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.

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.

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 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.

ObjectiveTo explore the relationship between the changes of neuro-electrophysiology and prognosis in children with Guillain-Barr? syndrome(GBS).MethodsThirty-eight children with GBS were divided into group A(rapid recovery,n=16) and group B(slow recovery,n=22) according to the time required for podosoma motor function recovery,at the same time,they were divided into the better prognosis group(n=22) and the worse prognosis group(n=16),for analyzing the difference between group A and B in terms of age,preceding infections,maximal Hughes grades and neuro-electrophysiology including motor conduction velocity(MCV),distal complex muscle action potential(dCMAP) and F wave,and investigating the related factors with the prognosis of GBS.Results1.MCV of tibial nerve was(40.2?2.53) m/s and(33.4?2.46) m/s in group A and group B,respectively;MCV of peroneal nerve was(45.2?3.23) m/s and(38.3?2.16) m/s in group A and group B,respectively,and the difference between group A and group B was significant(Pa0.05);abnormal rate of F wave(68.42%) was higher than abnormal rate of MCV(42.11%) and dCMAP(42.11%)(Pa

Objective To enhance patients' abilities in self-management. Methods We used the nursing project method to analyze reasons and develop standard process of follow-up management and health education. A retro-spective analysis of 84 patients with stage 3 to 4 CKD was performed by nursing project method. This analysis compared the changes after the intervention program,including the ability of self-management,follow-up,medication and diet compliance,and the control rate of physiological indicators. Results By comparison with the intervention before and after,there were significant improvements in each dimension of self-management ability (P<0.001),follow-up, medication and diet compliance were significantly improved(P<0.05),and there were significant improvements in the control rate of systolic pressure and blood uric acid(P<0.001),the differences were statistically significant. Conclusion The application of nursing project can improve self-management ability,the compliance of follow-up,medication and diet as well as physiological indicators in patients with stage 3 to 4 CKD.

Objective To investigate the clinical significance and correlation between RAR-βgene methylation and p53 gene mutation in bronchoalveolar lavage fluid(BALF)in non-small-cell lung cancer.Methods BALF samples from 85 lung cancer pa-tients(lung cancer group)and 70 cases(benign lung diseases group)with benign lung diseases were collected.RAR-βgene methyla-tion in BALF samples was detected by methylation-specific PCR (MSP),and p53 gene mutation was detected by PCR and DNA se-quencing method.Results The rate of RAR-βmethylation and p53 mutation in BALF in lung cancer were 49.4% and 36.5%,re-spectively.Both were higher than in benign lung diseases group(P <0.01).RAR-βmethylation rate(32.5%)of patients with TNM stages(Ⅰ+Ⅱ)(32.5%)was higher than the p53 mutation rate(12.5%)over the same stages (P <0.05).RAR-βmethylation rate and p53 mutation rate of patients with stages(Ⅲ+Ⅳ)were higher than those with stages(Ⅰ+Ⅱ)(P <0.01).p53 mutation rate in lung cancer patients with RAR-βmethylation was higher than those with unmethylated(P <0.01).RAR-βmethylation rate of lung cancer patients with p53 mutation was higher than those without p53 mutation(P <0.01).Conclusion Detection of RAR-βmethyl-ation and p53 mutation in BALF contribute to the diagnosis of lung cancer.