Objective To evaluate the efficacy of entecavir treatment up to 96 weeks for patients with chronic hepatitis B (CHB).Methods The study recruited 62 CHB patients who were admitted to or hospitalized at the Taixing People′s Hospital from July 201 1 to July 2014. The patients were treated with entecavir (0.5 mg/d)for 96 weeks of antiviral therapy.All the patients were divided into HBeAg-positive (n=43)and HBeAg-negative groups (n=19).The HBV DNA load was higher than 106 copies/ml in 38 patients and lower than 106 cop-ies/ml in 24 patients.The efficacy of entecavir in the two groups was compared at 24,48,and 96 weeks of treatment.Between-group com-parison of categorical data was performed byχ2 test.Results At 24,48,and 96 weeks of treatment,the HBeAg-positive group had a sig-nificantly lower HBV DNA clearance rate than the HBeAg -negative group (34.88% vs 78.95%,P=0.003;65.12% vs 89.47%, P=0.047;74.42% vs 100%,P=0.038);there was no significant difference in alanine aminotransferase (ALT)normalization rate be-tween the two groups (P=0.102,0.779,and 0.638).Patients with a HBV DNA load of >106 copies/ml had a significantly lower HBV DNA clearance rate than those with a HBV DNA load of <106 copies/ml at 24,48,and 96 weeks of treatment (34.21% vs 70.83%, P=0.005;57.89% vs 95.83%,P=0.001;76.32%vs 95.83%,P=0.002);there was no significant difference in ALT normalization rate between the two groups (P=0.940,0.150,and 0.280).Conclusion Entecavir has a high antiviral activity in the treatment of CHB, which can suppress HBV replication and concurrently improve liver function.

Objective:To observe the curative effect and security of nicardipine combined with metoprolol succinate sustained-release tablet on renal hypertension.Method:65 renal hypertension patients were randomly divided into two groups.The patients in the nicardipine group were treated with nicardipine 80 mg q8h,while the patients in the therapy group were treated with nicardipine 40mg qd and metoprolol succinate sustained-release tablet 47.5-95mg qd for 8 weeks.Their blood pressure,heart rate,hepatic function,renal function,blood glucose and lipid were observed and recorded before and after the treatment.Result:The total efficiency was 74.4%in the controlled group and 88.5%in the therapy group,respectively. There were no obvious changes or obvious adverse reactions in their heart rate,hepatic function,renal function,blood glucose and lipid after the treatment.Conclusion:Nicardipine combined with metoprolol succinate sustained-release tablet is efficient and safe but more efficient than nicardipine alone in the treatment of renal hypertension.

Objective:To investigate the relationship between flurbiprofen axetil injection and atrial fibrillation in the elderly pa-tients after cardiac surgery and underlying mechanism. Methods: A retrospective research method was applied, and the medical re-cords of 62 elderly patients with cardiac surgery were chosen and divided into the experimental group and the control group according to the different medication. After the heart surgery, fentanyl was used in the control group, and flurbiprofen was applied in the experimen-tal group. Before and after the treatment, the serum C-reactive protein levels, the incidence of postoperative atrial fibrillation, postop-erative atrial fibrillation duration, length of stay, incidence of cardiovascular disease in 6 months and adverse reactions were observed and compared between the two groups. Results:After the treatment, the serum CRP levels in the experimental group were significantly lower than those before the treatment and those in the control group after the treatment (P<0. 05 or P<0. 01). The incidence of post-operative atrial fibrillation in the experimental group was significantly lower than that in the control group (P<0. 05). The duration of postoperative atrial fibrillation in the experimental group was significantly shorter than that in the control group (P<0. 05). The differ-ences in the postoperative hospital stay, the incidence of cardiovascular disease in six months and the incidence of adverse reactions were not statistically significant between the two groups (P>0. 05). Conclusion: Flurbiprofen axetil injection used after cardiac sur-gery can reduce the incidence of atrial fibrillation, which shows important clinical significance.

The effective running of the teaching quality supervision system in institutions of higher learning is closely connected with the efficiency of the teaching quality supervision,thus affecting whether the teaching quality can be guaranteed and promoted or not.The paper,based on the formation of the teaching quality supervision system in institutions of higher learning,probes into the problem of how to effectively run the supervision for the purpose of promotion of teaching quality in colleges and universities.

BACKGROUND: The p27, one of the cyclin-dependent kinase inhibitors in renal disease, regulates cell growth through affecting cellular events. Abundant evidence has suggested that p27 has great role in regulating re nal cell proliferation, hypertrophy, differentiation and apoptosis, etc. OBJECTIVE: To investigate the relationship of protein 27 expressions in renal tissue with cell proliferation and apoptosis. DESIGN: Completely randomized grouping design, control animal experi ment. SETTING: Nephrology Laboratory, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. MATERIALS: This experiment was carried out at Nephrology Laboratory of Internal Medicine, Tongji Hospital and Micro-Pathology Center in Tongji Medical College from September 2004 to January 2005. A total of 48 adult male SD rats were enrolled, all belonged to cleaning grade. METHODS: ①Establishing diabetic models: diabetic rat models were es tablished with streptozotocin, 60 mg/Kg, given through intraperitoneal in. Jection in the experimental group. Blood glucose and urine glucose from caudal vein were measured after 48 hours. Animals in experimental group whose random serum glucose at least 16.7 mmol/L and urine glucose ()- ()-() were regarded as successful models. ②Six rats in experimental group and the control group, respectively were sacrificed in the experimental pe riod of the 3rd, 7th, 14th and 28th days. Before sacrificed, creatinine clearance (Ccr) was measured. Concentration of Retinal binding protein (Rbp) in urine was measured. Proteinuric elements were analyzed by sodium dodecyl sulfate-polyacrlamide gelelectrophoresis (SDS-PAGE). ③Renal tissues were observed pathologic changes through light microscopy and electronic mi croscopy. ④Expression of p27 and proliferation cellnuclear antigen (PC NA) were detected by immunohistochemical staining method, and apoptosis was determined by Terminal deoxynucleotidy 1 transferase-mediated dUTP nick end labeling (TUNEL). We use positive glomerular cells / total glomerular cells to present positive rate and apoptosis rate. ⑤The data were analyzed for statistically significant group difference using unpaired t test and Spearman correlative-analysis. MAIN OUTCOME MEASURES: Renal function, urine protein, p27 ex pression in glomerular cells, positive rate and apoptosis rate of proliferating cell nuclear antigen (PCNA) expression and compared with the control group. RESULTS: Totally 48 rats were involved in the result analysis. ①Changes of pathology: At the 7th day after establishing models, glomerular hypertro phy was found through light microscopy and focal fusion of epithelial foot processes through electron microscopy. At the 14th day, mesangial region, which kept expanding through electronic microscopy, was seen under electron microscope. At the 28th day, slight segmental hypercellularity be gan to show in light microscopy. ②Ccr and Rbp levels of diabetic rats were higher significantly than those in the control group at the 7th, 14th and 28th days (t=2.143-3.004,P ＜ 0.05 ). The results of SDS-PAGE showed that middle and low molecular protein could be observed in every group from the 3rd day. ③The level of p27 expression in glomerular cells were lower obviously at the 3rd day(t=2.536,P ＜ 0.05), but higher at the 7th, 14th and 28th days in diabetic rats, which was higher remarkably than that in the control group (t=2.704-2.823,P ＜ 0.05). The number of PCNA positive cell in diabetic glomerulus became the largest at the 3rd day, then decreased continuously, it was still higher than that in the control group at the 7th dan 14th days (t=2.681,2.525,P ＜ 0.05), but became normal at day 28. The number of TUNEL positive cells in glomerulus also increased significantly at the 3rd day (t=2.764,P ＜ 0.05), but it was smaller than that in the control group at the 7th, 14th and 28th days(t=2.096-2.627,P ＜ 0.05). ④The level of p27 expression and the number of PCNA positive cells in glomerulus were negative correlated (r=-0.446, P ＜ 0.05). The level of p27 expression and the number of TUNEL positive cells in glomerulus were also negative correlated (r=-0.517, P ＜ 0.05).CONCLUSION: Functional impairment of reabsorption induced by proximal convoluted renal tubule and high filtering of glomerulus in early diabetics occurs synchronously. Protein p27 may be participated in the occurring and developing of diabetic nephropathy by checking of proliferation and apoptosis of renal cell in the early stage of diabetes.

“Early clinical contact” is one of the teaching means of pre-clinical education.Internal medicine department of Tongji hospital attached to Huazhong university of science and technology has done many exploration and has gained many experiences in the stage of “Early clinical contact” of 8-year medical program.They put forward some ideas,including intensifying legal,ethics and morality sense; intensifying communication ability and clinical thinking ability cultivation; intensifying cultivation of scientific research and clinical scientific thinking consciousness ; intensifying learning of clinical medical English.They also summarize a set of effective teaching methods with characteristics.

Objective To get knowledge of the air pollution situation inside the car caused by the automotive components and decorative materials and the major impacting factors, and to provide the basis for the development of the car air pollution control and countermeasures. Methods Thirty-five cars of different types and ages were selected from January to July 2008. The concentration of benzene series compounds, formaldehyde and TVOC was determined, a survey and analysis of air pollution inside the car was conducted. Results The results showed that the air pollution inside the new cars was serious, with the increase of the using time, the concentration of pollutants reduced. The amount of formaldehyde emission inside the cars was related to the age of the car, the formaldehyde pollution inside the new cars was the most serious in one year. The longer the car was closed, the higher the concentration of pollutants would be. Using perfume or smoking inside the car, car washing or painting could increase the TVOC concentration inside the car. However, after purification treatment, the concentration of air pollutants inside the new cars could significantly decrease. Conclusion The air pollution inside the new cars is so serious, for the health of passengers and drivers, the related standards for the control of the air pollution should be set as soon as possible.

Objective To study the effect of simultaneously combined liver and kidney transplantation (SLKT) on end-stage liver and kidney diseases. Methods Thirteen cases subject to SLKT from 1996 to 2004 were reviewed in The First Affiliated Hospital of Sun Yat-sen University. Among them, there were 4 cases of polycystic liver and kidney, 4 cases of hepatic cirrhosis and renal failure, and 5 cases of fulminant heptic failure and hepatorenal syndrome. Ten were males and 3 females with an average age of 45.5 years old.Results Four cases of polycystic liver and kidney have all survived for more than one year after SLKT, and one of them has survived for 4 years. The 3 of 4 patients with hepatic cirrhosis and renal failure have survived more than one year, and one of them died perioperatively. The 2 of 5 patients with fulminant hepatic failure and hepatorenal syndrome have survived for one year, and 3 of them died perioperatively.Conclusion SLKT has been the effective therapy for end-stage liver and kindney diseases; The indications of SLKT for hepato-renal syndrome were discussed. SLKT may immunologically protect the renal graft.

Objective To evaluate the epidemiology, prophylaxis and treatment of bacterial infections after orthotopic liver retransplantation.Methods A retrospective study on bacterial infections in 22 patients undergoing othotopic liver retransplantation was carried out.Results Bacterial infections were confirmed in 8 of 22 preoperation and in 20 of 22 (90.9 %) postoperation. The median time of bacterial infections was 7 days after liver retransplantation. Fifty-one pathogenic organisms including 25 types were separated. The most commonly seen infected sites were biliary tract (50.0 %, 11/22), abdomen (45.4 %, 10/22), respiratory tract (36.4 %, 8/22), blood (31.7 %, 7/22), incision ((9.1) %, 2/22), bowel (4.5 %, 1/22), veins with venipuncture (4.5 %, 1/22). Seven cases of sepsis died.Conclusion The infectious rate after liver retransplantation is high and the types of bacterial disseminating loosely on organs are varied. The mortality will be increased if the patients develop sepsis. Reasonable use of immunosuppressants, selection of antibiotics and the supporting therapy are the keys to prevent and treat infections following liver retransplantation.

Objective To evaluate the surgical technique and outcome of the extended radical resections for hilar cholangiocarcinoma.Methods A patient with Bismuth-Corlette type Ⅳ Klatskin's tumor, which invaded the secondary intrahepatic bile duct and the pancreatic portion along the common bile duct, underwent the HPLT_ X . And then, the digest cannel was reconstructed according to the Child's methods. By using immunohistochemistry, the expression of cytokeratin9, 17, CEA and hepatocyte protein was detected. After operation, the immunosuppressive agents consisting of Tacrolimus and steroids were given; lamivudine and HBIg were used to prevent HBV from recurrence.Results Pathologic examination revealed low differentiated adenocarcinoma and immunohistochemistry stains confirmed the positive expression of cytokeratin9 and 17, carcinoembryonic antigen, and the negative expression of hepatocyte protein. Neither the margins of resection nor periductal lymph nodes were pathologically involved. She was currently alive for 17 months after the operation, the liver graft function was within normal range, and the patient was back to the previous work without any evidence of recurrent cancer. The tumor marker in plasma was decreased to the controllable level.Conclusion The HPLT_ X may be the treatment choice for unresectable Klatskin's tumor and provide the higher rate of radical resection and better prognosis.