significantly higher than that in sequential treatment group (P＜0.05).However,among the patients with early response,the efficacy did not show significant difference between groups (P＞0.05).The patients with early response showed significantly better efficacy than those without early response,in terms of higher HBV DNA negative conversion rate,higher HBeAg loss rate and HBeAg/ HBeAb seroconversion rate (P＜0.000 1 or P＜0.05),but lower virological breakthrough rate (P＜0.05).Conclusions Telbivudine has shown reliable efficacy in CHB patients.Initial telbivudine therapy is better than sequential therapy in CHB patients with poor response to adefovir.However,for patients with early response to telbivudine,no statistical difference is found between initial and sequential therapy in long-term treatment efficacy (104 weeks).The patients receiving sequential telbivudine therapy should be monitored closely for early antiviral response to optimize treatment.

Paroxysmal nocturnal haemoglobinuria ( PNH) is a clonal hematopoietic stem cell disease characterized by intravascular hemolytic anemia , pancytopenia and thrombosis .Although PNH is an non-malignant disease , its complications have very negative impacts on patient's quality of life .The most common serious complication is thrombosis formation .

[Objective] To investigate the causes,indications,operative methods and clinical results of lumbar reoperation.[Methods]Twenty-eight failure lumbar procedure cases were received reoperation from May 2003 to May 2005.There were 16 males and 12 females.These cases were from 31 to 70 years old(mean 47).It took a mean 1 year and 8 month(from 1 month to 8 year)from last operation to this registry.The causes of reoperation included rehemiated disc nucleus pulpous,degeneration of adjacent segment and instability and insufficiency of canal decompression.Some cases of discogenic back pain were operated by mistaken procedure.Some cases involved severe complications including infection in disc space or vertebral itself,pedicle screws misposition,aneurysm formation and CSF leakage.The operative methods included rediscectomy,lumbar canal decompression,and lumbar reconstruction by implant and fusion.[Results]The operative time and blood lose were from 50 to 350 minutes(mean 213)and from 100 to 3 000 ml(mean 760 ml)respectively.One patient died because of severe abdominal cavity infection.The other cases were recovered and clinical complaint became less.The VAS and Oswestry Disability Index decreased from(7.9?1.6)and(52.4?7.2)to(2.8?1.0)and(8.3?3.6)respectively(the decrease rate:64.3% and 66.5%)after 24 to 48 months follow-up(mean 32.8 months).[Conclusion]The causes of failure lumbar procedure must be analyzed as soon as possible.The risks and benefits of reoperation must be balanced although it may make patients get more chance to recovery.It is very difficult for these procedures and the risks are also high.The dura sac rupture is the most common complication.It is the most important to deal with the adhesion and bleeding control in canal.The use of the magnification and lighting equipment can reduce the complications.

Objective To observe the change of serum TG in elderly diabetic patients after fatty meal.Methods The diabetic patients and non-diabetic patients of fasting normotriglyceridemia ate the fatty test meal after having been fasting for 12h.Serum lipid were measured at 0,2,4 and 6h after the meal.Results The serum TG level increased in the two groups after the meal,the diabetic patients had a higher TG-AUC than the non-diabetic patients (P

Bronchi ; Child, Preschool ; Foreign Bodies ; complications ; Humans ; Male ; Pneumopericardium ; etiology ; Spinal Diseases ; etiology

Objective To summarize our preliminary experience and evaluate the clinical value of laparoscope diagnosis and treatment for annular pancreas in neonates.Methods A retrospective review of laparoscope diagnosis and treatment for annular pancreas in 9 children from September 2009 to January 2013 was performed.Among them,5 were male,4 were female.The age was ranging from 1 to 13 d.A lowerpressure pneumoperitoneum of 5 ～ 8 mm Hg (1 mm Hg =0.133 kPa) was used.Eight cases of diamond duodenal anastomosis were performed under laparoscope after the diagnosis was established,and 1 case underwent procedure through slightly enlarged umbilical port site.Results Eight cases of diamond duodenal anastomosis were performed under laparoscope,and the operation time was 80 ～ 140 min (mean 105 min),in 1 case it was performed through umbilical port incision,the operation time was 64 min,and the length of incision was about 2.5 cm.Feedings were started at postoperative day 4 to 7 (mean 5 d),and patients were discharged at postoperative day 8 to 14 (mean 10 d).The cases were followed-up for 3 ～ 20 months (mean 6.7 months),and I case complicated with anal atresia died of pneumonia 6 months later.Other cases were uneventfully recovered and symptoms were alleviated with normal gastroenterological function,no preoperative symptoms recurred,and the nutrition and growth status was excellent.Conclusions Annular pancreas can be diagnosed through laparoscopy.Laparoscope diagnosis and treatment for annular pancreas has the advantages of small incision,micro-invasion and faster recovery,can be safely performed in neonatal period.

BACKGROUND: Compression occurs in several horizontal spinal cords of patients with multilevel cervical spondylotic myelopathy (CSM), especially compression is attacked on both ends of spinal cord. Therefore, there are so many choices of approach and way for operation. However, which approach and way have good effects and few complications is still controversial up to now.OBJECTIVE: To observe the therapeutic effect of anterior multilevel decompression and internal fixation on multilevel CSM and compare with posterior mono-open-door vertebral canal expanding laminoplasty.DESIGN: Contrast analysis.SETTING: Department of Orthopaedics, Xiangya Hospital of South China University; Department of Orthopaedics, People's Hospital of Liuzhou.PARTICIPANTS: A total of 68 patients with multilevel CSM were selected from the Department of Orthopaedics, Xiangya Hospital of South China University from January 2000 to June 2005. All patients were divided into anterior approach surgery group (n =33) and posterior approach surgery group (n =35). Baseline data between the two groups were comparable.METHODS:①Anterior approach surgery group: All 33 patients received bone-transplanting and internal fixation through cervical spine. Among them, auto-iliac bone-graft was transplanted into 17 cases, Cage auto-bone graft combining with allogenic bone was transplanted into 11 cases, and titan-net and auto-bone combining with allogenic bone was transplanted into 5 cases. In addition, long segments were dealt with internal fixation of anterior cervical spine locking plate (CSLP). Among them, 12 cases used Orion plate, 13 cased used Zephir palte, and 8 cases used Codman plate. ②Posterior approach surgery group: Fifteen patients received total laminectomy for decompression and other twenty patients received mono-open-door vertebral canal expanding laminoplasty. After laminoplasty, all patients received negative pressure and neck support fixation for three months.MAIN OUTCOME MEASURES: ①Scores were measured based on JOA evaluating system before and after laminoplasty to calculate recovery rate. The scores of JOA ranged from 0 to 17. The higher the scores were, the milder the spinal cord damage was. ② Magnetic resonance image (MRI) was used to measure and calculate the sagittal diameter of dural sac.RESULTS: A total of 68 patients were involved in the final analysis. ①Mean operative time and bleeding volume were respectively shorter and less in the posterior approach surgery group than those in the anterior approach surgery group (P＜0.05). ②Recovery rates were higher in the anterior approach surgery group than those in the posterior approach surgery group [(58.28±7.16)%, (42.71±5.85)%; (45.64±6.56)%, (37.65±5.75)%; P＜0.05].③Follow up lasted for more than 6 months. Fusion rate in the anterior approach surgery group was 100%, and mean fusion time was 4.6 months. Mobilization and breakage of plate and screw were not observed during the laminectomy.CONCLUSION: The posterior approach surgery is simple and spends a short-term duration, but the effect of posterior approach surgery is inferior to anterior approach decompression.

BACKGROUND: The blood oxygen saturation is an important physiological parameter of human hfe; it can be affected by multiple factors due to the imbalance of oxygen supply and consumption, and consequently, the normal physical metabolism is affected. The existing manufacturing techniques are complex and are used with higher demands. OBJECTIVE: To investigate the accuracy of the novel reflecting oximeter designed on the basis of reflecting principle in monitoring the variance of blood oxygen saturation with the change of its concentration. DESIGN: To introduce the structure, working principle and design of the reflecting oximeter and make comparative study with adult rabbits as the subjects. SETTING: Cardiopolmonary Bypass Department of Cardiovascular disease hospital of the Chinese Academy of MedicalSciences. MATERIALS: The study was performed at the Departments of Anesthesiology and Cardiopulmonary Bypass of the Cardiovascular Disease Hospital,Chinese Academy of Medical Sciences from August to October in 2001.Ten adult rabbits were selected. METHODS: The oximeter consists of a converter, a driver, a central processing mould and liquid-crystal monitor. It is characterized by the onethree optical cable connected with reflecting probe, postcentral management system and digital displayer. This oxmeter was developed basing on the basis of fixed relationship between blood oxygen saturation and radiant absorbency (or reflecting). In this study,cardiovascular-pulmonary bypass was established on rabbits that were then exposed to oxygen and NO mixture supply of different concentrations,and then the corresponding blood oxygen saturations were determined with the new oximeter and compared with series-wound Baite saturation meter and blood-gas analysis. MAIN OUTCOME MEASURES: The blood oxygen saturation at different concentrations determined with the reflecting oximeter and Baite saturation meter. RESULTS: At the same oxygen concentration, the blood oxygen saturation determined with the new measure was not significantly different from that determined with Baite blood oxygen saturation meter(P＞0.05 ). CONCLUSION: The variance of blood oxygen saturation with the change of oxygen concentration can be detected by the reflecting oximeter with the result similar to that by Baite blood oxygen saturation meter.

Objective To study the effect of three kinds of disinfection liquid,namely chlorine dioxide,silver ion and BIOCIDE,on sterilization of Legionella pneumophila.Methods The suspended quantified disinfection test was conducted by using 7 type of Legionella p neumophila,0.5 ml of bacterial suspension and 4.5 ml disinfection liquid were mixed for certain period, the normal saline was used as the control.1.0 ml of the above liquid or its dilution was incubated with BCYE for 72 h in CO_2 and 35 ℃,the colony count and sterilization rate were calculated.Results The sterilization rate of chlorine dioxide was 6.04%,7.87% and 18.18% at the sterilization time of 0.5,1 and 2.5 h respectively.The sterilization rate of silver ion was 52.61%,99.46% and 99.80% at the time of 0.5,1,1.5 and 2.0 h respectively.As for BIOCIDE,the sterilization rate was 25.28%,93.62%,96.60% and 99.81% at the time of 0.5,1,1.5 and 2 h respectively.Conclusion Compared with chlorine dioxide,silver ion and biological disinfectant has a better sterilization effect on Legionella pneumophila.

SARS coronavims is an emerging virus. A lot of animals could be infected by SARS-CoV and Himalayan palm civets, as one of important hosts, is an ideal animal model. Viral genetic factors have been implicated in the emergence of SARS-CoV, with the suggestion that this virus is a recombinant between mammalian and avian coronaviruses. However, the recombination is unlikely to explain the appearance of SARS in humans.