Objective To investigate the correlated clinic factors of prostecdtive efficacy and recurrence in chronic hepatitis B patients who got the combinated fully respond to Lamivudine.Methods To divide the chronic hepatitis B patients who got the combinated fully respond to Lamivudine into two groups,according to whether the curative effect was consolidated after the withdrawal of lamivudine therapy for two years.Group A was consolidated and group B was repeated.To compare the two groups correlated clinic factors.Results Consolidated ratio of prostecdtive efficacy was 64.71% in the first year,then it dropped to 55.88% in the second year.There was apparent difference between two groups which included:ages,total months of treatment,serum HBV DNA before and after treatment,ALT,time to HBeAg seroconversion and consolidation.Particularly is time stoped a medicine,the pro-s 1 Ag was negative,the HbeAg fixed amount is a 0 Ncus/ml,two all match 33 example,only 1 while stopping a medicine for 12 months relapse,two years long-term curative effect consolidation rate reaches to 97%,.But come short of twos to all match 35 example,29 HBVDNA rebound,relapse of illness,two years long-term curative effect consolidation rate reaches to 17.14% only.(P=0.0000).Conclusions To achieve the withdrawal indication after long-term antiviral therapy with nucleoside according to The Guideline of Prevention and Treatment for Chronic Hepatitis B,it still must refer to that the pro-s1Ag was negative.whether the quantitated index of HbeAg had achieved to 0Ncu/ml,otherwise,it was necessary to extend the course of treatment of antiviral therapy.The extensive course of treatment was very safe,because the ratio of mutation of YMDD and some other virus was tiny.

Objective To explore the influencing factors of job stress of clinical nursing teachers in order to provide information for nurse managers formulating targeted stress management.Method Toally 185 clinical nursing teachers were evaluated with the Chinese nurses stressors scale (CNSS).Results The scores by CNSS was 75.4 ±23.6.Age,working experience,job rank,education background,working department,marriage status and demission intention were found to be adverse impacts on CNSS's scores (all P＜0.01).Conclusion Clinical nursing teachers have middle working pressure.Effective intervention should be provided by nursing managers to prevent and relieve job stress and negative psychological conditions of these teachers.

Objective To study the effect of comprehensive interventions on anxiety of nursing students at internship. Methods Comprehensive educational interventions were practiced at the beginning,middle-term and end of their internship. The Self-Rating Anxiety Scale(SAS)was adopted to assess their level of anxiety.Results There were differences in SAS scores between the three phases(F=2.680,P<0.05).The scores were decreased from the beginning to the end.Conclusion Targeted comprehensive educational interventions can reduce anxiety and stress of nursing students.

Objective To explore the stress perception among acute myocardial infarction (AMI) patients during acute stage.Methods Phenomenological method of qualitative study was adopted.18 AMI patients during the acute stage of 3～4 days after the onset of the disease were interviewed.Results Stress made AMI patients hard to accept the fact of illness,worry about the treatment of illness and the impact on future life,be difficult to alter living habits,be hard to relieve negative emotion.Conclusions AMI patients during acute stage will experience different levels of psychological stress.Stress management should be fabricated and effective measures should be adopted to relieve their negative emotions in terms of inducing factors.

Objective To investigate the value of multipoint and multidirectional ultrasound-guided fineneedle aspiration cytology (US-FNAC) in preoperative diagnosis of papillary thyroid microcarcinoma (PTMC).Methods From Jan.2012 to Jan.2013,multipoint and multidirectional US-FNAC were performed in 177 patients with 233 nodules suspected as PTMC,and the cytopathological findings were compared with surgical pathological results and clinical follow-up results.Results Of the 233 biopsies,the cytology were classified as malignant for 146 lesions,suspicious for malignancy for 43 lesions,benign for 24 lesions,follicular lesions for 4 lesions and inadequate sample for 16 lesions.After the second multipoint and multidirectional US-FNAC,only 1 case did not have sufficient cells for diagnosis,and the puncture failure rate was 0.43％.Actually there were 189 malignant and 44 benign lesions confirmed by clinical follow-up and pathological results.The sensitivity,specificity,and accuracy of multipoint and multidirectional US-FNAC was 99.5％,81.8％ and 96.1％ respectively.Conclusions Multipoint and multidirectional US-FNAC has definite value in increasing puncture qualified rate and positive diagnosis rate before operation.

Objective To explore and observe the clinical characteristics and laboratory testing results of children with infectious mononuclear cells syndrome (IM),in order to improve diagnostic level.Methods 152 children with IM were selected,and the clinical manifestations,laboratory testing were retrospectively analyzed.Results There were a variety of clinical symptoms,the main clinical manifestations included fever 138 cases(90.8％),swollen lymph nodes 145 cases(95.4％),angina 112 cases (73.7％),hepatosplenomegaly 28 cases(18.4％),double eyelid edema 25 cases(16.4％),rash 7 cases(4.6％).Laboratory-testing of white blood cell count ＞ 10 × 109/L in 125 cases (82.2 ％),atypicallymphocyte proportion were more than or equal to 10％ in 48 cases (31.5 ％),liver function damage in 58 cases (38.2％),myocardial damage in 38 cases (25％),abnormal urine analysis in 30 cases (19.7％),thrombocytopenia 2 cases (3.4％).Conclusion Clinical symptoms of IM children are diversity,in some cases the clinical sympotoms are not typical,to improve the understanding of this disease can reduce the rates of missed diagnosis and misdiagnosis.

ObjectiveTo observe the effect of Buzhongyiqi decoction on post stroke fatigue.Methods60 stroke patients with fatigue were given Buzhongyiqi decoction for 4 weeks continuously. Chinese New Drug Clinical Guidelines was to evaluate the effect for patients according to improvement of symptoms.ResultsIn 60 cases, markedly effective in 47 cases (78.33%), effective in 10 patients (16.67%), invalid in 3 cases (5%). Symptoms of malaise, anorexia, muscle soreness were significantly improved.ConclusionBuzhongyiqi decoction can improve post stroke fatigue of stroke patients.

Objective To assess the contrast-enhanced ultrasound (CEUS) characteristics of pleomorphic adenoma (PA) and carcinoma ex pleomorphic adenoma (CXPA).Methods A retrospective analyse was made from the contrast-enhanced ultrasonic features of 42 PA and 8 CXPA.The features included tumor size,echotexture,boundary,shape and blood flow richness on conventional US imaging and rise time (RT),time to peak (TP),peak intensity(PI),time from peak to one half(HT),mean transit time (MTT),and area under the curve(AUC) on contrast-enhanced ultrasound.Results All of PA and CXPA were hypoechoic,but there was no difference between them in shape and blood flow richness (P ＞0.05).37.5％ CXPA has hetergeneous echotexture with the presence of anechoic area,but it appeared in only 4.8％ PA(P ＜0.05).The following findings were observed from a perfusion kinetics of CEUS in all of PA and CXPA:slow in,centripetal,heterogeneous enhancement,with no enhancement area.Well-defined margins were presented in 42 PA and in 7 CXPA(P ＜0.05).Their time-intensity curves showed RT,TP,HT and MTT in CXPA group were obviously higher than those in the PA group(P ＜0.05).However there was no statistical difference in PI and AUC between both groups (P ＞ 0.05).Conclusions Conventional US and CEUS perfusion patten provide limited diagnostic information for distinguishing PA from CXPA.CXPA could be diagnosed by ill defined margins,more internal anechoic area and poorly defined margins.But CEUS quantitative analysis can significantly promote the differentiation.

Objective To analyze how is the elastography of renal tissue correlated to clinical biochemical indexes and pathological changes in patients with chronic kidney disease (CKD), and toexplore the potential of renal elastography to become a new noninvasive method available for the dynamic monitoring of renal disease progression, as well as its efficacy assessment and prognosis evaluation. Methods Patients admitted to the department of nephrology of the First Affiliated Hospital of China Medical University and received renal biopsy from August 2014 to January 2015 were selected. One hundred and thirteen cases of CKD patients, 61 males and 52 females were enrolled, including 23 cases of IgA nephropathy, 39 cases of membranous nephropathy, 15 cases of minimal change nephropathy and 7 cases of focal segmental glomerulosclerosis. The Young modulus of renal cortex and medulla (YMcortex and YMmedul a) were detected by Aix Plorer type full digital color Doppler ultrasound. The correlations between the YMs and clinical biochemical indicators in blood and urine, and the difference of YMs among different pathological changes in patients with CKD were analyzed by statistics. Results The YMcortex and YMmedul a in CKD patients were higher than those in the control group (all P<0.05); and with the progression of CKD, the YMcortex and YMmedul a gradually increased. The YMcortex in CKD G5 patients was higher than that in CKD G1?3 patients (all P<0.05). The YMmedul a in CKD G3?5 patients was higher than that in CKD G1?2 patients (all P<0.05). The YMcortex was correlated with systolic pressure, serum creatinine, cystatin C, serum albumin, serum phosphorus, calcium and phosphorus product, uric acid, intact parathyroid hormone (iPTH), urinary NAG, estimate glomerular filtration rate (eGFR) and hemoglobin (all P<0.05). The YMmedul a was correlated with systolic pressure, serum creatinine, serum albumin, uric acid, iPTH, urine microalbumin (MA), urinary NAG and hemoglobin (all P<0.05). Serum cystatin C (β=0.485, P=0.018) and uric acid (β=0.418, P=0.039) were independently correlated with the YMcortex. Serum creatinine (β=0.380, P=0.019), uric acid (β=0.482, P=0.004) and smoking (β=0.337, P=0.009) were independently correlated with YMmedul a. The YMcortex and YMmedul a in different pathological types were statistically significant (P<0.001, P=0.003). The YMcortex and YMmedul a in patients with membranous nephropathy and IgA nephropathy were higher than those in the patients with minimal change nephropathy (all P<0.05). The YMmedul a in patients with focal segmental glomerulosclerosis was higher than that in the patients with minimal change nephropathy (P<0.05). The YMcortex in the patients with phases Ⅳ and Ⅴ based on the Lee grading system of IgA nephropathy was higher than that in the patients with phases Ⅱ andⅢ (P<0.05). According the Oxford classification for IgA nephropathy, the YMcortex and YMmedul a in the T1 and T2 patients were higher than those in the T0 patients (P<0.05). The YMcortex and YMmedul a showed no statistically significant differences among different stages of membranous nephropathy. Conclusions The YMcortex and YMmedul a are associated with the progress of renal insufficiency, which may become new indicators for determining CKD progression. The renal ultrasound elastography may become a new non?invasive method for early diagnosing CKD, dynamic monitoring disease progression, and assessing efficacy and prognosis.

Objective To extract,isolate and identify the polysaccharide from ginseng,and to investigate its anti-tumor activity in vitro. Methods The ginseng polysaccharide was obtained through water extraction and ethyl alcohol deposition method. Use the Sevage method to remove the protein in the crude polysaccharide. The structural characteristics of the polysaccharide were determined by FT-IR spectra.The RM-1 and HeLa cells were divided into control group and different concentrations (0,50,100,200,300,400 and 500 mg·L-1 )of ginseng polysaccharide groups. The survival rates of the cells in various groups were detected by MTT method. The indirect killing effects of ginseng polysaccharide with different concentrations (0,50,100,200,300,400 and 500 mg·L-1 )on the cancer cells were determined by CTL test. Results The extraction rate of ginseng polysaccharide was 8.7 6% and the structural characteristics demonstrated that the main component of the extract was polysaccharide.The result of MTT showed that there were no significant differences of the survival rates of RM-1 and HeLa cells between different concentrations of ginseng polysaccharide groups after treated for 24 h compared with control group (P>0.05).The result of CTL test showed that the cytototic LHD release rates in different concentrations of ginseng polysaccharide groups were increased significantly (P<0.05)compared with control group;with the increase of ginseng polysaccharide concentration, the cytotoxic LDH release rates were increased firstly and then were decreased.When the concentration of ginseng polysaccharide was 100 mg·L-1 ,the cytotoxic LDH release rate was the biggest.Conclusion Ginseng polysaccharide can indirectly inhibit the growth of the tumor cells by activating T cells and play an anti-tumor effect.