Chronic hepatitis B (CHB) is still a global public health problem, resulting in the high risk of decompensated cirrhosis and hepatocellular carcinoma.At present, there are no single available medications that can induce both potent HBV DNA suppression, and high rates of HBeAg and HBsAg clearance.Therefore, there is great interest in developing combination therapies for patients with chronic HBV infection, which can achieve sustained viral suppression and HBsAg negative inversion after a finite course of treatment leading to clinical cure.This article reviews the current status and advances of combination therapy for CHB.

The electroencephalography (EEG) has a wide range of content, complex graphics and abstract theory. Meanwhile, there are differences in professional level, learning ability and subjective initia-tive among refresher doctors. In order to improve the quality of teaching, and to better serve the refresher doctors, the following strategies have been applied in the teaching process. We not only make the training target according to the actual condition of every refresher doctors, but also make them take a correct atti-tude towards study and follow the teaching arrangement. Besides, we not only orient at the operational skills training, including electrode installation, EEG evoked test, Point-of-Care test to eliminate the interference, but also promote the refresher doctors to seek the law of the diagram in the actual interpretation process with longitudinal development view and horizontal comparison perspective. Furthermore, we not only stan-dardize their report, but also broaden their view.

Objective To analyze the therapeutic effect of intracoronary versus intravenous bolus tirofiban on myocardial perfusion and major cardiovascular events (MACE) in elderly patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and explore the optimal route of tirofiban application. Methods From July 2009 to July 2010, 120 NSTE-ACS patients undergoing percutaneous coronary intervention (PCI ) were consecutively enrolled in this study. They were randomly divided into two groups: intracoronary (60 cases) versus intravenous (60 cases) bolus tirofiban. Thrombolysis in myocardial infarction (TIMI) flow, TIMI myocardial perfusion grade (TMPG) and MACE 30 days after PCI were observed. Results The incidence of TIMI flow and TMPG 3 grade in intracoronary group were higher than in intravenous group [53(88.3%) vs. 38(63.3%); 53(88.3%) vs. 40(66.7%), respectively, both P＜0.05]. However, MACE incidence and bleeding complications during hospital 30 days after PCI had no significant difference between the two groups [1 (1.7%) vs. 0; 3(5.0%) vs. 5(8.3%)], which were not statistically significant (P＞0.05). Conclusions Intracoronary bolus tirofiban before PCI more effectively increases coronary blood flow and myocardium blush than intravenous route in elderly NSTE-ACS patients.

Objective To evaluate the clinical efficacy of interferon(IFN) α-2b,adefovir dipivoxil (ADV),granulocyte-macrophage colony stimulating factor (GM-CSF) and hepatitis B vaccine in the treatment of patients with HBeAg-positive chronic hepatitis B (CHB).Methods Two hundredand forty HBeAg-positive CHB patients admitted in the First Affiliated Hospital,Zhejiang University School of Medicine during November 2013 and December 2015 were retrospectively reviewed.They were randomly assigned to four groups with 60 cases in each group,to receive IFNα-2b (group A),IFNα-2b + ADV (group B),IFNα-2b + ADV + GM-CSF (group C) or IFNoα-2b + ADV + GM-CSF + hepatitis B vaccine (group D) for treatment,respectively.All patients were treated for 48 wks and then followed up for 24 wks.The HBsAg serological response,HBeAg serological response,virological response,biochemical response,histological response and adverse effects were compared among 4 groups.Results After 48-wk treatment,the HBsAg negative conversion rate of group D was significantly higher than that of group A and B (x2 =8.634 and 8.634,both P ＜ 0.01);the seroconversion rate of HBsAg in group D was significantly higher than that in group A and group B (x2 =7.149 and 7.149,both P ＜0.01).The baseline drop rate of HBsAg in group C and D was higher than that in group A (t =4.194 and 4.508,both P ＜0.01).In 24-wk follow-up,HBsAg negative conversion rate was as same as that after 48-wk treatment;the seroconversion rate of HBsAg in group D was significantly higher than that in group A and B (x2 =8.634 and 8.634,both P ＜0.01).The baseline drop rate of HBsAg in group C and group D was higher than that in group A (t =4.546 and 4.969,both P ＜0.01).After 48-wk treatment,the HBeAg negative conversion rate in group D was significantly higher than that in group A (x2 =8.792,P ＜ 0.01);the HBeAg seroconversion rate of group C and D was higher than that of group A (x2 =7.064 and 10.159,P ＜0.01).In 24-wk follow-up,the HBeAg negative conversion rate in group C and D was higher than that in group A (x2 =10.159 and 13.713,P ＜0.01);the HBeAg negative conversion rate in group D was higher than that in group B (x2 =8.155,P ＜0.01);the seroconversion rate of HBeAg in group C and D was higher than that in group A (x2 =10.506 and 12.857,P ＜ 0.01).After 48-wk treatment,the negative rate of HBV DNA in group B,C and D was significantly higher than that in group A (x2 =12.452,17.062 and 20.670,all P ＜0.01).In the 24-wk follow-up,the negative rate of HBV DNA in group B,C and D was also significantly higher than that in group A (x2 =21.121,26.880 and 33.611,all P ＜ 0.01).After 48-wk treatment,the alanine aminotransferase (ALT) normalization rate of the group of C and D was significantly higher than that in group A (x2 =8.711 and 8.711,both P ＜0.01).In the 24-wk follow-up,the ALT normalization rate in group C and D was significantly higher than that in group A (x2 =8.076 and 9.624,P ＜0.01).After 48-wk treatment,the improvement rate of inflammation or fibrosis in the group of A,B and C was significantly higher than that in the group A (x2 =8.543,13.348 and 16.205,all P ＜ 0.01).There were no half-way withdrawal and no serious adverse reactions.The main adverse reactions were fever,headache and fatigue,and no significant difference of above reaction was observed among 4 groups (P ＞ 0.05).Conclusion The new anti-virus/immunoregulation therapy containing IFNα-2b + ADV + GM-CSF + hepatitis B vaccine has a better therapeutic effect for patients with HBeAg-positive CHB.

Objective:To investigate the changes of liver pathology and its influencing factors in patients with chronic hepatitis B viral (HBV) infection and low level of serum alanine aminotransferase (ALT).Methods:The clinical data of 135 with chronic HBV infection patients, in whom the serum ALT levels were less than two times of the upper limit of normal (ULN), were collected from the Affiliated Hospital of Medical School of Ningbo University and the First Affiliated Hospital, Zhejiang University School of Medicine during July 2017 and July 2019. The result of hepatic histological examination was reviewed, and the risk factors of obvious liver inflammation (G≥2) or fibrosis (S≥2) in patients were analyzed with Logistic regression analysis.Results:The pathological examination of liver tissue revealed G≥2 or S≥2 in 52 cases (38.5%). The univariate analysis showed that age, family history of HBV infection, ALT 1-<2×ULN, aspartate aminotransferase(AST)≥1×ULN, low platelet count(PLT)and prolongation of prothrombin time(PT)were associated with G≥2 or S≥2 in chronic HBV infection patients with low level ALT ( P<0.05 or <0.01). Multivariate Logistic regression analysis showed that age( OR=1.052, 95% CI 1.007-1.100), family history of HBV infection( OR=5.448, 95% CI 2.191-13.548)and AST( OR=1.042, 95% CI 1.005-1.081)were independent risk factors of G≥2 or S≥2 in chronic HBV infection patients with low level ALT ( P<0.05 or <0.01). Conclusion:Age, family history of HBV infection and AST level can be used to judge the severity of liver pathological changes and necessity of antiviral treatment for patients with chronic HBV infection having ALT<2×ULN.

Corona virus disease 2019 （COVID-19） has led to more than 500 million cases， including 6.19 million deaths. Mutated strains of SARS-CoV-2 （alpha， beta， gamma， delta and omicron） have successively emerged. Currently the omicron variant is gradually replacing the delta variant， driving a surge of cases in most countries including China， posing a great challenge to the prevention and treatment of COVID-19. In the face of the severe pandemic situation， a large number of non-medical volunteers are fighting on the front lines of the war against the pandemic and are vulnerable to exposure due to lack of professional knowledge. This paper introduces the routine skills training of volunteers and emergency response， aiming to provide behavioral guidance for non-medical volunteers in designated isolation facilities.