A 61-years male patients with chronic hepatitis B developed hypophosphatemic osteomalacia following long-term use of adefovir dipivoxil in our hospital.With "adefovir dipivoxil" and "osteomalacia" as the search terms,we searched Wanfang database and Chinese Biomedical bibliographic database since 2005,and retrieved 79 cases of adefovir dipivoxil-induced hypophosphatemic osteomalacia.Of the 80 cases,there were 63 males and 17 females with a mean age of (52 ± 11) years.The average duration of disease to first diagnosis made was 17 months,the average duration of adefovir dipivoxil administration to the onset of the disease was 62 months,and the average duration of hepatitis B was 11 years.The most common clinical manifestation was progressive bone pain in all parts of the body (80/80 cases);the most common laboratory finding was decreased serum phosphorus (80/80 cases),followed by abnormal urine tests (55/56 cases) including increased urinary phosphorus,urinary protein and positive urinary occult blood.The X-ray,CT and MRI showed different degrees of decreased bone density,osteoporosis,and bone fracture in severe patients (76/77 cases).It is suggested that clinicians should pay attention to the renal damage during the treatment of adefovir dipivoxil,and the renal function,electrolyte and bone density should be monitored regularly.

Objective To investigate the effect of early mobilization on diaphragmatic function in patients with mechanical ventilation (MV). Methods Sixty chronic obstructive pulmonary disease with acute exacerbation (AECOPD) patients with respiratory failure (RF) and underwent MV admitted to intensive care unit (ICU) of Huxi Affiliated Hospital of Jining Medical College from January 2016 to January 2017 were enrolled. The patients were divided into treatment group (n = 30) and control group (n = 30) by randomly number table method. The two groups were given analgesia, sedation, MV, antibiotics, nutritional support and other treatments. An implementation plan was developed based on the clinical practice of pain, irritability and delirium in adult patients (PAD) with ICU, while the treatment group was given early mobilization (such as joint activity, stand to the bed, 3 times a day). The diaphragmatic thickness at the end of expiration (DTee), diaphragmatic thickness at the end of inspiration (DTei) and diaphragmatic thickening fraction (DTF) were measured by bedside ultrasonography before and 24 hours, 48 hours, 3 days and 5 days after treatment respectively. Results There were no significant differences in the parameters of the diaphragm before treatment between the two groups. In the control group, DTee was gradually decreased at 5 days after treatment and was significantly lower than that before treatment (cm: 0.26±0.06 vs. 0.28±0.08, t = 3.045, 1 = 0.005). While there was no significant change in DTee in the treatment group. There was no significant difference in DTee between the two groups at different time points after treatment. DTei and DTF were significantly increased in the two groups after treatment, and reached the peak value at 48 hours; with the prolonged of MV time, DTei and DTF in the control group at 3 days and 5 days were significantly lower than those at 48 hours [DTei (cm): 0.35±0.07, 0.34±0.07 vs. 0.36±0.08; DTF: (29.29±11.01)%, (28.62±11.97)% vs. (32.48±15.63)%, all 1 < 0.01]; there were no significant changes in the treatment group. DTF in the treatment group at 3 days and 5 days was significantly higher than that in the control groups [(38.53±11.39)% vs. (29.29±11.01)%, (37.27±11.26)% vs. (28.62±11.97)%, both 1 < 0.01]. Conclusion MV can lead to diaphragmatic dysfunction, while early mobilization can delay diaphragmatic atrophy and systolic dysfunction in MV patients.