Objective To compare the 96-week efficacy of de novo combination therapy with lamivudine ( LAM ) and adefovir dipivoxil (ADV) to that of optimization monotherapy for chronic hepatitis B (CHB).Methods A total of 155 CHB patients were collected from the First Affiliated Hospital of Anhui Medical University during 2007 and 2009.All patients were randomly assigned to LAM monotherapy group ( n =53 ),ADV monotherapy group ( n =50 ) or LAM with ADV combination group ( n =52 ) according to randomized digital table.The liver and kidney functions,HBV serum markers,and HBV DNA loads were tested every 24 weeks.If patients in LAM or ADV group had poor response or virological breakthrough,they were given optimized therapy with ADV or LAM at week 24,48 or 72.One-way ANOVA (normal distribution and homoscedasticity ) and non-parametric test (non-normal distribution ) were performed to compare measurement data among groups.The impact factors of early virological response were analyzed by binary Logistic regression method.Results At week 24,the complete virological responses in LAM group,ADV group,and LAM + ADV group were 66.0％ ( 35/53 ),34.0％ ( 17/50 ) and 90.4％ ( 47/52 ),respectively (x2 =35.282,P ＜ 0.01 ) ; while,at week 96 the complete virological responses in three groups were96.2％ (51/53),86.0％ (43/50) and 100.0％ (52/52),respectively (x2 =19.115,P＞0.05).At week 96,the cumulative recover rates of ALT in LAM group,ADV group,and LAM + ADV group were 86.8％ (46/53),82.0％ (41/50)and 94.2％ (49/52),respectively (x2 =3.613,P ＞0.05);however,the ALT levels in three groups were statistically different (x2 =11.195,P ＜ 0.01 ).At week 96,the HBeAg seroconversion rates in LAM group,ADV group,and LAM + ADV group were 31.3％ ( 10/32),20.7％ ( 6/29 ) and 38.7％ ( 12/31 ),respectively (x2 =2.313,P ＞ 0.05 ).Early virological response was not found in I patient in LAM group and 19 patients in ADV group; virological breakthrough occurred in 11 patients in LAM group and 1 patient in ADV group.All patients in LAM + ADV group had early virological responses and had no virological breakthrough.Logistic regression showed that complete virological response at week 24 was correlated with the baseline HBeAg,the initial treatment and HBV DNA load.Layered evaluation showed that there were significant differences in early complete virological responses among three groups for patients with positive HBeAg,HBV DNA ＞ 6.28 × 106 copies/mL and ALT ≤5 ×ULN (x2 =7.726,10.921 and6.100,P＜0.05 or ＜0.01) ; for those with HBV DNA ＞6.28 × 106copies/mL,complete virological response was not observed in ADV group treated for 24 weeks.Conclusion LAM combined with ADV has stronger antiviral activity,lower resistance rate and can improve liver function and virological response,especially for the patients with HBeAg-positive,high HBV DNA loads and ALT ≤5 × ULN.

Adenoma ; pathology ; Carcinoma ; pathology ; Carcinoma in Situ ; pathology ; Gastric Mucosa ; pathology ; Humans ; Neoplasm Invasiveness ; Precancerous Conditions ; pathology ; Stomach Neoplasms ; classification ; pathology

Objective To investigate the mastery of clinical students' doctor-patient communi-cation skills and to assess the teaching effectiveness about the doctor-patient communication, and then propose some improvement ideas. Methods We conducted a study in students of clinical medicine of Nanjing Medical University in Grade 2009, using Objective Structured Clinical Examination (OSCE) after internship, which included graduation assessment of doctor-patient communication skills. Then we analyzed the doctor-patient communication skills and related scores of students trained in different clinical medical programs. Results The average score of doctor-patient communication skills of 549 students was (82.72±4.23), of which, the average score of 329 five-year students of clinical medicine was (81.88±4.23) and the average score of seven-year students was (83.96±3.91) in. The average score of seven-year students of clinical medicine was significantly higher than five-year students (P=0.000). Moreover, there was a significant positive correlation between the total score of OSCE and the score of doctor-patient communication skills in both five-year and seven-year students of clinical medicine (five year program students' score correlation coefficient was 0.520, P=0.000;seven year pro-gram students' score correlation coefficient 0.416, P=0.000). Conclusion The teaching effectiveness of doctor-patient communication has proved to be quite effective, and it is definitely of great significance in improving clinical students' doctor-patient communication skills. The score of the assessment of the doctor-patient communication reflects not only the training effectiveness of the communication skills, but also the comprehensive capacity.

Objective To investigate the relative risk factors of glucose metabolism disorder in newborn infants.Methods Clinical information of 791 newborns suffered from glucose metabolism disorders who had been hospitalized in NICU from Jan.2004 to May 2007 were analyzed retrospectively.Four hundred and thirty-nine cases presented with hypoglycemia,275 cases presented with hyperglycemia,and 77 cases presented with both hypoglycemia and hyperglycemia.Data of risk factors were processed with both ?2 test and multiple Logistic regression analysis.Results The statistic analysis showed that low birth weight[258 cases(58.77%)],asphyxia[217 cases(49.43%)],acidosis[146 cases(33.26%)],hypothermia[128 cases(29.16%)],maternal gestational hypertension[83 cases(18.91%)],pneumonia[63 cases(14.35%)],anomaly of placenta[35 cases(7.97%)],maternal diabetes[17 cases(3.87%)] and septicaemia[10 cases(2.28%)]were significant hypoglycemia risk factors(according to the level of morbidity).Pneumonia[98 cases(35.64%)],asphyxia[129 cases(27.23%)],hypoxemia[61 cases(22.18%)]and septicaemia[24 cases(8.73%)]were significant hyperglycemia risk factors.Acidosis[33 cases(42.86%)],pneumonia[27 cases(35.06%)]and maternal diabetes[6 cases(7.79%)] were significant risk factors for neonates with both hypoglycemia and hyperglycemia.Conclusion Dynamic monitoring of blood glucose concentration and reasonable adjustment is recommended for neonates with risk factors to lower morbility and mortality.

Objective To investigate the role of mitochondrial permeability transition pore (mPTP) in attenuation of myocardial ischemia-reperfusion (I/R) injury by delayed preconditioning with sevoflurane in rats.Methods Eighty male SD rats, weighing 250-300 g, were randomly assigned into 5 groups ( n = 16 each): Ⅰsham operation group (group S), Ⅱ group I/R, Ⅲ sevoflurane delayed preconditioning group (group SP), Ⅳ the mPTP opener atractyloside + sevoflurane delayed preconditioning group (group A + SP), and Ⅴ atractyloside group (group A). Myocardial I/R was induced by ligation of anterior descending branch of left coronary artery for 30 min followed by 120 min of reperfusion in group I/R, SP, A + SP and A. In group SP and A + SP, 2.5%sevoflurane was inhaled for 1 h, while pure oxygen was inhaled for 1 h in the other groups, and then myocardial ischemia was performed 24 h later. In group A + SP and A, atractyloside 5 mg/kg was injected intravenously via caudal vein 15 min before ischemia. Blood samples were taken from carotid arteries for detection of serum cardiac troponin-Ⅰ (cTnI) concentrations at the end of reperfusion. Then the rats were sacrificed and hearts removed. The myocardial infarct size (IS) and expression of Bcl-2 and Bax in the myocardium were determined. Myocardial ultrastructure was examined with the electron microscope. Results Serum cTnI concentrations and Bax expression were significantly higher, the myocardial IS was significantly larger and Bcl-2 expression was significantly lower in the other groups than in group S ( P ＜ 0.05). Serum cTnI concentrations and Bax expression were significantly lower, the myocardial IS was significantly smaller and Bcl-2 expression was significantly higher in group SP than in group I/R ( P ＜ 0.05). Microscopic examination showed less damage in group SP than in group I/R. The protection provided by sevoflurane preconditioning was abolished by atractyloside. Conclusion Inhibition of mPTP opening can result in an up-regulation of Bcl-2 expression and down-regulation of Bax expression, which plays a role in attenuation of myocardial I/R injury by delayed preconditioning with sevoflurane in rats.

Objective:Based on relevant database data analysis,to explore the correlation of the abnormal expression of EMT related factors and chronic obstructive pulmonary disease and its related non-small cell lung cancer.Methods: Based on some data sets of GEO in the NCBI database,to perform express analysis,survival analysis and correlation analysis.Results: ①Snai1 and other EMT related regulatory factors exist significantly higher expression in non-small cell lung cancer patients,and E-cadherin (CDH1) was showed significantly lower expression. ②A large number of COPD patients samples were analyzed,and some EMT-related molecules in patients with COPD also showed significant abnormal expression and consistented with the changes in patients with non-small cell lung cancer.Conclusion: The results showed that dysregulation expression of EMT related regulatory factors may have some correlation with disease progression of COPD patients through the EMT markers and their expression and correlation analysis in COPD patients.

Objective: To explore the effect of suberoylanilide hydroxamic acid (SAHA) improving cardiac hypertrophy via inhibiting histone deacetylases (HDAC) in experimental mice and to provide a new idea for prevention and treatment of cardiac hypertrophy. Methods: Cardiac hypertrophy mice model was established by thoracic aorta ligation. A total of 60 Kunming mice were randomly divided into 4 groups: Normal control group, Sham operation group, Cardiac hypertrophy (CH) group and CH+SAHA group. There were 6 mice used in each group. Myocardial cell morphology was observed by HE staining, cardiac function was assessed by echocardiography, mRNA and protein expressions of HDAC5 (the isoform of HDAC) and β-MHC were examined by RT-PCR and Western blot analysis. Results: The mice in CH group had myocardial cell hypertrophy, disordered arrangement and hyperchromatic nucleus. Compared with Sham operation group, CH group showed decreased left ventricular end diastolic diameter (LVEDD), left ventricular end diastolic volume (LVEDV) and increased thickness of inter-ventricular septum (IVS), allP<0.05; CH group presented elevated mRNA and protein expressions of HDAC5 and β-MHC,P<0.05. SAHA obviously decreased HDAC5 expression, down regulated cardiac hypertrophy related β-MHC gene expression, improved cardiac function and hypertrophy, all P<0.05. Conclusion: HDAC were involved in myocardial hypertrophy; SAHA could inhibit HDAC expression and therefore,improved myocardial hypertrophy in experimental mice.