1.0 ?10 7 copies/ml than those with lower HBV DNA levels both in combination group and lamivudine group (52.0% vs 25.8%, P= 0.04; 63.2% vs 28.6%, P= 0.03). Necro-inflammatory activity, fibrosis and the expression of HBV DNA showed no correlation with response rate in combination group. Among those who had higher levels of HBV DNA expression, seroconversion rate in combination group is higher than that in lamivudine group (46.2% vs 9.5%, P= 0.03). Conclusions The efficacy of combination therapy appeared to be better in patients with at least moderately elevated baseline ALT, high level of HBV DNA as well as HBV DNA expression in hepatocytes. Combination therapy may delay or diminish the development of YMDD mutation-related resistance to lamivudine.

Objective To discuss the influence of nursing intervention on psychological state and glu-cose control of patients with diabetes mellitns before and after intensive treatment of insulin pump. Methods 120 patients who were going to receive intensive treatment of insulin pump were divided into the control group and the observation group with 60 patients in each group by simple random method.The two groups both re-ceivecl routine nursing. The observation group was given psychological intervention along with health education by application of progressive dominant content education method. The psychological state and glucose control of the two groups were compared by χ2 test and t test. Results The score of health knowledge and satisfaction degree with health education in the observation group were higher than those of the control group.The score of anxiety and depression in the observation group decreased more significantly and satisfaction rate of glucose control was higher than that of the control group after 14 days of insulin pump treatment. Conclusions Health education to patients with intensive treatment of insulin pump by application of progressive dominant content education method can make patients to master health knowledge easily.Psychological intervention can alleviate the negative emotion of these patients and facilitate better effect of insulin pump treatment.

After several thousand years of development,TCM has formed its own sets of research methods.such as observation,comparison,classification,trial and error,and deduction,etc.Based on the unique TCM theory,experiences of clinical diagnosis and treatment of TCM,the author put forward that the research of TCM should combine macrophenomenon and microphenomenon,quality and quantity,and"Zheng"and"Xie",emphasize locality feature for the purpose of promoting the science research level.

Objective To analyze the impacts of early enteral nutrition (EN) and parenteral nutrition (PN) on the prognosis of acute pancreatitis.Method By searching relevant literature between January 1996 and August 2013 in Chinese and English databases including Wanfang,VIP,CNKI,PubMed,the Cochrane Library,CBM,and EMABSE,we compared the prognosis of acute pancreatitis after EN or PN in terms of casefatality rate,infections,multiple organ failure,and other complications.Result Compared with PN,early EN significantly reduced the case-fatality rate [OR =0.37,95％ CI (0.23,0.58),P ＜ 0.000 1],decreased the infection rate [OR =0.24,95％ CI (0.15,0.39),P ＜0.000 01],shortened hospital stay [MD =-9.87,95％ CI (-10.84,-8.89),P ＜ 0.000 01],and reduced complications [OR =0.26,95％ CI (0.12,0.58),P =0.001 0] in patients with acute pancreatitis,although the incident of multi-organ failure showed no significant difference [OR =0.35,95％ CI (0.10,1.19),P =0.09].Conclusions For patients with acute pancreatitis,early EN is superior than PN in terms of case-fatality rate,infection rate,hospital stay,and complications.Therefore,it should be applied in such patients whenever condition allows.

Adult ; Female ; Hemofiltration ; Humans ; Hydrocarbons, Chlorinated ; poisoning ; Male ; Middle Aged ; Poisoning ; therapy ; Treatment Outcome

Objective To investigate the clinical features and pathogenesis of severe congenital neutropenia (SCN) by detecting the gene mutation of a SCN patient suspected by clinical diagnosis. Methods The intravenous anticoagulant and clin-ical data and laboratory results of this child were collected;the phagocyte and oxidation function of neutrophils were evaluated by flow cytometry;ELANE, HAX1, WAS, GFI1, CSF3R and CXCR4 genes were screened by PCR amplification and sequencing. Results The neutrophil function of this patient was normal; sequencing results revealed no mutation occurred in ELANE, HAX1, WAS, GFI1, CSF3R and CXCR4;and granulocyte colony-stimulating factor (G-CSF) can obviously enhance the level of neutrophils. Conclusion SCN is a kind of genetic heterogeneity syndrome associated with multiple gene mutations, gene diag-nosis will contribute to understanding of the pathogenesis of the disease and provide theoretical basis for treatment. Though more and more pathogenic genes were found to be connected with SCN, the cases of unknown mutation still account for a large proportion of this disease.

Objectives To understand the social support levels among breast cancer patients in Yunnan, as well as to explore the factors associated with social support. Methods According to the unified inclusion and exclusion criteria,121 breast cancer in-patients with chemotherapy were interviewed with structured questionnaire. Social demographic characteristics, Xiao's Social Support Rating Scale,General Self-Efficacy Scale,clinical and experimental data were collected. SPSS version19.0 was used to analyze the frequency and the correlation between social support and influential variables were analyzed by using the chi-square test and non-parametric test. Results The levels of social support in total, objective social support, subjective social support and utilization degree for breast cancer patients were (49.43 ±5.69), (13.35 ±2.51), (27.59 ±3.78), (8.50 ±1.98) respectively. Marriage status and self-efficacy were associated with social support level significantly. The influencing factors such as age, education level, marital status, occupation, income, place of residence, religion, medical expenses payment type, self-efficacy were included in the univariate analysis. However, only marital status and self efficacy were positively correlated with social support (p<0.05) . Conclusions The breast cancer patients in Yunnan have a higher social support level overall. Having-marriage status and higher self-efficacy have a positive influence on breast cancer in patients' social support level.

Teaching model plays an important role in clinical education. Problem based learning (PBL) model, with an outstanding feature of stimulating the learning enthusiasm of students, was applied by many American colleges. American College of Acupuncture&Oriental Medicine (ACAOM) combined PBL teaching model with traditional lecture based learning (LBL) model, which had achieved good results. In this article, PBL model and its characters were explored via qualitative case analysis, to provide reference for universities and colleges of traditional Chinese medicine on clinical education.

Objective To study the role of src-suppressed C kinase substrate (SSeCKS) in the secretion of tumor necrosis factor (TNF-α) in rat pulmonary micro-vascular endothelial cells (PMVEC) induced by lipopolysaccharide (LPS).Methods Wistar rat PMVEC cultured in vitro were randomly (random number) divided into several groups (n =4) as per exposure to given dosage of LPS for different lengths of time and to different dosages of LPS for given length of time.After PMVEC exposed to 10 mg/L LPS for 1 hour (h),3 h,6 h,12 h and 24 h or 0.1 mg/L,1 mg/L and 10 mg/L LPS for 24 h,the levels of TNF-αin the supernatant of culture medium were examined by the method of enzyme linked immunosorbent assay (ELISA).Another PMVEC was pre-treated by protein kinase C (PKC) inhibitor bis-indolylmaleimide (BIM) for 0.5 h or had the transfection of SSeCKS-specific small interfering RNA (siRNA) for 48 h before 10 mg/L LPS challenge for 24 h,and subsequently the supernatant was also examined by ELISA.One-way analysis of variance (ANOVA) was employed for statistical analysis by SPSS version 10.0 to compare values among all groups.A significant difference was presumed as a probability value ＜ 0.05.Results After PMVEC incubated with 0.1 mg/L,1 mg/L and 10 mg/L LPS for 24 hours,the levels of TNF-αsecreted were (253.70 ± 23.55),(327.88 ± 37.25),(403.20 ± 36.22),respectively,which were higher than that in un-stimulated PMVEC (82.28 ± 22.56,all P =0.000).After 10 mg/L LPS challenge for one hour,the level of TNF-αin the supernatant of PMVEC raised substantially (170.11 ±49.22),peaked at the time of 6 h (404.82 ± 13.78),then persisted at a higher level until 24 h (395.67 ± 36.23) than that in un-stimulated PMVEC (84.60 ± 23.61,P =0.001,0.000,0.000,respectively).After PMVEC pre-incubated with BIM,the level of LPS-induced TNF-αdecreased obviously (200.44 ± 27.39 vs.402.28 ± 31.07,P =0.000).Compared with LPS challenged PMVEC (407.28 ± 32.64),depletion of endogenous SSeCKS in PMVEC after inhibited by SSeCKS-siRNA significantly attenuated increase in the level of LPS-induced TNF-α (195.20 ± 13.28,P =0.000).Conclusions Down-activation of SSeCKS and PKC can inhibit the secretion of TNF-αin PMVEC induced by LPS,relieving the inflammatory response of PMVEC.

A total of 1342 individuals underwent physical examinations according to the criteria of metabolic syndrome of International Diabetes Federation (IDF) in 2005.And 314 patients with metabolic disorders were screened for diabetes by standard meal and methods oral glucose tolerance test (OGTT).Newly diagnosed diabetics was 12 (4.1％ ) vs.17 (5.8％) respectively.No significant difference existed between two methods (P =0.332).Kendall's (τ)b =0.313,Kendall's (τ)c =0.208 and Gamma coefficient =0.580 (P =0.000).The mixed meal method was correlated with OGTT,Kappa =0.258 (P =0.000) and two methods were consistent.Diabetic screening should be stressed in the subjects with metabolic abnormalities.And the detecting efficiency of postprandial plasma glucose is similar to OGTT.