Objective To investigate the immune response of Adefovir ester combine the Fuzheng Huayu in the process of the treatment of chronic hepatitis B.Methods 100 cases with CHB from March 2010 to October 2014 collected in outpatients clinic or hospital were randomly divided into Adefovir ester treatment group and Adefovir ester joint the Fuzheng Huayu treatment group.Levels of AST, ALT, HBsAg and HBV DNA pre-and-post treatment were detected.CD3-CD56 +,CD244 +NK,CD3 +,CD3 +CD4 +,CD3 +CD8 +T cells and the contents of CD 4 +T cells in serum of two groups were measured by flow cytometry analysis.Results The levels of AST、ALT、HBV-DNA of two group post-treatment were all significantly lower than pre-treatment(P<0.05),and the level of AST and ALT in Adefovir ester and Fuzhengh Huayu treatment group at 3 months and 6 months were obviously lower than Adefovir ester treatment group.HBV-DNA contents between two groups had no significant difference.HbsAg levels of two groups were all significantly increased after 6,9,12 months’treatment (P<0.05),While there was no significant difference between two groups post-treatment.CD3-CD56 +cell at 6,9,12 months in two groups were all higher than pre-treatment(P<0.05), which in Adefovir ester and Fuzhengh Huayu treatment group were more higher than Adefovir ester treatment group(P<0.05).CD244 +NK,CD3 +T cell, CD3 +CD4 +Tcell at each point post-treatment in peripheral blood of two groups were all increased significantly(P<0.05),which in Adefovir ester and Fuzhengh Huayu treatment group increased more obviously than Adefovir ester treatment group (P<0.05).However, CD3 +CD8 +cells were reduced obviously after treatment in two groups(P<0.05), which besides 3 month point, its ratio in Adefovir ester and Fuzhengh Huayu treatment group decreased more significantly than Adefovir ester treatment group at other points( P<0.05 ).Cytokines in serum of two groups were all increased significantly post-treatment ( P<0.05 ) , which in Adefovir ester and Fuzhengh Huayu treatment group were more lower (P<0.05).Conclusion Adefovir ester and Fuzhengh Huayu treatment can improve the situation of AST, ALT, HBV DNA and HBsAg in patients with chronic hepatitis B,promote the expression of NK cells,T cells and Tcell secrited cytokines,and the efficacy is better than Adefovir estertreatment alone.

Comparing with the world level, the bibliometric indicators of Chinese medical journals in oncology field are rather lower, but our medical journals have big development space. In the world journals with high impact index, the papers published by Chinese authors are fewer; in the papers number, the superiority of Chinese authors is in tumor clinical therapy field. Most papers are written by researchers from large institutions with plenty of medical resources.

OBJECTIVE To evaluate mortality prediction by analyzing clinical features and pathogens of patients with candidemia in intensive care unit(ICU).METHODS The clinical data of candidemia cases admitted to ICU of the First Affiliated Hospital of Zhejiang University in recent five years were analyzed retrospectively,including risk factors,accompanied diseases,Candida species,drug sensitivity,mortality and prognosis.RESULTS Seventy five cases with candidemia were diagnosed in recent five years.Single factor Logistic regression analysis combined with multiple conditional Logistic regression model analysis was conducted.Compared to other risk factors,indwelling central venous catheter(97.2% vs 74.3%,P=0.043,OR=6.4,95%CI 1.06-38.72),hypoproteinemia(91.7% vs 56.4%,P=0.020,OR=6.01,95%CI 1.33-27.0)and APACHEⅡ score(19.6?3.7 vs 15.0?3.8,P=0.00,OR=1.36,95%CI 1.15-1.62) were markedly different.CONCLUSIONS Candidemia cases in ICU increase gradually and lead to higher mortality.Indwelling central venous catheter,hypoproteinemia and APACHEⅡ score are related to mortality of candidemia cases.

Objective To summarize the clinical experience of retroperitoneal and transperitoneal laparoscopic adrenalectomy for adrenal tumors.Methods Laparoscopic adrenalectomy was carried out in 56 cases of adrenal tumors via transperitoneal(10 cases) or retroperitoneal(46 cases) approaches.For transperitoneal laparoscopic adrenalectomy,the operation was performed through 3 abdominal trocars.After the peritoneum and the Gerota's fascia were opened,the adrenal gland or tumor were disconnected near the upper polar of the kidney.Then the tumor was removed by using the LigaSure system and a harmonic scalpel.For retroperitoneal laparoscopic adrenalectomy,a self-made balloon was used to dilate the retroperitoneal space.Then the Gerota's fascia was opened and the tumor was removed by using the LigaSure system and a harmonic scalpel. Results Of the 10 cases of transperitoneal adrenalectomy,conversions to open surgery were required in 3 cases because of extensive abdominal adhesion;of the 46 cases of retroperitoneal adrenalectomy,a conversion to open surgery was needed in 1 case because of massive hemorrhage of the inferior vena cava.Of the remaining 52 cases,the intraoperative blood loss was 20~200 ml(mean,70 ml) and no blood transfusion was needed.The operation time was 40~200 min(mean,110 min).The postoperative hospital stay was 3~8 d (mean,5.4 d).Follow-up for(6~36) months(mean,8 months) in 52 cases showed no tumor recurrence and metastasis.Conclusions Laparoscopic adrenalectomy has advantages of reliable effects,minimal invasion,rapid recovery,and short hospital stay.This procedure can be used as the first choice for the treatment of adrenal tumors.

Objective To evaluate the salvage surgery for papillary thyroid cancer patients with residual neck metastatic lymph nodes after thyroidectomy.Methods Clinical data of 97 patients undergoing salvage neck dissection between September 2007 to June 2010 were analyzed retrospectively.Results Among 97 patients,residual metastatic lymph nodes were found in 80 patients in lateroposterial neck,overall residual rate was 82.47％.Residual rate was 85.71％ in 56 patients who underwent initial lateroposterial neck dissection in other hospitals:100％ in 8 patients who underwent berry-picking; 93.33％ in 30 patients who underwent partial dissection; 66.67％ in 18 patients who underwent whole neck dissection.Residual rate was 78.05％ in 41 patients who did not undergo initial lateroposterial neck dissection.The number of dissected lymph nodes was 15-45,with an average of 23 nodes removed and 8.21 metastatic lymph nodes per case.Residual metastatic lymph nodes were found in 67 patients in central neck,overall residual rate was 82.47％,residual rate was 53.85％ in 13 patients who underwent initial central neck dissection,and 71.42％ in 84 patients who did not undergo initial central neck dissection.Conclusions Correct imaging diagnosis decreases cervical residual metastatic lymph nodes in patients with papillary thyroid cancer.Successful salvage operation lies in choosing correct mode of neck dissection and carrying out sufficient dissection.

To describe the epidemiology, etiology, pathological features, clinical manifestation,diagnosis and management, and the role of surgery in mucosa-assoeiated lymphoid tissue (MALT) lymphoma.The relationship between the pathogenesis of gastric MALT lymphoma and helicobacter pylori infection, and its therapeutic principles and follow up study were specially stressed.

Mutations of BRCA1 and BRCA2 are closely related to developing of breast cancer andovarian cancer. There are a great diversity of founder mutations of BRCA1 and BRCA2. Their types and fre quency are greatly different in populations from different geographic regions and ethnicities. In particular ethnicgroups, founder mutations show a high frequency due to a founder effect. Compared with the expensive wholegenomic scan, screening of founder mutations which could provide information for the prevention and treatmentof related cancer is more convenient and easy to popularize with low cost.

Objective To observe the effect of interventional occlusion for the treatment of residual leak after repaired of patent ductus arteriosus (PDA).Methods A total of 23 patients with residual leak after repaired of PDA underwent interventional occlusive procedures.Original operative methods:15 patients performed surgical ligation of PDA,4 patients performed neoplasty under cardiopulmonary bypass,4 patients performed transcatheter occlusion.Twenty-three patients were treated by standard interventional occlusion.The lateral descending aortographies and echocardiography were performed to evaluate the immediate results after occlusion 15 min.Echocardiography was rechecked after occlusion 1 week,1 month to find whether there was residual shunt and recanalization.Results Twenty-three patients per formed aortographies in operation showed residual leak.The mean minimum diameter of the residual leak was 2-8 (3.7 ± 1.4) mm.After occlusion 15 min,heart murmur disappeared,the form of interventional occlusive procedures was better.One patient had little residual leak,22 patients (95.65％,22/23) residual leak disappeared.Aftertreated 1 week,1 month,aortographies and echocardiography showed the form of interventional occlusive procedures was better,all patients had no residual leak.Conclusion Residual leak after repaired of PDA can be treated safely and effectively with interventional occlusive procedures.

ObjectiveTo discuss the effect of surgical procedure and interventional procedure on coronary arterial fistula.Methods The clinical data of 25 cases of coronary arterial fistula were retrospectively analyzed.Seven cases received surgical procedures,18 cases received interventional procedures.ResultsOf the 7 cases with surgical procedures,coronary arterial fistula shunt disappeared in 6 cases after review of echocardiography,coronary arterial aneurysms was found in 1 case who had limited residual flow.Of the 18 cases with interventional procedures,12 cases were completely cured,2 cases had limited residual flow,4 cases did not succeeded.ConclusionsSurgical procedures and interventional procedures on coronary arterial fistula are safe and efficient.The choice of method should be based on the specific situation.