Early and accurate diagnosis of hepatic fibrosis and application of antiviral therapy are the key to improving the prognosis of patients with chronic hepatitis B (CHB).Liver biopsy and transient elastography cannot be widely used for the diagnosis of hepatic fibrosis in clinical practice,and therefore,the serological diagnostic model has become a hot research topic in recent years.This article introduces a new serological diagnostic model,γ-glutamyl transpeptidase-to-platelet ratio (GPR),which has a high value in the diagnosis of hepatic fibrosis in CHB patients;however,the accuracy of GPR varies between different populations and different areas.GPR is also an excellent predictor for the prognosis of hepatitis B-associated liver cancer.It is pointed out that GPR has a promising future in the diagnosis of hepatic fibrosis in CHB patients,but due to a lack of clinical research data on GPR,further studies are needed to support its application in China.

Recent studies have found that inflammatory response is positively associated with the progression of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer and can affect their prognosis,and as a marker for inflammatory response,neutrophil/lymphocyte ratio (NLR) is easy to calculate,has good repeatability,and holds promise for prognostic evaluation.This article introduces the research advances in the association of NLR with the prognosis of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer and points out that NLR plays an important role in evaluating the prognosis of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer.However,there are still controversies over the selection of optimal cut-off values for different diseases,and further studies are needed.

Chronic obstructive pulmonary disease (COPD) is the leading death cause of pulmonary diseases, ranking the fourth of global death causes. Self-management program is able to gradually improve the Airways of COPD patients with ventilation, reduce the degree of lung failure, elevate the health status as well as promoting self-efficacy, which is the key process to effectively control COPD relapse. In recent years, more and more domestic and foreign academic employ the widely-used network technology and carry out a large number of information study on COPD self-management intervention. This article reviewed literatures about the intervention methods on self-management of patients suffered from COPD, aimed at providing a better basis for exploring more effective self-management.

SUMMARY Hyperparathyroidism is the clinical syndrome that results from elevated circulating parathyroid hormones,leading to multiple systems manifestations,and is divided into three kinds: primary, secondary and ternary.This patient’s main chief complaint was intermittent melena for 3 days,with the diagnosis of upper gastrointestinal hemorrhage according to endoscopy. Hypercalcemia, hypophosphatemia and high level of circulating parathyroid hormone and chronic renal failure were also found during hospitalization. Furthermore, MIBI showed a parathyroid adenoma located near the isthmus in the lower part of the left lobe. The patient had undergone nephrectomy because of kidney carcinoma 2 years ago. Primary hyperparathyroidism usually has the common gastrointestinal syndrome , but upper gastrointestinal hemorrhage reported as the chief complaint is rare and we had never seen similar reports before.

Clinical teaching effect is directly affected by internship tutors’quality which is not very good at present. For this reason,a questionnaire on teachers and students was made and several solutions were put forward by analysis on the survey results.

Objective To observe the changes in OLETF kideys at different stage and the beneficial influences by modulating serum lipids. Methods OLETF rats aged 8 wks were randomly divided into treated group and untreated group,and LETO rats served as normal control.Fenofibrate 20 mg/kg was given daily to the treated group.OGTT was performed at the age of 8,16 and 24 wks.Blood glucose,serum lipids and 24 h urine albumin excretion(UA) were investigated.The rats were killed at 16 and 24 wks of age,and the kidney sections were stained with PAS.Transforming growth factor-?_1(TGF?_1),vascular endothelial growth factor(VEGF) and fibronectin(FN) were investigated by immunohistochemistry assay.The electron microscope(EM) sections were made to measure GBM width and to observe the mesangial matrix.Results(1) Blood glucose had no significant difference between untreated and treated groups at 16 and 24 wks of age;(2) Fenofibrate decreased serum TG, increased HDL-C markedly but had no influence on LDL-C;(3) As aging,24hrs UA increased in untreated group,and reduced significantly in fenofibrate group at 24 wks of age;(4) TGF-?_1,VEGF and FN expressions were all higher in untreated group than in treated group at 24 wks of age.(5) EM revealed GBM obviously thickened and mesangial matrix widened in untreated group.Fenofibrate attenuated the kidney lesion greatly in EM picture.Conclusions (1) Dyslipidemia occurs prior to glucose metabolism abnormity in OLETF rats;(2) As aging,dyslipidemia progresses accompanying markedly the increased UA,enlarged glomeruli,thickened GBM and widened masangial matrix;(3) Modulating lipids early couldn′t improve glucose metabolism,but corrects dyslipidemia and reveals beneficial influence on kidneys;(4) The possible mechanism is that modulating lipids decreases TGF-?_1 and VEGF expressions.

Adrenal hemangioma is a rare neoplasm.The clinical data of a case of adrenal cavernous hemangioma and review of related literatures are herewith presented.Adrenal cavernous hemangioma is often nonfunctioning and benign.CT and MRI show the features of hemangioma.The treatment depends on the size of the mass,and the diagnosis is based on pathology.

To summarize the clinical data of two cases with severe hyponatremia diagnosed as adrenal insuffiency combined with syndrome of inappropriate secret on of antidiuretic hormone(SIADH),and to review related literatures.Case 1 diagnosed as Addison's disease for 27 years and developed severe hyponatremia again but did not response well to sufficient glucocorticoid.Further examination showed SIADH caused by lung cancer and tolvaptan worked well.Case 2 was diagnosed as SIADH caused by lung cancer and responsed well to tolvaptan.However,hyponatremia reoccurred with the decreasing level of ACTH and cortisol during the chemotherapy.It was thought that hyponatremia was caused by drug-related adrenal insuffiency and glucocorticoid replacement therapy achieved good response.Both primary/secondary adrenal insuffiency and SIADH can lead to severe hyponatremia,but it is rare that the two situations exist in one patient and occur in different time.We should consider the possibility of the situations when we make differential diagnosis of refractory hyponatremia,monitoring the curative effects carefully,then correct the diagnosis timely,and reduce missed diagnosis and misdiagnosis.

Objective To explore the possibility of anterior open reduction and internal fixation to treat the lower cervical irreducible dislocation. Methods 15 cases of lower cervical irreducible dislocation were treated by the anterior open reduction and internal fixation, 11 cases were male and 4 cases were female, 10 cases were unilateral facet locked and 5 eases were bilateral facet locked which were confirmed by the MRI and CT scan. All the cases were failed to the skull traction before operation and received anterior open reduction and plate fixation, and interver-tebral fusion. All the cases were followed up, the recovery of neurological function and the fusion rate were evaluated. Results 15 cases were completely reduction and none of them got a worse neurological function. Conclusion The treatment effect of anterior open reduction and fixation for the lower cervical irreducible dislocation were good.

Objective To evaluate a somatostaitn analogue (Octreotide) in the treatment of hepatocellular carcinoma (HCC). Methods In this study 62 HCC patients were divided into therapy group (30 cases) and control group (32 cases) based on patients' own will. Patients in treatment group were assigned to receive an average dosage of 339.43±165.53 mg of octreotide. Treatment results and patients' life quality were evaluated on 3rd and 6th month. Result (1) The average live time of the treatment group was (12.89±6.21) months much longer than that of the control group (5.36±6.36) months (P < 0.05). The 6 month, 12 month survival rate of treatment group (73.3% ,50.0% ) was better than that of the control group(40.6% ,9.37% ) (χ2 =4.02 ,χ2 =9.67,all P <0.05). (2) Appetite was improved in 21 patients, body weight increased in 12 patients. Debility ameliorated in 17 patients in therapy group. (3) Tumor grew larger in 8 cases in control group on the sixth month based on liver CT and 6 of them had extrahepatic metastasis. While in therapy group tumor size decreased in 6 cases; did not change in 9 cases; 3 grew larger, and 1 had extrahepatic metastasis. (4) As for side-effects of octreotide therapy, 6 patients had diarrhea at the beginning, as the treatments continued, the symptoms disappeared within one month. Conclusion Octreotide prolongs the surviving time of patients with hepatocellular carcinoma, increases the 6 and 12 months survival rate, causing mild side-effects, and improves the life quality of patients with hepatocellular carcinoma.