Up to date, there are two types of drugs approved to treat hepatitis B: interferons and nucleos (t) ide analogues. However, the therapies are limited in the clinical context because of the negative side effects of interferon-α and the development of substantial viral resistance to nucleos (t) idic inhibitors. Therefore, new drugs with novel structures and mechanisms are needed. In this article, the drugs approved by FDA or the European Commission for treating chronic hepatitis B virus infection, as well as those under clinical trials, and several compounds in preclinical studies are reviewed. Additionally, some potential targets and strategies to combat chronic hepatitis B virus infection are discussed.

OBJECTIVE:To establish a cluster analysis method applied in plant classification and the identification and assessment of traditional Chinese medicine.METHODS:The raw data of the shape,the chemical composition and the UV-spectra data of plants were collected,and these data were assigned with values in accordance with the binary assignment then subjected to a cluster analysis.RESULTS:The 11 species of plants under study were accurately classified into the proper categories by the new method.CONCLUSION:By this method,the analytic data are comprehensive and the conclusion is detailed and reliable,which serves as the supplement and development for traditional cluster analysis method.

Objective:To explore the application and nursing of protein A immunosorbent in patients with neuromyelitis optica spectrum diseases.Methods:Ten patients with neuromyelitis optica spectrum diseases were treated with protein A immunoadsorption therapy. Psychological nursing was emphasized. Comprehensive evaluation was conducted before adsorption to determine the prescription of adsorption therapy. During adsorption therapy, hypotension, membrane rupture and hemolysis of plasma separator, shivering and other adverse reactions were accurately prevented and treated. After treatment, attention should be paid to the prevention of nosocomial infection, regeneration and preservation of adsorption column.Results:After immunoadsorption therapy, the serum IgG level, antibody and EDSS score of 10 patients decreased to varying degrees. The serum IgG decreased from (6.04±2.77)g/L to (2.23±1.74)g/L. No serious complications occurred, no failure of immunosorbent operation, and the patients′ condition was better than before.Conclusions:Protein A immunosorbent therapy for neuromyelitis optica spectrum diseases is safe and effective. Standardized evaluation, operation and nursing are the key to achieve good results.

Objective To investigate the effects of echocardiography-guided pacemaker parameters optimization in order to enhance the efficacy of cardiac resynchronization therapy(CRT).Methods Seventeen patients with chronic heart failure received biventricular resynchronous pacing therapy.A-V delay and V-V delay was optimized under the guiding of spectral Doppler echocardiography and tissue Doppler imaging.Results The indices of heart function in all patients were significantly improved after the treatment.The NYHA class of the patients was improved from class Ⅲ～Ⅳ to class Ⅱ～Ⅲ.Since PAV/SAV was optimized to 130-180/100-150 ms,left ventricular filling time(LVFT) was increased from (354±147)ms to (420±112)ms,mitral reflux (MR) was decreased from (8.41±4.55)cm2 to (5.36±4.71)cm2.After VV delay was optimized to 4-40ms,standard deviation of time to regional peak systolic velocity (Ts-SD-12) was decreased from (48.4±17.9)ms to (30.2±18.6)ms,left ventricular outflow tract velocity time integral(VTI LVOT) was increased from (20.6±9.0)cm/s to (26.1±3.1)cm/s.Conclusions Echocardiography-guided optimization of the pacemaker parameters is necessary in order to enhance the efficacy of CRT.

Objective To investigate the current situation and related risk factors of healthcare-associated infection (HAI),so as to provide evidence for making prevention and control measures of HAI.Methods On November 26, 2014,a combination method of bedside visiting and medical record reviewing was adopted to survey HAI status, pathogen examination,and antimicrobial application in all hospitalized patients in a tertiary first class military hospi-tal.Results A total of 1 657 hospitalized patients were investigated,66 patients developed 71 times of HAI,HAI rate and HAI case rate were 3.98% and 4.28% respectively.The top 4 departments with HAI prevalence rates were departments of neurosurgery (24.49%),hematology(19.05%),cadre ward(13.73%),and burn surgery (10.91 %).The top 5 HAI sites were lower respiratory tract (40.85%),urinary tract(23.94%),upper respirato-ry tract(12.68%),surgical site(9.86%),and gastrointestinal tract(5.63%).Of 66 cases of HAI,39 (59.09%) patients sent specimens for culture,a total of 48 pathogens were cultured,the major isolated bacteria was Esche-richia coli (n = 10,20.84%),followed by Staphylococcus aureus ,Klebsiella pneumoniae ,and Pseudomonas aeruginosa ,each was 7 (14.58 %)respectively.The usage rate of antimicrobial agents was 34.40%,specimen de-tection rate in patients receiving therapeutic and therapeutic+prophylactic antimicrobial agents was 59.28%.Risk factors for HAI were age <2 years old or >60 years,with respirator,tracheotomy,urinary tract catheterization, arteriovenous catheterization,hemodialysis,and surgery,difference was significant(all P <0.05).Conclusion Mo-nitoring on key departments and key sites of HAI should be strengthened,antimicrobial agents should be used rationally based on pathogenic detection results,specimen pathogenic detection rate should be improved,and effective prevention and control measures needs to be taken according to the risk factors of HAI.

Objective To evaluate the value and feasibility of tissue mitral annular displacement (TMAD) in the assessment of left ventricular global and segmental longitudinal systolic function and synchronization in patients with hypertrophic cardiomyopathy.Methods The study population consisted of 39 on-obstructive hypertrophic cardiomyopathy (nHCM) patients and 39 healthy volunteers matched by gender and age.Left ventricular global and segmental longitudinal were measured by speckle tracking imaging(STI).The mitral annular displacement (MAD) (anterioseptal,posterioseptal,anterior,lateral,posterior and inferior sites,respectively),peak of time (PT) and left ventricular systolic dyssynchrony index (SDI) were measured by TMAD.The correlation between LSR and MAD was analyzed,and the parameters of MAD and SDI for tow groups were compared.Results The rate of effectively track segments of TMAD was significantly higher than that of STI(98.7％ vs 77.9％,P ＜0.001).There were high correlationship between segmental LSR and MAD(r =-0.784,P ＜0.001),and global and MADglobal (r =-0.897,P ＜0.001).Compared with the control group,MAD of six spots and MADglobal were significantly decreased (P ＜ 0.001,respectively),SDI was significantly increased(P ＜0.001).Conclusions TMAD is a sensitive and reproducible method for the assessment of LV longitudinal functionin patients with nHCM.

According to the constructivism approach, instructors have to adapt to the role of fa-cilitators but not teachers. Whereas a teacher gives a didactic lecture that covers the subject matter , a fa-cilitator helps the learner to get to his or her own understanding of the content. In the former scenario the learner plays a passive role and in the latter scenario the learner plays an active role in the learning pro-cess. Under the guidance of this theory, a multi-dimension teaching model based on classroom teaching, network platform and innovate experiments has been established in the course of basis of clinical labora-tory. It has been found that this model is conducive to raising students' interests in learning and to culti-vating student's comprehensive quality.

Detection of Oncotype DX and MammaPrint has been recommended by the American Society of Clinical 0ncology.For specific populations,such as early endocrine-dependent breast cancer,under the condition of sufficient evidence in the evidence-based medicine,we can choose genetic testing in combination with clinical pathologic factors to guide clinical treatment,which has reached the goal of micro combined with macro,more detailed division of the patients,and individualized treatment.

Objective: To explore the time and genotype distribution of human enterovirus (HEV) isolated from sewage in Shanghai in 2013-2014. Methods: One sewage sample each was collected from two local sewage plants located in Minhang District and Jiading District on the same day at the day 24-28 of every month from 2013 to 2014. Each sample weighed 1 L. The specimens were concentrated by anionic membrane absorption, eluted with beef extract solution, and then used to inoculate RD, HEp-2, and L20B cell lines. A total of 249 enterovirus strains were isolated from sewage samples during the study period, including 185 non-polio enterovirus (NPEV) and 64 poliovirus (PV) strains, which were identified as vaccine strains. RT-PCR and Sanger sequencing were performed to identify HEV genotypes. Homologous analysis of VP1 sequences was conducted using BioEdit (version 7.0.0). Phylogenetic analysis was performed using the neighbor-joining method based on the alignment of VP1 gene sequences using MEGA (version 4.0.2). Results: Among 185 NPEV strains, 178 strains were successfully sequenced and classified into 15 genotypes, including coxsackievirus group B (CVB) 2, 3, and 5; enteric cytopathic human orphan (ECHO) virus 1, 3, 6, 7, 11, 13, 19, 20, 24, 25, and 30; and coxsackievirus group A 4. CVB5 and ECHO6 genotypes accounted for 33.5% (56 strains) and 24.9% (43 strains) of NPEV isolates, respectively. During the study period, HEV isolates were mainly isolated in summer and autumn in Minhang District. ECHO6 strains were frequently isolated from June 2013 to July 2014. Thereafter, the number of ECHO6 strains gradually reduced in the second half of 2014. CVB5 strains demonstrated scattered distribution from 2013 to the first half of 2014 and gradually increased in the second half of 2014. The distribution of ECHO6 and CVB5 strains in Jiading District was similar to that in Minhang District. In 2013-2014, CVB5 strains comprised C6 and C8 subgenotypes, which belong to two transmission chains and show large differences compared with foreign strains isolated during the same period. ECHO6 strains comprised C6, C8, and D9 subgenotypes, which belong to three transmission chains. Moreover, ECHO6 subgenotype D9 was a dominant subgenotype in Shanghai, with broad geographical distribution both at home and abroad. Conclusion Poliovirus was identified as a vaccine strain in environmental surveillance from June 2013 to April 2014 in Shanghai. Several transmission strains of ECHO6 and CVB5 were identified, which were the dominant serotypes.

Objective: To explore the clinical and radiological features of myelin oligodendrocyte glycoprotein (MOG) antibody associated disease. Methods: The clinical data of 22 MOG antibody associated disease cases treated in the Department of Neurology, Qilu Hospital of Shandong University from January 2017 to June 2019 were retrospectively analyzed. The clinical data of MOG antibody associated disease were summarized, including clinical and imaging features. Results: Of the 22 included patients with MOG antibody associated disease, the average age was 38.5 years, 13 were male and nine were female. Among them, 11 cases manifested as aquaporin-4 (AQP4)-negative neuromyelitis optica spectrum disorder (NMOSD), four cases optic neuritis, two cases transverse myelitis, one case acute disseminated encephalomyelitis (ADEM), two cases cortical encephalitis and two cases vestibular neuronitis. Magnetic resonance imaging (MRI) results showed that multiple anatomical areas were involved. Among the nine patients with optic nerve involvement, five patients had longitudinally extensive optic nerve lesions, which were longitudinally enhanced. In eight patients, MRI lesions in the spinal cord showed mostly long or short segments involvement, involving 2-5 spinal cord segments. Five cases involved the cervical spinal cord, six cases involved the thoracic spinal cord, and one case involved the lumbar spinal cord. Brain MRI abnormalities were found in 13 cases and the lesions were mostly patchy and point-shaped. MRI lesions demonstrated T₂ hyperintensity and some of them could be strengthened, which may involve the basal ganglia, thalamus, radiographic crown, frontal temporal lobe, brain stem and other parts. Among them, 16 patients were sensitive to high-dose intravenous/oral methylprednisolone in the acute phase. Seven patients had recurrence after two months to two years of follow-up. Conclusions MOG antibody associated disease include multiple manifestations. Among them, AQP4-negative NMOSD is the most common form. The clinical manifestations of patients showed diversity. Imaging is characterized by multiple parts involvement such as optic nerve, spinal cord, and brain. Most patients are sensitive to high-dose intravenous/oral methylprednisolone, and have a good prognosis in the acute phase, but some patients may relapse.