ObjectiveTo analyze the characteristics of S gene varivants of patients with chronic hepatitis B virus infection with coexistence of HBsAg and HBsAb.MethodsHBV DNA S gene regions were amplified and sequenced in 26 HBsAg-positive/HBsAb-positive patients (test group) and the newly diagnosed 39 HBsAg-positive/HBsAb-negative patients (control group).The sequencing results and amino acid variants of this region were analyzed.ResultsThe amino acid variants were significantly more frequent in test group than in control group among the complete S gene region (P＜0.05).In addition,a significantly bigher amino acid variants arose in patients group versus control group in HBsAg major hydrophilic region (MHR),especially the first loop area of a-determinant (6.69％ vs 0.89％,P＜0.05).ConclusionThe coexistence of HBsAg and HBsAb in patients with chronic HBV infected might be related to the emergence of S gene variants in and around HBsAg a-determinant especially in the first loop area.

Objective To compare the efficacy of dexmedetomidine and pethidine for prevention of postoperative shivering in patients requiring general anesthesia.Methods Sixty ASA Ⅰ-Ⅲ patients of both sexes,aged 18-75 yr,weighing 40-85 kg,were randomly divided into 2 groups (n =30 each) ∶ pethidine group (group P) and dexmedetomidine group (group D).At the end of pneumoperitoneum,pethidine 0.5 mg/kg and dexmedetomidine 1 μg/kg were infused intravenously over 10 min in groups P and D,respectively.The shivering,respiratory depression,somnolence,nausea and vomiting,bradycardia and hypotension were recorded within 1 h after operation.Results There were no significant differences in the incidence and degree of shivering between group D and group P (P ＞ 0.05).The incidences of respiratory depression and nausea and vomiting were significantly lower,and the incidence of bradycardia was significantly higher in group D than in group P(P ＜ 0.05).Conclusion The efficacy of dexmedetomidine for prevention of postoperative shivering is better than pethidine in patients requiring general anesthesia.

Objective:To evaluate the effect of esketamine on postoperative delirium (POD) in elderly patients undergoing general anesthesia.Methods:Two hundred and twenty-four elderly patients, aged ≥ 65 yr, with American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, undergoing elective surgery under general anesthesia, were divided into 2 groups ( n=112 each) using a random number table method: esketamine group (S group) and control group (C group). Esketamine 0.5 mg/kg was intravenously injected before anesthesia induction in S group, while the equal volume of normal saline was given instead in C group.The Fuzzy Consciousness Assessment Scale (3D-CAM) was used to assess the occurrence of POD within 7 days after surgery.The consumption of propofol, remifentanil and sufentanil and use of vasoactive drugs were recorded during operation.The rescue analgesia within 48 h after operation and occurrence of postoperative complications were recorded. Results:Compared with C group, the incidence of POD was significantly decreased, the intraoperative consumption of remifentanil was reduced, and the utilization rate of vasoactive drugs, rate of rescue analgesia and incidence of postoperative vertigo, nausea and vomiting within 48 h after surgery were decreased in S group ( P<0.05). Conclusions:Esketamine can reduce the development of POD in elderly patients.

Objective To investigate the effect of dexmedetomidine on the incidence of POCD and the inflammatory response of central nervous system in elderly patients with radical gastrectomy,so as to provide reference for the selection of POCD prophylaxis in elderly patients.Methods A total of 86 elderly patients aged 36-79 years with ASA grade Ⅰ-Ⅲ underwent radical gastrectomy with general anesthesia were enrolled.They were randomly divided into two groups using computer random software:dexmedetomidine group (D group) and saline group (S group),43 patients in each group.MMSE score and MoCA score were recorded 1 day before anesthesia (T0),6h after operation (T1),24h after operation (T2) and 48h after operation (T3).Interleukin-1β (IL-1β),interleukin -6 (IL-6) and C-reactive protein (CRP) were measured at different time points.The incidence of hypotension and bradycardia was recorded.Results There were no significant differences in MMSE scores and MoCA scores between the two groups 1 day before anesthesia (t =0.356,0.403,all P ＞0.05).The MMSE score and MoCA score of the D group were significantly higher than those of the S group at T1,T2 and T3 (t =5.998,6.886,5.943,6.180,6.947,7.151,all P ＜0.05).The levels of IL-1β,IL-6 and CRP in the D group were significantly lower than those in the S group at T1,T2 and T3 (t =2.239,2.731,2.134,15.47,17.28,12.93,4.583,6.444,7.544,all P ＜ 0.05).Conclusion Dexmedetomidine can significantly reduce the risk of POCD in elderly patients with radical gastrectomy,and can inhibit the inflammatory response.It is worth to use in clinic.