OBJECTIVE:To study the persistence of the effects of nucleoside (acid) analogues in the treatment of chronic hepatitis B (CHB) after drug withdrawal. METHODS:150 cases of CHB were selected and received nucleoside (acid) ana-logues for one year at least. They were divided into the standard group(n=56)and non standard group(n=87)according to the drug withdrawal standard stated in Guidelines for Prevention and Treatment of CHB,and followed up for one year except 7 cas-es of drug withdrawal who were followed up less than one year. HBV serum markers HBVM and HBV-DNA were detected quan-titatively in 2 groups. CHB recurrence,HBsAg disappearance and the change of HBV in serum were observed in 2 groups after drug withdrawal. RESULTS:The recurrence rate of CHB patients with HBeAg (+) in standard group and non standard group were lower than those with HBeAg(-),with statistical significance(P<0.01 or P<0.05);that of CHB patients with HBeAg (+) in standard group was lowe than those with HBeAg (+) in non standard group,with statistical significance (P<0.05);there was no statistical significance in recurrence rate of CHB patients with HBeAg(-)between standard group and non stan-dard group(P>0.05);the total recurrence rate of standard group was lower than that of non standard group,with statistical sig-nificance(P<0.05). There was no statistical significance in recurrence rate between 2 groups after drug withdrawal following 4 kinds of nucleoside (acid) analogue monotherapy (P>0.05). Among sustained responders,HBsAg of 3 patients disappeared in standard group,including 2 cases of HBsAg seroconversion,1 case of no HBsAg seroconversion. Among patients with recurrent CHB,2 patients suffered from HBeAg(+)again in standard group,and 1 patient with HBeAg(-)developed liver cancer;5 patients suffered from HBeAg(+)again in non standard group,including 1 patient died and 1 patient with HBeAg(-)devel-oped liver cancer. CONCLUSIONS:Taking Guidelines for Prevention and Treatment of CHB as drug withdrawal standard,there still is a high recurrence rate after stopping nucleoside(acid)analogues;the recurrence rate of patients with HBeAg(-)is high-er than those with HBeAg(+),and that of patients in non standard group is higher than in standard group. The types of nucleo-side(acid)analogues do not influence recurrence rate after drug withdrawal.

Optical coherence tomography angiography (OCTA) is a noninvasive angiography technique developed in recent years.Without using contrast medium,this technology can quickly and safely get retinal vascular images with relatively high-resolution.It has been widely used in the diagnosis and management of eye diseases,especially in the vascular diseases,such as diabetic retinopathy (DR),age-related macular degeneration (AMD),retinal central/branch venous obstruction (CRVO/BRVO),choroidal neovascularization(CNV),etc.This article reviews the clinical application of OCTA in diabetic retinopathy.

Objective To build new management model for diabetic foot disease,and to observe the therapeutic effect of diabetic foot ulcers under the new model.Methods 52 patients with newly diagnosed diabetic foot disease were recruited and randomly divided into the experimental group (n=26) and the control group (n=26).While the experimental group adopted the interdisciplinary collaboration model (nurse-doctor jointed diabetes care management model),the control group were treated by the single department pattern.The foot ulcer healing rate,average length of stay (ALOS),fasting plasma glucose (FPG),2 h postprandial blood glucose (2 h PBG),glycosylated hemoglobin (HbA1c),and the patient awareness of the knowledge about diabetes self-management were respectively compared at 3 and 6 months.Results After receiving a multidisciplinary joint diagnosis and treatment,FPG and 2 h PBG of the patients from the experimental group [(6.44±2.93)mmol/L,(8.52± 2.09)mmol/L] were significantly decreased than those of the patients from the control group [(8.17±3.19)mmol/L,(10.77±3.27)mmol/L].HbA1c at 3 and 6 months (7.2％,7.7％) and ulcer recurrence rate (3.8％) after 6 months of patients of the experimental group were significantly reduced than those of the control group(8.9％,9.1％ and 15.4％).When compared with patients of the control group,patients of varying severity in the experimental group showed significantly shortened ulcer healing time and hospital stay.Moreover,patients from the experimental group showed statistically higher knowledge level and self management ability (P＜0.05).Conclusion Through interdisciplinary collaboration,podiatric medical joint management model can significantly improve cure rate,shorten ALOS,improve blood sugar control and patient satisfaction.

Endolymphatic Hydrops ; Hearing Loss, Sudden ; Humans

AIM: Using optical coherence tomography angiography (OCTA) to observe the changes and clinical significance of macular blood flow density in patients with diabetic retinopathy (DR).METHODS: Totally 47 eyes (28 patients) with diabetic retinopathy (DR) were enrolled in the DR group.According to the international clinical grading criteria of diabetic retinopathy, 30 eyes (19 patients) with non-proliferative diabetic retinopathy were classified as the NPDR group, and 17 eyes (11 patients) with proliferative diabetic retinopathy were classified as PDR group.A total of 46 (27 subjects) healthy eyes with matched age were enrolled in the control group.All the subjects underwent the 3mm×3mm scanning of macular retina by optical coherence tomography angiography (OCTA), obtaining 4 levels of macular blood flow density map.The macular blood flow density at 3 levels, including superficial retinal layer, deep retinal layer and choroidal capillaries layer, were measured.RESULTS: The macular blood flow density of superfical retinal layer, deep retinal layer and choroidal capillaries layer in DR group were 0.4963±0.0840, 0.4798±0.0801 and 0.5290±0.0528, respectively.Among them, the blood flow density of each layer were 0.5064±0.0843,0.4983±0.0766,0.5345±0.0529, respectively, for the NPDR group, and were 0.4786±0.0830, 0.4473±0.0778,0.5192±0.0526, respectively, for the PDR group.For the control group, the density of each layers were 0.5919±0.0704, 0.6301±0.0527, 0.5691±0.0169, respectively.The macular blood flow density was significantly different in the superficial retinal layer, deep retinal layer and choroidal capillary layer between the control group and the NPDR group, as well as the PDR group and the DR group (total P<0.001).Statistically significant difference was found between the NPDR group and the PDR group in the deep retina layer (P=0.029), but not in the superficial retina layer and choroid capillary layer (P=0.236, 0.268).CONCLUSION: Compared with the control group, the macular blood flow density of superficial retinal layer, deep retinal layer and choroidal capillary layer in the patients with diabetic retinopathy decreased significantly.It indicated that the macular ischemia existed in both retina and choroid.By quantitatively measurement of the macular blood flow, OCTA may be used for monitoring the progression of diabetes, and early detection of diabetic retinopathy.

Circulatory state and metabolic homeostasis could be more easily disturbed during perioperative periods for children compared with those of adults especially when receiving massive transfusions.Patient's age would be an important factor for clinical evaluation if certain amount of blood was lost.Component transfusions have now gained wide recognitions.Specific blood components should be considered according to different diseases,which would make transfusion more accurate and blood resources used more efficiently.This article focused on the indications,doses and several specific issues for perioperative component transfusions among pediatric patients.

As introduced in the paper,Australian government subsidize the public hospitals with all their budget needs as compensation,with the two levels of governments constituting the largest buyer of health products and services in the country.In addition,the government supports the hospitals with their facilities.A rational government investment mechanism is proposed with reference to such a model for the ongoing reform of public hospitals in China.

Objective To evaluate the surgical approach of endovascuar exclusion for thoracic dissection.Methods Thirty-seven cases of Stanford B type thoracic aortic dissection were undergone endovascular exclusion (EVE) and had been studied retrospectively. Preoperative evaluations for delivery arteries, including common femoral artery, iliac artery, and abdominal aorta, were earried out by using duplex ultrasonography (US), computed tomographic angiography (CTA) and magnetic resonance angiography(MRA). Factors such as arterial calibers, stenosis, tortuosity, sclerotic plaque and media dissection were taken into account. Choices of surgical approach were decided after comprehensive consideration of these factors. If the common femoral artery inner diameter was wider than 8 mm, without severe iliac artery stenosis or tortuosity; the common femoral artery should be selected as the delivery artery. In case of severe arterial stenosis and tortuosities, then the common iliac arteries were exposed by retroperitonial approach and graft was delivered through this artery. Results Mural sclerotic plaques were more sensitive to be revealed by US, conversely with CTA and MRA in showing stenosis and tortuosity directly and clearly. Utilizing this preoperative evaluating system, all the grafts passed successfully and favourably through the arteries, without any delivery artery associated complications.Conclusions Using US, CTA and MRA in combination was necessary for preoperative evaluation of the delivery artery. In those with poor femoral artery condition, exposing common iliac artery decidedly is necessary to ensure the procedure favorably and to avoid delivery artery associated complications.

Objective To investigate the frequency of autoimmune encephalitis (AE) in limbic encephalitis (LE) syndrome and compare its clinical features with viral encephalitis.Methods Patients diagnosed with LE syndrome who admitted to Huashan Hospital between December 2015 and June 2016 were enrolled and screened for autoantibodies associated with AE (anti-N-methyl-D-aspartate receptor, anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor, anti-gamma-amino-butyric acid B-receptor, anti-leucine-rich glioma inactivated 1 and anti-contactin-associated protein-like 2 antibodies) in cerebrospinal fluid (CSF) and serum. Their clinical features and auxiliary examinations were also collected and analyzed retrospectively. Results Fifty-four patients were diagnosed with LE syndrome, including 35 males and 19 females. The age of these patients was (38.98±17.29) (15-75) years. Twenty patients (37.0%) were identified as AE, 17 patients (31.5%) as viral encephalitis. Other cases included three (5.5%) with neurosyphilis, one (1.9%) with glioma and 13 (24.1%) of unknown cause. Young patients(15-29 years old)and patients older than 45 years accounted for 46.0% (17/37) and 37.8% (14/37) of all AE and viral encephalitis cases respectively. Patients with AE had longer disease progression time than patients with viral encephalitis ((22.45±11.62) d vs (6.24±2.95) d, t=6.015, P<0.01).Emergency hospitalization of patients with AE was less frequent than that of patients with viral encephalitis (3/20 vs 12/17, P=0.001). Patients with AE were less common to present with fever at disease onset than patients with viral encephalitis (8/20 vs 15/17, P=0.006). Seizures as the first neurological symptom were less common in AE than in viral encephalitis (2/20 vs 8/17, P=0.023). White blood cell counts in CSF were less frequently elevated in AE than in viral encephalitis (7/17 vs 12/15, P=0.036). The differences of age, gender, disease severity as well as abnormal rates of brain MRI, electroencephalogram and CSF protein were not statistically significant between the two groups. Tumors were discovered in 6 (6/19) patients with AE. Conclusions The frequency of AE in LE syndrome is not low. It is worthwhile to screen for autoantibodies associated with AE in patients diagnosed with LE syndrome. AE and viral encephalitis have their own characteristics, which could offer help in differential diagnosis between them and application of effective treatment.

Objective To assess the value of T?SPOT.TB test in the diagnosis of active tuberculosis. Methods The clinical data of 975 hospitalized patients receiving T?SPOT.TB test were collected in our hospital. The clinical information and testing results were analyzed. The receiver operating curve (ROC) was used to determine the optimal threshold of T?SPOT.TB test for differentiating active tuberculosis. Results T?SPOT.TB test results showed that the positive rate was 29.26%for the non?active tuberculosis group(n=793),but was 91.21%for active tuberculosis patients group (n = 182),which indicated that the test had a significant value in active tuberculosis detection(P<0.001). The sensitivity of T?SPOT.TB test was 0.912 and the specificity was 0.707. The detection threshold of T?SPOT.TB was optimized. As the spot?forming count(sfc)of ESAT?6 antigen threshold was 11.5 and that of the CEP?10 threshold was 9.5,the efficiency of T?SPOT.TB test for detection of active pulmonary tuberculosis was the highest. Conclusions T?SPOT.TB test has a good diagnostic performance for active tuberculosis, and it can be further optimized to better serve the clinical practice.