Objective To observe the attenuated and synergistic effect of meteorism tablets in treating HBeAg-positive chronic hepatitis B patients. Methods Eighty patients of HBeAg-positive chronic hepatitis B were randomly divided into treatment group (meteorism tablets combined with telbivudine) and control group (telbivudine), and treated for one year. The changes of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), the negative rate of HBV-DNA, the negative rate of HBeAg, HBeAg/HbeAb serological conversion rate, creatine kinase (CK) before and after treatment, and safety were observed. Results After treatment, biochemical response, virological response and HBeAg serological response was more significant in the treatment group than that in the control group (P<0.05). The percetage of patients with elevated CK in the treatment group was significantly lower than that in the control group (32.5% vs 60%, P<0.05). Conclusion Meteorism tablets combined with telbivudine has attenuated and synergistic effect in treating HBeAg-positive chronic hepatitis B patients.

Objective To investigate the diagnosis and disease assessment of serum pancreatic stone protein(PSP/reg) in ventilator-associated pneumonia(VAP) by a prospective study.Methods The blood sample was collected in patients with mechanical ventilation(MV) from September 2012 to October 2015.Then the concentration of PSP/reg was detected by ELISA method and the time of MV and the outcome of VAP were recorded,while the patients who did not have VAP occurred in the same period regarded as control group.Results Compared with the control group,there was no significant difference in the serum concentration of PSP/reg in VAP group(P>0.05).From continuous monitoring,compared with the start time of MV,there was a significant increase in the concentration of PSP/reg in VAP group(P<0.05),and reached the highest peak in the fourth day.That of the seventh day was significantly decreased,but still higher than the first day(P<0.05).It decreased further in the fourteenth day,but compared to the start time of MV was still higher(P<0.05).In this study,38 cases were successfully evacuated in VAP group.Compared with the fourth day,the concentration of PSP/reg in the 38 cases in the stop of MV had significantly decreased(P<0.05),close to that of in the start of MV,but still a difference between them(P<0.05),and higher than that of the control group in the stop of MV(P<0.05).By Spearman analysis,we found that PSP/reg concentration in the first day had a significant correlation with CRP(r=0.570,P<0.05),but WBC and PCT were not(P>0.05).Conclusion PSP/reg can be used as one of the indicators for diagnosis of VAP,and may be related to the severity of VAP.

Objective To investigate the effect of once yearly zoledronic acid of 5 mg on postmenopausal women with osteoporosis of different causes. MethodsFrom October 2009 to December 2009,a total of 89 postmenopausal women with osteoporosis were enrolled and assigned into 2 groups.There were 45 cases of primary postmenopausal osteoporosis,including 27 cases of fresh fracture,in group A.They were aged from 47 to 83 years,with an average of 63.7 years.There were 44 cases of secondary postmenopausal osteoporosis,including 28 cases of fresh fracture,in group B.All patients were given a.single 30-minute intravenous injection of zoledronic acid (5 mg),supplemented by 1,25-dihydroxyvitamin D of 0.25 μg and calcium of 600 mg with VitD125 IU daily.At pre-intervention and 12 months after intervention respectively,bone mineral density (BMD) was measured by dual-X-ray absorptiometry (DXA) at the lumbar spine and hip,and a balance test(Sunlight Tetrax- Ⅱ) was performed to evaluate the risk of falling.Intervention compliance of the patients and adverse events related to zoledronic acid infusion were observed. Results All cases of fresh fracture healed well at 3-month follow-up.At 12 months,43 subjects in group A and 42 subjects in group B completed the follow-up.In group A,BMD increased by 5.8％ at the lumbar spine,by 2.9％ at the femoral neck,by 5.2％ at the Words area,by 5.3％ at the greater trochanter and by 3.9％ at the total hip while the risk of falling decreased by 26.1％; in group B,BMD increased by by 3.4％ at the lumbar spine,by 2.1％ at the femoral neck,by 3.2％ at the Words area,by 3.0％ at the greater trochanter and by 2.5％ at the total hip while the risk of falling decreased by 21.8％.The differences between pre-intervention and post-intervention were significant in both groups ( P ＜ 0.05).No intolerable adverse events occurred in both groups except that one new fracture happened in each group but responded to conservative treatment.ConclusionA once-yearly infusion of zoledronic acid of 5 mg is a convenient and effective therapy for treatment of osteoporosis in postmenopausal women.

Objective To investigate the risk factors of articular cartilage damage secondary to anterior cruciate ligament (ACL) rupture.Methods Clinical data of 490 patients sustaining ACL rupture from July 2008 to July 2014 were collected for a retrospective cohort study.The factors relating to the incidence and degree of the secondary articular carticular damage were analyzed,including gender,age,weight,blood group,places of residence,causes of injury,complication of meniscus tear,damage part and duration of disease.Results Factors associated with the incidence of secondary articular cartilage damage were blood type O (OR =0.605,95％ CI 0.381-0.960,P ＜ 0.05) and complication of meniscus tear(OR =2.241,95％ CI 1.378-3.643,P ＜0.01).Factors associated with the degree of articular cartilage damage were duration of disease (rs =0.168 7,P ＜0.01),damage part (Hc =53.237,P＜0.01),and complication of meniscus tear (x2 =16.944,P＜0.01).Conclusions Meniscus tear is the moderate risk factor for the incidence of secondary articular cartilage damage while blood type O has weak protective effect.Damage part,course of disease,and meniscus tear are factors associated with the degree of secondary articular cartilage damage.

Objective To explore the relationship between plasma interleukin-11(sIL-11) level and platelet count post-chemotherapy with hematological malignancy patients and analyse a sIL-11 level which may maintain a safe platelet count so as to guide the treatment. Methods Blood samples were collected from the patients with hematological malignancy at certain time point of pre-and post-chemotherapy, and serum level of sIL-11 and platelet count were determined separately. Different statistical methods were applied to test the relationship between sIL-11 level and platelet changes. Results 99 cases finished this study. The findings are: the sIL-11 level went up and reached the peak on day 6 post-chemotherapy, while the platelet count kept dropping to the lowest on day 10, the sIL-11 peak occurred before the lowest platelet count, patients with faster sIL-11 increase may maintain a comparatively higher plateled count. 99 eases were grouped according to the lowest platelet count and compared: the group with higher platelet count tend to have higher peak sIL-11, more cases with higher peak sIL-11, with faster daily average sIL-11 increase, the lowest platelet count occurred later. Logistic regression analysis showed the factors contributed to lower platelet includes slower daily average sIL-11 increase and sIL-11 level less than 2000 pg/ml on Day4 post-chemotherapy. Conclusion There were correlation between the serum sIL-11 level and platelet counts, the platelet count change may be predicted by determining the plasma sIL-11 level post-chemotherapy. Patients with sIL-11 level less than 2000 pg/ml on Day4 post-chemotherapy may be endangered with severe thrombocytopenia, rhIL-11 or platelet transfusion treatment should be considered.

Objective To investigate the diagnosis and prognosis evaluation value of neutrophil elastase (NE) in ventilator-associated pneumonia (VAP).Methods A retrospective analysis was conducted.The data of patients undergoing mechanical ventilation admitted to Department of Central Intensive Care Unit (ICU) of Boai Hospital of Zhongshan City Affiliated to Southern Medical University from September 2012 to October 2015 were enrolled.The patients were divided into two groups according to whether they suffered from VAP or not.The content of NE in serum and bronchoalveolar lavage fluid (BALF) at the time of mechanical ventilation start,VAP diagnosis (the worst value from 48 hours after mechanical ventilation start to weaning in non-VAP patients),and at the time before mechanical ventilation weaning,as well as inflammation parameters,clinical pulmonary infection score (CPIS),duration of mechanical ventilation and prognosis were recorded.Receiver operating characteristic curve (ROC) was used to analyze the predictive value of NE on VAP diagnosis and prognosis.Results Finally 38 patients were enrolled in the VAP group,and 40 in non-VAP group,and baseline data was similar between the two groups.There was no significant difference in the content of NE in serum and BALF between VAP group and non-VAP group [serum NE (μg/L):67.04 (63.00,75.75) vs.69.00 (63.75,75.00),BALF NE (μg/L):96.26 (85.26,176.01) vs.95.26 (86.76,107.11),both P ＞ 0.05].From continuous monitoring,no significant change in the content of NE in serum and BALF during mechanical ventilation was found in the non-VAP group,but the content of NE in serum and BALF at the time of VAP diagnosis in VAP group was significantly higher than that at mechanical ventilation start [μg/L:157.00 (153.04,165.75) vs.67.04 (63.00,75.75),178.04 (153.00,188.25) vs.96.26 (85.26,176.01),both P ＜ 0.05],and NE content in serum and BALF was significantly decreased at the time after VAP clinical recovery and before mechanical ventilation weaning [μg/L:75.67 (64.51,110.55) vs.157.00 (153.04,165.79),95.50 (66.56,183.02) vs.178.04 (153.00,188.25),both P ＜ 0.05].The NE in the start time of VAP in VAP group was divided into four groups according to quartile,it was found that with the increase of NE content in serum and BALF,the CPIS was increased,the duration of mechanical ventilation was prolonged,and the prognosis was poor (all P ＜ 0.01).Compared with non-VAP group,white blood cell count (WBC),neutrocyte proportion,C-reactive protein (CRP),and procalcitonin (PCT) in VAP group were significantly increased (all P ＜ 0.01).NE in BALF was significantly positively correlated with WBC,neutrocyte proportion,CRP and PCT (r value was 0.507,0.432,0.779,and 0.519,respectively,all P =0.000),among which the highest correlation was CRP.NE in BALF used for VAP diagnosis has good accuracy,with sensitivity of 87.4％,and specificity of 90.6％,and sensitivity and specificity of NE in serum for VAP diagnosis was 78.6％ and 79.2％ respectively.Conclusion NE can be used as one of the indicators for VAP diagnosis,and it is related to the prognosis of VAP.

Objective To analyse the graft impingement after anterior cruciate ligament (ACL) reconstruction based on three-dimensional graft and tunnel images of dual-source computer tomography (DSCT).Methods From November 2012 to November 2014,a consecutive 134 cases of ACL reconstruction with various techniques had their knees scanned by DSCT.Graft and femoral as well as tibial tunnel images were three-dimensionally reconstructed and carefully inspected if there was any impinging on the graft at knee extension,meanwhile the femoral and tibial tunnel location were measured.Of these 134 cases,a serial of 118 patients had been single-bundle reconstructed with same type of graft material.There were 83 males and 35 females aged from 15 to 64 years old (mean,32 years old).Special attention had been paid to examine if there was any graft impinging,and their origin and finally impingement types were identified and classified according to the position and origin of impingement.Bernard and Lorenz method were used to measure the relative locations of femoral and tibial tunnel respectively.Difference was statistically compared between impingement-free and impingement groups.Results Patients were divided into two groups,impingement-free group and impingement group according to graft impinging based on graft visible 3D-CT imaging postoperatively.Of 118 cases,39 (33％) were impingement-free and 79 (67％) existed various types of impingement.Impingement group was further divided into two subgroups according to different impingement location,outlet impingement of intercondylar notch group (77 cases,account for 65％ of total and 97％ of impingement group,respectively) and mid-way impingement of intercondylar notch group (2 cases,account for 2％ of total and 3％ of impingement group,respectively).The outlet impingement group was more further classified into three subtypes,bird beak impingement,10 cases (13％,10/77),tibial plateau impingement,46 cases (60％,46/77) and clamp impingement,21 cases (27％,21/77).Statistic analysis with NAONA revealed that no significant difference between impingement group and impingement-free group regardless of femoral or tibial tunnel placement.Conclusion Three new types of impingements are found based on visible 3D-CT graft imaging after ACL reconstruction which are mid-way impingement of intercondylar notch,tibial plateau impingement and clamp impingement.

As the most common organ-specific autoimmune disease,autoimmune thyroiditis (AIT) is characterized by intrathyroidal lymphocyte infiltration and specificthyroid autoantibodies.Modern medicine is short of effective etiological treatment at present,and has no specific medicine foreuthyroidism of AIT patients,who have been followed-up passively.Chinese medicine treatmenthas the characteristics of multiple-targets,multiple-links and multiple-pathways,which plays a special superiorityrole in the prevention and treatment of AIT.The purpose of this article was to sort out and set forthmore Chinese medicine pharmacology on AIT recently,which provided evidence for further clinical apply.

Objects:To investigate the current situation of counselors'implementation and their attitude to informed consent in Beijing.Methods:Eleven counselors who worked in Beijing were interviewed,the average of their working years was (7.4 ± 4.4).A semi-structured interview was used to learn about their practicing processes in and viewpoints on informed consent,and their interview transcripts were analyzed through qualitative method.Results:The results could be categorized into four categories,including the content of informed consent,the influential factors of informed consent,problems and confusions,and the significance of informed consent.The crucial role of informed consent in psychotherapy was generally recognized by counselors,and they could obey the related rules as well.The therapists had some confusion and problems about informed consent,such as the form and length,the consent for special population and online consultation.Conclusion:Basically,the counselors in Beijing could comply with the ethical standards of informed consent.However,they also suggest that certain limitations of these rules should be noticed.

Objective: To understand the epidemiological characteristics of influenza A(H1N1)pdm09 virus in Sichuan population during the monitoring period of 2018-2019, and to clarify the antigenic variation, the gene characteristics and the matching of current epidemic strains, vaccine strains, representative strains at home and abroad. Methods: A total of 118 strains of influenza A(H1N1)pdm09 virus isolated in Sichuan region influenza network laboratory from April 2018 to March 2019 were selected. The hemagglutination inhibition (HI) assay was conducted for antigen analysis. The HA and NA genes of 16 strains with low-response strains were sequenced. Phylogenetic analysis and amino acid locus variation analysis were applied using BioEdit and MEGA5.0 software. Results: The result of the antigen analysis demonstrated that more than 95% of the A(H1N1) pdm09 influenza viruses detected were similar to the WHO recommended vaccine strain A/Michigan/45/2015. The analysis of HA gene characteristics showed that some low-response strains had amino acid site variation in the Sa, Sb and Cb regions of the HA protein. A total of 15 low-response strains belonged to the 6B.1 branch. And their evolutionary relationship were close to the representative strains A/beijin-xicheng/SWL1633/2018 and A/brisbane/02/2018, which were popular at home and abroad. Compared with A/sichuan/1/2009, there are mutations involving 6, 14 and 1 amino acid sites in the antigen-determining regions (Sa, Sb, Ca and Cb), non-determined regions and receptor binding site(RBS) respectively. No amino acid site mutations related to resistance to NA gene were found. Conclusions In 2018-2019, the epidemic A(H1N1) pdm09 influenza virus in Sichuan is consistent with the global epidemic characteristics, which also matched with vaccine strains recommended by WHO in the northern hemisphere. Compared with A/sichuan/1/2009 which was the first isolated in China in 2009, there were amino acid sites mutations in antigen-determining region and receptor binding site of the HA protein, and the transmembrane region of the NA protein, drug and antibody binding sites.