OBJECTIVE:To observe therapeutic efficacy and safety of telbivudine combined with adefovir dipivoxil in long-term treatment of active hepatitis B cirrhosis. METHODS:76 patients with active hepatitis B cirrhosis in our hospital were ran-domly divided into observation group and control group,with 38 cases in each group. Control group was treated with adefovir dip-ivoxil 10 mg,qd;observation group was additionally treated with telbivudine 600 mg,qd,on the basis of control group. Both groups received 2-year consecutive treatment. TBIL,ALB,ALT,AST,rate of HBV-DNA negative conversion and serum virologi-cal index were compared between 2 groups after treatment,and clinical efficacy and ADR were also compared between 2 groups. RESULTS:After treatment,the levels of AST,ALB,ALT and TBIL in observation group were significantly better than the control group,with statistical significance(P<0.05);the rate of HBV-DNA negative conversion,the decreased of serum virus in observa-tion group were significantly higher than control group after 1 and 2 years treatment,with statistical significance(P<0.05). The to-tal effective rate of observation group was significantly higher than that of control group,with statistically significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Telbivudine combined with adefovir dipivoxil can significantly improve the liver function of patients with hepatitis B cirrhosis and have good long-term therapeutic efficacy with high safety.

Objective: To investigate the characteristics and pathogenic characteristics of acquired immunodeficiency syndrome (AIDS) complicated with severe pneumonia. Methods: The clinical data of patients with AIDS complicated with severe pneumonia who were hospitalized and treated in the First People′s Hospital of Linhai City from January 2016 to January 2018 were collected. The laboratory test results, imaging findings, distribution of pathogens, mixed infections of pathogens, treatment and outcomes were statistically analyzed. The influencing factors of the prognosis were tested by Fisher′s exact test, and Logsitic regression analysis was used for multivariate analysis. Results: Among the 42 patients, the majority were male patients(90.48%), and most of them were 21 to 50 years old(78.57%), and the onset involved multiple systems. The CD4⁺ T lymphocyte count was less than 200/mm² (100.0%) in the 42 patients, including 69.05% less than 50/mm² and 73.81% of patients had albumin levels lower than 25 g/L. Chest CT showed multiple or diffuse distribution of increased density and ground glass opacity. Various strains of microorganisms were successfully isolated from 29 cases (69.05%), a total of 76 strains. The top three of pathogen spectrum were fungi (60.53%, 46/76), Gram negative bacteria (15.79%, 12/76) and Gram positive bacteria (10.53%, 8/76); 92.86% of the patients were infected with 2 or more kinds of pathogenic bacteria. In the 42 patients, 17 cases (40.48%) survived and 25 cases (59.52%) died. Univariate analysis showed that CD4⁺ T lymphocyte count<50 /mm^2, the albumin level<25 g/L and mechanical ventilation were related to the prognosis of the disease. Multivariate Logstic regression analysis showed that the albumin level <25 g/L and mechanical ventilation were independent risk factors affecting the prognosis of the disease. Conclusions Fungal infection is the most common infection in patients with AIDS complicated with severe pneumonia, and 92.86% of them are accompanied by mixed infections. Low albumin level and mechanical ventilation are important risk factors influencing the prognosis.

Objective: To evaluate the risk factors of postoperative upgrade to pT₃a of cT₁ renal cell carcinoma, and to establish a nomogram prediction model to improve the ability of predicting locally advanced renal cell carcinoma and provide a reference for clinical surgical decision-making. Methods: Clinical data of 1 376 patients with cT₁ (diameter ≤ 7 cm) renal tumor hospitalized for surgery from January 2010 to December 2016 were retrospectively analyzed. There were 979 males and 397 females, with the mean age of (57.65±10.92) years. The mean body mass index (BMI) was (25.47±3.27) kg/m² and the average tumor size was (4.02±1.52) cm. There were 711 tumors on the left and 665 on the right. There were 363 cases with clinical symptoms, 567 patients with smoking history , 732 cases with history of chronic disease. There were 289 cases with tumor necrosis, 636 cases with tumor protrusion, 822 cases with irregular tumor , and 738 cases with renal sinus compression. Partial nephrectomy and radical nephrectomy were performed in 396 cases and 980 cases respectively. Mann-whitney U test and chi-square test were used for univariate analysis, logistic regression analysis was used for multivariate analysis to analyze the predictors of upgrading, R software was used to construct the nomogram predictive model, C-index was used to evaluate the model discrimination, and calibration curve method was used to evaluate the consistency of the model. Results: Postoperative pathology of total 1 376 cases showed that there were 1 195 cases of clear cell carcinoma of kidney, 48 cases of papillary cell carcinoma, 57 cases of chromophobe cell carcinoma, and 76 cases of other types. Among the 1 376 patients with cT₁ renal tumor, 75 patients were upgraded to pT_3a, accounting for 5.5% of all patients. Univariate analysis showed that the patients who upgraded to pT_3a were older [(63.08±10.17) years old and (57.34±10.88) years old], and the tumor length and diameter were larger [(5.24±1.35) cm and (3.95±1.51) cm]. Patients with clinical symptoms [46.7% (35/75) vs. 25.2%(328/1 301)], patients with CT indication of tumor necrosis [40.0%(30/25 975) vs. 19.9% (259/1 301)], patients with irregular tumor contour [73.3%(55/76 775) vs. 59.0%(767/1 301)], and patients with radical nephrectomy were higher [(92.1% (70/91 075) vs. 70%(910/1 301)]. All the differences were statistically significant (P<0.01). Multivariate analysis showed that the independent predictors of upgrading were age (OR=1.046, P<0.001), larger tumor (OR=1.504, P<0.001), clinically symptom (OR=2.153, P=0.004), irregular tumor profile (OR=2.466, P=0.002), and tumor necrosis on CT (OR=2.588, P<0.001). The C-index was 0.808, the calibration curve of forecasting curve with the standard curve fit was good, and the prediction of renal cancer are better in predict consistency. Conclusions Based on the five preoperative predictors, including age, tumor size, clinical presence or absence of symptoms, tumor profile, and whether or not the tumor necrosis indicated by CT, this study developed a nomogram of cT₁ renal cancer upgrade to pT_3a. This nomogram has a good statistical significance, and this model can provide prognosis consultation for patients and provide reference for doctors to make decisions before treatment.

Primary ureteral plasmacytoid carcinomas is a rare tumor with high grade and poor diagnosis. Pathological and immunohistochemical staining play an extremely key role in diagnosis since there is no specific clinical and radiological evidence. The surgical removement is the first line treatment. Herein, we report a case of ureteral plasmacytoid carcinoma that was well controlled with multimodal therapy.