Objective To compare the 96-week efficacy of de novo combination therapy with lamivudine ( LAM ) and adefovir dipivoxil (ADV) to that of optimization monotherapy for chronic hepatitis B (CHB).Methods A total of 155 CHB patients were collected from the First Affiliated Hospital of Anhui Medical University during 2007 and 2009.All patients were randomly assigned to LAM monotherapy group ( n =53 ),ADV monotherapy group ( n =50 ) or LAM with ADV combination group ( n =52 ) according to randomized digital table.The liver and kidney functions,HBV serum markers,and HBV DNA loads were tested every 24 weeks.If patients in LAM or ADV group had poor response or virological breakthrough,they were given optimized therapy with ADV or LAM at week 24,48 or 72.One-way ANOVA (normal distribution and homoscedasticity ) and non-parametric test (non-normal distribution ) were performed to compare measurement data among groups.The impact factors of early virological response were analyzed by binary Logistic regression method.Results At week 24,the complete virological responses in LAM group,ADV group,and LAM + ADV group were 66.0％ ( 35/53 ),34.0％ ( 17/50 ) and 90.4％ ( 47/52 ),respectively (x2 =35.282,P ＜ 0.01 ) ; while,at week 96 the complete virological responses in three groups were96.2％ (51/53),86.0％ (43/50) and 100.0％ (52/52),respectively (x2 =19.115,P＞0.05).At week 96,the cumulative recover rates of ALT in LAM group,ADV group,and LAM + ADV group were 86.8％ (46/53),82.0％ (41/50)and 94.2％ (49/52),respectively (x2 =3.613,P ＞0.05);however,the ALT levels in three groups were statistically different (x2 =11.195,P ＜ 0.01 ).At week 96,the HBeAg seroconversion rates in LAM group,ADV group,and LAM + ADV group were 31.3％ ( 10/32),20.7％ ( 6/29 ) and 38.7％ ( 12/31 ),respectively (x2 =2.313,P ＞ 0.05 ).Early virological response was not found in I patient in LAM group and 19 patients in ADV group; virological breakthrough occurred in 11 patients in LAM group and 1 patient in ADV group.All patients in LAM + ADV group had early virological responses and had no virological breakthrough.Logistic regression showed that complete virological response at week 24 was correlated with the baseline HBeAg,the initial treatment and HBV DNA load.Layered evaluation showed that there were significant differences in early complete virological responses among three groups for patients with positive HBeAg,HBV DNA ＞ 6.28 × 106 copies/mL and ALT ≤5 ×ULN (x2 =7.726,10.921 and6.100,P＜0.05 or ＜0.01) ; for those with HBV DNA ＞6.28 × 106copies/mL,complete virological response was not observed in ADV group treated for 24 weeks.Conclusion LAM combined with ADV has stronger antiviral activity,lower resistance rate and can improve liver function and virological response,especially for the patients with HBeAg-positive,high HBV DNA loads and ALT ≤5 × ULN.

With the popularization of rehabilitation and the development of the physiotherapy, some chronic diseases do not only mean the history of the patients, but also the objects of physiotherapy. The exercises will affect the cardiopulmonary function of the patient, and result in a high risk of accident. This article would review the risk factors and risk management in physiotherapy for chronic diseases.

Objective Preoperative autologous blood donation(PABD) can reduce the demand of allogeneic blood transfusion and its safety in obstetrical application has been proved.The article aimed to explore the effects of PABD on reducing allogeneic blood transfusion in pregnant women with placenta previa and the optimal PABD volume for implanted placenta.Methods Retrospective analysis were made on 156 cases with placenta previa hospitalized in our hospital from January 2015 to April 2016, including 78 cases with placenta implantation.According to the volume of PABD, the cases were classified into no PABD group, 300~400mL PABD group, and 600ml PABD group.Data of postpartum hemorrhage volume and allogeneic blood transfusion after delivery were collected to analyze the effectiveness of PABD in reducing the need for allogeneic blood transfusion during pregnancy.Results The hemorrhage volume during the delivery of all 156 patients with placenta previa was 230-5670mL (median 985ml), the rate of severe postpartum hemorrhage (PPH) was 49.4% (77/156), and the rate of allogeneic blood transfusion was 33.3% (52/156).In patients who had no PABD, the rate of allogeneic blood transfusion was 48.2% (40/83).However, this rate dropped down to 16.4% in PABD patients (12/73)(χ2=17.624,P<0.001).The rate of allogeneic blood transfusion in patients was different according to the situation of placenta planting, 43.3% in patients with no placenta plantingand 53.8% in patients with placenta planting.600ml autologous blood could meet all the needs for blood transfusion if there was no placenta implantation.300-400mL PABD could meet the needs of more than 80% patients.11.2%-13.3% of ABD patients might need allogeneic blood transfusion in addition to autologous blood.However, the amount of allogeneic RBC and FFP per capita reduced.Conclusion Patients with placenta previa is in high risk of PPH and PABD can improve their medical safety by reducing the rate and volume of the allogeneic blood transfusion.The strategy of 300-400mL PABD during pregnancy are recommended if there is no contraindication.

Objective: To investigate the inhibitory effect of soluble KDR(sKDR) and its antibody on endotheliocyte(EC) proliferation.Methods: The binding of sKDR with VEGF was detected by ELISA. The KDR262 antiserum was prepared from rabbit and the specificity was defined by Western blot. The inhibition of EC proliferation was analyzed by 3H-TdR up-take, MTT and cell counter. Results: The sKDR could bind to VEGF165 specially, the ability was enhanced by heparin. The specific binding of KDR262 antiserum to KDR was also detected. The inhibitory rate of sKDR(10,2,0 4?g/ml) on EC proliferation was 56%,44%,32% respectively. The inhibitory rate of KDR262 antiserum (1∶50,1∶200,1∶800) was 70%, 56%,43% respectively. The cell counter also showed that EC proliferation was inhibited significantly in sKDR group and KDR262 antibody group, vs VEGF165 group, GST group and PBS group. The inhibitory effect was characterized by concentration-dependent and was higher in KDR262 antibody group than that in sKDR group. Conclusion: sKDR expressed by E.coli and its antibody had significant inhibitory influence on EC proliferation.

Physiotherapy involves wide range elements. Many factors, such as the complications of the patients, may complicate the treatment. It is important for the physiotherapists to control the potential risk factors as much as to improve their efficacy.

ObjectiveTo explore the association of smoking to the Aspirin and Clopidogrel antiplatelet in patients with stable angina after percutaneous coronary intervention (PCI). Methods241 smoking patients and 252 non-smoking patients underwent PCI for stable coronary artery disease, all patients had taken aspirin 100 mg/d for 7 d or more. The arachidonic acid (AA)- and adenosine diphosphate (ADP)-induced platelet aggregation were tested as they got in hospital. Then, they accepted Clopidogrel 300 mg as loading dose, continued with 75 mg/d for 3 d. The ADP-induced platelet aggregation were re-tested. ResultsThe incidence of aspirin resistance (AR) and aspirin semiresponder (ASR) was 19.1% in all the cases, and was 25.5% in smoking group, 14.3% in non-smoking group (P=0.027). Age (OR=3.79，95%CI: 1.77～8.12) and smoking (OR=1.98，95%CI: 1.18～4.43) were the independent risk factors of AR and ASR. The incidence of Clopidogrel resistance was 19.5% in all the cases, and was 13.2% in smoking group, 24.3% in non-smoking group (P=0.03). Smoking (OR=0.22，95%CI: 0.09～0.54) may reduce the risk of Clopidogrel resistance. ConclusionSmoking increased the risk of AR and ASR, but reduced the risk of Clopidogrel resistance.

AlM: To examine the retinal nerve fiber layer ( RNFL ) changes in early primary open angle glaucoma ( POAG ) by comparing the superior half of the optic disc with the inferior disc half.METHODS: lt was a clinical observational study. The study included 30 patients ( 39 eyes ) with POAG and 20 normal subjects ( 40 eyes ) . Visual field was tested by Zeiss Humphrey750 and the optic disc topographic parameters and RNFL thickness were measured by Zeiss Cirru HD-OCT. Collecting information included visual field mean defect ( MD ) , glaucoma hemifield test ( GHT ) , intraocular pressure ( lOP ) , C/D ratio and RNFL thickness. Data were analyzed by statistic software SPSS18. 0. The differences between two groups were assessed using t test.RESULTS: The differences of superior RNFL minus inferior RNFL thichness on the corresponding clock-hour locations were caculated in two groups. There was a significant difference in superonasal- inferonasal RNFL thickness between two groups (t=2. 526, P=0. 014), and there were no significant differences in the others ( all P>0. 05).CONCLUSlON: The asymmetry of optic disc hemifield RNFL is found in early primary open angle glaucoma patients. The superonasal RNFL ( 1 o’clock for right eye, and 11 o’clock for left eye ) is more fragile to loss than inferonasal RNFL (5 o’clock for right eye, and 7 o’clock for left eye) .

[ABSTRACT]OBJECTIVETo study the mRNA expression of glucocorticoid receptor(GR) in peripheral blood mononuclear cells in patients with obstructive sleep apnea hypopnea syndrome(OSAHS) and its clinical significance. METHODSReal-time fluorescent quantitative PCR was used to detect GRα mRNA and GRβ mRNA exprssion in PBMC of 30 male patients with moderate to severe OSAHS and 27 healthy male subjects. The relationships between the expression of glucocorticoid receptor mRNA and the apnea hypopnea index, body mass index, neck circumference, waist circumference, the lowest oxygen saturation, the average oxygen saturation, the Epworth sleepiness scale(ESS) score, fasting blood glucose, heart rate and blood pressure were analyzed.RESULTSCompared with the control group, the expression level of GRα mRNA was lower in the OSAHS group(t=2.25,P<0.05) and the expression level of GRβmRNA had no difference between the two groups(t=1.43, P>0.05). We had not found the significant correlation between the expression of GRα mRNA and the clinical parameters above in OSAHS patients.CONCLUSIONThe expression of GRα mRNA in PBMC in moderate to severe OSAHS male patients have a downward trend compared with healthy group, but the mechanism remains unclear.

Objective To investigate the clinical significance of universal newborn hearing screening for deaf‐ness predisposing genes in newborns .Methods A total of 965 newborns at Subei Hospital in Yangzhou were taken blood samples at heel and received for deafness predisposing genes screening .The most common deafness genes were detected by gene sequencing ,including mt12SrRNA c .1555A > G ,c .1494C > T ,GJB2 35delG ,167delT ,176_191del16 ,235delC ,299_300delAT ,SLC26A4 281C> T ,589G>A ,IVS7 -2A>G ,1174A> T ,1226G> A ,1229C> T ,IVS15+5G> A ,1975G>C ,2027T > A ,2162C> T ,2168A> G ,GJB3538C> T ,547G> A .At the same time ,all infants received hearing screening .Otoacoustic emission(OAE) was used as the first step screening ,and OAE combined with auto-auditory brainstem response(AABR) detection were used as the second step screening . Results Fifty -three cases (5 .49% ) had partial gene mutation ,one case of 12SrRNA gene mutation ,33 cases of GJB2 gene mutation ,18 cases of SCL26A4 gene mutation ,one case of GJB3 gene mutation .Of 965 cases ,28 cases failed to pass hearing screening while 18 cases did not pass rescreening .There were 10 cases taking audiological di‐agnosis at the age of three months .Six cases were confirmed with hearing loss .There were 905 cases passed thehearing screening and genetic screening ,11 failed born hearing and gene screening .Conclusion That the newborn gene screening was added into the hearing screening can be helpful to find out the deafness predisposing genes and drug -induced or late-onset hearing loss .

Objective To explore the relationship of insulin resistance with serum 25-hydroxyvitamin D levels and arterial stiffness in elderly patients.Methods A total of 162 elderly inpatients (aged 60 years or over) were recruited from 2012 to 2014.Levels of fasting serum insulin,fasting serum glucose,creatinine and vitamin D were determined.Insulin resistance (IR) was evaluated by the homeostasis model assessment of insulin resistance (HOMA-IR).The patients were divided into the following three groups according to HOMA-IR:the low IR group with HOMA-IR less than 2 (n=78),the median IR group with HOMA-IR between 2 and 6 (n=43),and the high IR group with HOMA-IR greater than 6 (n=41).Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV).Arterial stiffness and serum vitamin D levels were compared among the three groups.Results cfPWV was increased and the serum 25-hydroxyvitamin D level was decreased in the high insulin resistance group compared with the low insulin resistance group[(13.2± 5.7) μg/L vs.(17.8±6.2) μg/L,(14.3±5.2) m/s vs.(11.9±3.0) m/s].Multiple liner regression analysis showed that IR was negatively correlated with the serum 25 hydroxyvitamin D level (r=-0.63,P＜0.05) and positively correlated with arterial stiffness (r=0.45,P＜0.05) after adjustment for age,sex and other confounders.Conclusions Elderly patients with high insulin resistance may have lower levels of serum vitamin D and higher arterial stiffness.