Objective To compare the effect of entecavir and lamivudine combined with adefovir in treatment of patients with e antigen -positive chronic hepatitis B.Methods 72 patients with HBeAg positive chronic hepatitis B were randomly divided into group Ⅰ (36 cases)and group Ⅱ (36 cases).Group Ⅰ was treated by grace entecavir,group Ⅱ was treated with adefovir and lamivudine,two groups were treated for 24 months.The HBV -DNA negative rate,ALT recovery rate,HBeAg seroconversion rate,negative conversion rate of HBsAg,HBeAg and HBeAb conversion rate of the two groups were compared after 6 months,12 months and 24 months treatment.Results After treatment for 6 months,12 months and 24 months,the HBV -DNA negative rate,HBeAg negative conversion rate, HBeAg and HBeAb rate in the two groups had no statistically significant differences.After 6 months and 12 months treatment,the ALT recovery rates of group Ⅰ were 52.78%,83.33%,which were significantly higher than 27.78%, 38.89% of group Ⅱ,the differences were statistically significant(χ2 =4.677,14.961,all P <0.05 ).The total response rates of 6 months,12 months and 24 months after treatment were 47.22%,77.78%,88.89%,72.22%, 83.33% and 44.44%,respectively.There were no significant differences between the two groups(all P >0.05). Conclusion There is similar effect of entecavir and lamivudine combined with adefovir in treatment of patients with e antigen -positive chronic hepatitis B,which can inhibit HBV replication and improve liver function,and the security was good,but entecavir has better ALT normalization rate at early,the treatment should be selected according to clini-cal practice.

Laparoscopic minimally invasive surgery technology is rapidly developing in the tumor treatment field. Due to the lack of space perception of the previous 2 D laparoscopic surgery, it has been unable to meet the current needs, and then 3 D laparoscopic technology emerged and got widely development. This paper summarizes the difference between the 3 D laparoscopic technique and traditional 2 D laparoscopic technology, and then analyzes the classification of 3 D signal display technology and common format. At the same time, this paper introduces the integration operating room structure with 3 d technology, signal format, and signal transmitting method. Finally, this paper prospected the application foreground for 3 D laparoscopic technology in the operating room.

Objective:To analyze the relationship between the concentration of glucose and the impedance of human blood, and study the relationship between human blood glucose detection and human blood impedance.Methods:The system adopts the AD5933 digital frequency synthesizer (DDS) in the excitation signal is produced, imposed on the impedance under test, the ADC acquisition signal and sent to the corresponding chip DFT digital processing module, measurement results through the I2C sent to the microcontroller, again by the single-chip microcomputer and PC computer communication, the computer shows that the impedance values. Results:The instrument can realize the resistor, capacitor, inductance, glucose solution impedance measuring rapidly and accurately, through experimental verify that resistive impedance deviation from the mean is 0.04, phase deviation from the mean is 0.15°.Conclusion:The glucose concentration of aqueous solution was linearly correlated with the impedance, the correlation coefficient greater than 0.99.

Objective To investigate the clinical efficacy and the influence on T cell subsets of telbivudine in the treatment of HBeAg -positive chronic hepatitis B , guide clinical treatment .Methods 70 patients HBeAg -positive chronic hepatitis B in our hospital were randomly divided into the telbivudine group which were received telbi -vudine 600mg/d and lamivudine group which were received lamivudine 100mg/d,35 cases of each group ,both group had been treated for 48 weeks,the liver function (ALT,AST) were detected for making a statistics of ALT normaliza-tion,the serum were extracting for detecting HBV -DNA and making a statistics of HBV -DNA negative rate by PCR,the HbeAg were detected for making a statistics of HBeAg seroconversionby ECLIA ,T cell subsets ( CD3+,CD4+, CD8+,CD4+/CD8+) were detected by flow cytometry ,observed adverse events .Results The ALT,AST,HBV-DNA of the telbivudine group and lamivudine group after treatment were (36.04 ±7.62)U/L and (63.53 ±14.13)U/L, (34.26 ±8.51)U/L and (55.31 ±15.48)U/L,(2.22 ±0.73)copies/mL and (3.28 ±0.95)copies/mL,all indi-cators significantly lower than before treatment (t =24.826,18.564,7.495 and 17.413,13.331,5.442,all P<0.05),and the ALT,AST of the telbivudine group were significantly lower than the lamivudine group ( t=3.867, 3.774,3.498,all P<0.05).The ALT normalization,HBV-DNA negative rate,HBeAg seroconversion rate of the telbivudine group and lamivudine group were 97.14%and 74.29%,94.29%and 68.57%,62.86%and 37.14%, telbivudine group,the telbivudine group were significantly higher than that of lamivudine group (χ2 =7.467,7.652, 4.629,all P<0.05).The CD3+,CD4+,CD4+/CD8+of telbivudine group and lamivudine group after treatment were (66.3 ±3.8)%and (60.6 ±3.5)%,(38.8 ±5.4)% and (35.2 ±4.4)%,(1.33 ±0.16)% and (0.95 ±0.11)%,all indicaitons significantly higher than before treatment ( t =5.442,6.173,3.753 and 3.404,3.635, 3.222,all P <0.05),the telbivudine group were significantly higher than lamivudine group (t =3.473,3.207, 3.422,all P<0.05).Conclusion The telbivudine has better efficacy than the lamivudine in the treatment of HBeAg-positive chronic hepatitis B because of enhancing immune function ,can improves ALT normalization ,HBV-DNA negative rate and HBeAg seroconversion rate ,inhibit HBV replication .

Objective To investigate effect of probiotics in the treatment of patients with severe hepatitis and its influence on inflammatory cytokines.Methods A retrospective analysis of the data of patients with severe hepati-tis were maded.There were 100 patients,which including 50 cases of the observation group and 50 cases of control group,the control group was given conventional treatment,the observation group was given Bacillus viable capsule (Zhengchangsheng) for 4 weeks,2 granule a time and three times a day.The clinical symptoms were observed before and after treatment,the blood was exsanguinated for detecting bowel flora,total bilirubin,liver function and inflamma-tory cytokines.Results The total effective rate of the observation group was 86%,which was significantly higher than 56% of the control group(χ2 =11.409,P <0.01).The enterobacter of the observation group after treatment was (6.71 ±1.30)lgn/g,which was lower than before treatment(t =3.602,P <0.05),the bifidobacterium,lactobacillus, bacteroides were (7.88 ±1.18)lgn/g,(8.08 ±1.65) lgn/g,(8.30 ±1.20)lgn/g,respectively,which were higher than before treatment(t =3.772,3.707,3.523,all P <0.05).The intestinal flora in the control group had no differ-ence before and after treatment.After treatment,the total bilirubin,ALT,plasma endotoxin of the observation group and the control group were (195.0 ±25.4)μmol/L and (307.6 ±40.5)μmol/L,(58.2 ±11.5)U/L and (90.2 ± 10.5)U/L,(0.18 ±0.06)EU/mL and (0.29 ±0.08)EU/mL,respectively,which were lower than before treatment (t =16.307,9.408,10.157 and 4.032,8.075,5.076,all P <0.01).The serum TNF -α,IL -6 levels of the obser-vation group were (106.2 ±12.5)pg/mL,(82.3 ±18.9)pg/mL,which were lower than before treatment(t =3.732, 4.017,all P <0.05),which of the control group were (130.5 ±20.6)pg/mL,(110.2 ±17.8)pg/mL,there was no difference before and after treatment.The IL -2,IL -10 levels of the observation group were (60.7 ±10.0)pg/mL, (31.7 ±6.6)pg/mL,which were significantly higher than before treatment(t =3.757,3.877,all P <0.05),which of the control group were (46.2 ±5.8)pg/mL,(23.4 ±5.1)pg/mL,which had no difference before and after treat-ment.The total bilirubin,ALT,plasma endotoxin,serum TNF -α,IL -6 levels of the observation group were lower than the control group(t =7.653,8.104,3.309,3.511,3.787,all P <0.05).The IL -2,IL -10 levels of the obser-vation group were higher than the control group(t =3.487,3.428,all P <0.05).Conclusion Probiotics can correct intestinal flora,reduce plasma endotoxin,inhibit inflammatory mediators,reduce inflammation of the liver damage, improve liver function and clinical symptoms and should be introduced in the treatment of severe hepatitis.

Objective To probe the differences and similarities of clinical feature between alcoholic and biliary chronic pancreatitis (CP) and their therapy. Methods Retrospective analysis of the clinical features was made in 110 cases of CP in Peking Union Medical College Hospital from 1991 to 2000. Results ① In 110 cases of CP, the clinical manifestations were abdominal pain (85.4%), diarrhea (22.7%), calcification of pancreas (13.6%), and pseudocyst of pancreas (28.2%); 3 cases (2.7%) complicated with pancreatic carcinoma. ② The frequency of the different kind of clinical manifestations in alcoholic CP was higher than in biliary CP.③The frequency of diarrhea (29.1%),diabetes mellitus (41.9%) and calcification of pancreas (22.6%) in alcoholic CP was also higher than in those caused by bile duct system diseases (16.7%, 19.1% and 9.5%).④The response rate of medical treatment was 81.2%. Conclusions The clinical features and complications are more typical and occur earlier in alcoholic CP than those in biliary CP. With regard to management, medical treatment is less used than surgical therapy.

Objective To evaluate the significance of detecting plasma methylated Septin9 (SEPT9) alone and combined with fecal immunochemical test (FIT) in screening colorectal cancer (CRC) and adenoma.Methods From October 2014 to April 2015,outpatients received CRC and adenoma screening were enrolled.Colonscopy examination and pathological diagnosis were taken as gold standard.The sensitivity and specificity of plasma methylated SEPT9 and FIT in CRC and adenoma were calculated.The diagnostic value of combined examination was evaluated.Receiver operating characteristic (ROC) curve of SEPT9 in CRC diagnosis was drawn.Results A total of 300 outpatients were enrolled.Among them,CRC was detected in 45 patients (15.0％) and adenoma was detected in 68(22.7％) patients,including 37(12.3％) cases of advanced adenomas.The sensitivity of SEPT9 and FIT for CRC diagnosis was 80.0％ and 88.9％,and the specificity was 95.3 ％ and 54.1％,respectively.The area under concentration curve (AUC) of methylated SEPT9 in CRC diagnosis was 0.923.The sensitivity of SEPT9 and FIT in advanced adenoma diagnosis were 10.8％ and 62.2％,and the specificity were 83.3％ and 49.0％,respectively.The sensitivity of combined examination in CRC diagnosis was 97.8％ and the specificity was 52.9％;the sensitivity in advanced adenoma diagnosis was 67.6％ and the specificity was 47.4％.Conclusions Plasma methylated SEPT9 is helpful in CRC screening,moreover,when combined with FIT,it can increase detection rate of colorectal adenoma.

Objective To realise the clinical features and to reduce the diagnostic errors of hepatolenticular degeneration patients with liver injure. Methods Clinical manifestations, results of las tests and admitting diagnosis of 23 hepatolenticular degeneration cases were reviewed. Results All cases showed the elevation of serum transami-nase and/or total bilirubin. 17 cases(73.9% ) had manifestation of liver malfunction while nervous system symptoms were merely found in 2 cases. The decreased ceruloplasmin and elevated 24 hour urinary cuprum were detected in 23 and 21 cases respectively. Positive K-F rings were observed in 17 of 23 patients. Misdiagnosis rate of admitting diagno-sis exceeded 43.5%. 2 cases died after treating with penicillamine. Conclusion Liver injure that is one of the com-mon clinical features results in the diagnostic errors, but the combination detection will improve the accuracy of hepa-tolenticular degeneration.

Objective To evaluate the clinical value of the three-category classification of severe acute pancreatitis (SAP).Methods Clinical data of 337 traditional SAP patients,who were admitted to Peking Union Medical College Hospital (PUMCH)from January 2001 to December 2012,were retrospectively studied.These patients were classified into moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) according to the latest 2013 Atlanta Classification.SAP patients were further categorized as critical acute pancreatitis (CAP) and non-CAP.Disease severity,therapy and prognosis among three groups were compared.Results Among the total 337 traditional SAP patients,253 were classified as MSAP and 84 as SAP.In the group of SAP,40 patients were categorized as CAP and 44 as non-CAP.Compared with non-CAP patients,CAP patients had significantly higher mortality rate which was 70％ (28/40).Other results were all significantly higher in CAP group rather than non-CAP group,including ICU admission rate 77.5％(31/40),length of ICU stay (15.5 ± 20.6) days,Ranson,APACHE Ⅱ,BISAP,MCTSI,modified Marshall scores 4.6 ± 1.4,16.8 ± 5.8,3.0 ± 1.0,8.6 ± 1.7,and 7.4 ± 2.9,respectively (P ＜ 0.01 in each endpoint).These parameters of SAP group were also significantly higher than those of MSAP group (P ＜0.01).Conclusions Using the new three-category classification to distinguish traditional severe acute pancreatitis,namely MSAP,SAP,and CAP,can better reflect the severity of disease,predict outcome and guide clinical management.

Objective To explore the clinical features and possible carcinogenesis mechanism of the ulcerative colitis (UC)-associated colorectal cancer. Methods From 1984 to 2008, 6 clinical cases of UC-associated colorectal cancer were collected at Peking Union Medical College Hospital. The characters of morbidity, clinical features, pathology type, treatment and prognosis were analyzed.Immunohistochemistry(IHC) was performed to study the protein expression of adenomatous polyposis coli protein(APC), β-catenin, P53 and Wnt-1 in the specimens. Results The canceration of UC was 1.1 %, higher in female cases (5/6), the average duration was 14.3 years. All cases presented typical UC manifestation, most involved total colon (5/6) and none of them complicated with primary sclerosing cholangitis (PSC). There were 4 rectal cancers and 2 descending colon caners the UC cases collected. The major pathology type was adenocarcinoma with poor prognosis. The positive protein expression ratio of APC, β-catenin, P53 and Wnt-1 were 6/6, 6/6, 5/6 and 6/6 respectively.Conclusion The rectal cancer should be monitored and prevented in UC patients with total colon involved and long disease duration. Multi-pathway may possibly be involved in the carcinogenesis.