Objective To study the distribution of drug resistance mutations and genotypes in the patients with chronic hepatitis B(CHB)in Taicang area.Methods 350 cases of CHB were selected and detect the drug resistance mutations and genotypes before using nucleoside(acid)anti-viral drugs.The correlation between the drug resistance mutations with genotypes in CHB patients was analyzed.Results Among 350 cases of CHB,the distribution of genotypes was genotype B in 172 cases,accounting for 49.14%, genotype C in 164 cases,accounting for 46.85%,genotype D in 9 cases,accounting for 2.57%,mixed genotype of B and C in 5 ca-ses,accounting for 1.42%,no other genotypes were found.In this study,the drug resistance mutations were detected in 58 cases,in-cluding 22 cases of genotype B,35 cases of genotype C and 1 case of genotype D,no drug resistance mutations were found in mixed genotype B and C.The drug resistance mutations sites:lamivudine resistance-associated mutations in 36 cases(10.28%),and adefo-vir resistance-associated mutations in 16 cases(4.57%)and entecavir associated resistance mutations in 6 cases(1.71%).Conclusion The genotype of CHB patients in Taicang area was dominated by genotype B and C,which accounting for more than 90% and the proportion of these two kinds of genotype is similar.The proportion of drug resistance mutation occurrence in the patients with gen-otype C is higher than that with genotype B.The lamivudine resistance-associated mutation has the highest proportion of drug re-sistance occurrence.It is suggested that the CHB patients with undefined medication history and recurrence treatment should be per-formed the drug resistance detection for selecting the targeted therapeutic schemes before accepting nucleoside(acid)drug therapy.

To examine the actual clinical diagnosis capability,the import of computer-based case simulations ( CCS ) technology in medical education is very important.The CCS examination system that integrated the ASP.NET and CCS technology can simulate doctor's clinical course more realistically and realize the students' practical skills evaluation.The system has a good prospect in medical education and clinical skills training.

In view of the difficulties in the practice of innovation education,Harbin Medical University identified the education objective,cultivated innovative education concept and implemented this concept by launching innovative ability training projects for college students,establishing innovation base and emphasizing on information technology and network based innovative education practice.satisfactory education effect was achieved.

Idiopathic pulmonary fibrosis (IPF) is one of the most common idiopathic interstitial pneumonia.The main symptoms for IPF are dry cough and exertional shortness of breath,which is worsen gradually with the development of pulmonary fibrosis.Patients with IPF often suffer from sleep disordered breathing (SDB).Sleep architecture for these patients including the sleep efficiency,deep sleep,rapid eye movement sleep and arousal index,are changed,which seriously affects the quality of life.In the absence of effective therapies,optimizing the quality of life may become a major therapeutic target for IPF.The diagnosis and treatment of SDB can significantly improve the quality of life for patients with IPF.

Objective To observe the efficacy of total ankle replacement in treatment of osteoarthritis of ankle joint.Methods Between October 1999 and October 2006,42 patients with ankle osteoarthritis were admitted in Beijing Jishuitan Hospital.All the patients met surgical indications and were performed total ankle replacement with S.T.A.R.system ( Scandinavian Total Ankle Replacement) (Waldemar Link,Hamburg,Germany).The pain in patients,motion and function of joint were evaluated pre- and post-operatively according to Kofoed scoring system,and the efficacy was evaluated with the Mayo'evaluation criteria of total ankle replacement.Results According to Kofoed scoring system,the postoperative situation was obviously superior to the preoperative in pain,motion and function of joint(P ＜ 0.05 ),and the excellent and good rate was 90.32％.While,the excellent and good rate was 87.5％with the Mayo' evaluation criteria of total ankle replacement.Conclusion Total ankle replacement,which can relieve pain,restore ankle function and improve ankle activity,provides another effective method for the patients who need ankle arthrodesis.

Objective To investigate the effects of antibiotic prophylaxis on the incidence of infection and prognosis in acute phase aftersevere stroke. Methods 165 patients within 24 h from clinic onset were divided into the intervention group and control group. The interventionincluded cefuroxime+metronidazole or moxifloxacin. The body temperature was continuously monitored, and the presence of infectionwas daily assessed with C-reactive protein (CRP), leukocyte count, and bedridden X-ray. They were also assessed with Glasgow ComaScale (GCS) and Acute Pathologic and Chronic Health Evaluation (APACHE)-Ⅱ. Primary end points was incidence of infection; secondaryend points included death and other clinical outcome. Results There was no difference between tow groups in infection rate (P=0.58), intervaluntil diagnosis of infection (P=0.74), so as mortality (P=1.00) and interval of death (P=0.84), body temperature (P=0.99), CRP (P=0.37) , leukocyte (P=0.51), scores of GCS (P=0.31) and APACHE-Ⅱ (P=0.28). Conclusion Antibiotic prophylaxis works little to prevent infectionand improve outcome in patients with acute stroke.

Objective To analyze the relationship between the least diameter of autogenous arteriovenous fistula and other parameters like flow rate and artery diameter. To identify an appropriate way in defining fistula stenosis. Methods Physical examination and Doppler ultrasound were used to examine the autogenous arteriovenous fistula of maintenance hemodialysis patients. Well?used wrist arteriovenous fistula was included. The least diameter of the fistula vein was found and marked by ultrasound, and the diameter and the distance between the point and the anastomotic stoma were measured. Diameters of different places along the cephalic vein of the fistula, including the forearm place, the place close to elbow and the upper arm place were measured by ultrasound. Meanwhile, diameter as well as flow velocity and flow rate of brachial artery, radial artery and ulnar artery were also measured. Result Sixty?eight patients were enrolled in the study. The average age of those patients was 52.56 ± 2.00 years old. Thirty?one patients were female. Forty?nine fistula were located on the left arm. The average diameter and flow rate of brachial artery were 5.72(5.34, 6.33) mm and 821.50 (540.50, 1075.00) ml/min, respectively. The average diameters of radial artery and ulnar artery were 3.95 ± 0.10mm and 3.17(2.73,3.75) mm, respectively. The least diameter of cephalic vein was 3.34 ± 0.11mm in average. The distance between the least place to the anastomotic stoma was 3.76±0.14cm in average. The diameter of forearm cephalic vein was averaged 5.36(4.52, 6.45) mm. Diameter of place close to elbow and the upper arm place in the cephalic vein were (5.57±0.12) mm and (5.80±0.14) mm, respectively. The least diameter of cephalic vein was positively and statistically associated with the diameter and flow rate of brachial artery as well as radial artery. The least diameter was also positively and statistically associated with the diameter of each place in the cephalic vein. Statistical inter?group difference was found when the division was based on the value of the least diameter. Conclusion sThe least diameter of the wrist autogenous arteriovenous fistula vein will indeed affect the whole diameter and flow rate of the fistula. The value of the least diameter is more closely associated with the fistula function rather than narrow rate.

Objective To detect the impact of Diltiazem on the major adverse cardiac events (MACE) in six months after percutaneous coronary intervention (PCI).Methods A total of 192 patients after PCI with coronary atherosclerotic heart disease were enrolled in this study.The patients were randomly divided into Diltiazem therapy group (101 patients) and non-Diltiazem therapy group (91 patients).The high-sensitivity C-reactive protein (hs-CRP) was assessed before and 24 h after PCI,and the incidence of Major adverse cardiovascular events(MACEs) were assessed at the sixth month after PCI.Results Compared with before PCI,hs-CRP level increased significantly in both group after PCI (P＜0.01),but hs-CRP level was lower in Diltiazem therapy group than in non-Diltiazem therapy group (P＜0.05).Compared with non-Diltiazem therapy group,there was lower incidence of MACEs during six months follow-up in Diltiazem therapy group.Conclusions Diltiazem can decrease the incidence of MACEs during six months after PCI.

Objective To explore the effect of Autar scale in risk assessment on deep venous thrombosis after stroke. Methods From March 2016 to March 2018, 234 stroke patients admitted to our hospital were selected in our study. According to the random digit table, they were divided into the control group and the observation group, 117 cases in each group. The patients in the control group were given routine nursing, while those in the observation group were given risk assessment by Autar scale, and the predictive nursing scheme was adopted based on the evaluation results. The two groups were compared in view of incidence of deep venous thrombosis. Self-rating depressive scale (SDS) and self-rating anxiety scale (SAS) were used to evaluate the mental status before and after intervention. Results The incidences of venous thrombosis and hospitalization time in the observation group were significantly lower than those in the control group (P＜0.001). After the intervention, the scores of SDS and SAS in the two groups decreased significantly, and the mental state was basically at the normal level. The scores of SDS and SAS in the observation group were significantly lower than those in the control group (P＜0.001). Conclusions Autar scale used for the risk assessment can effectively prevent deep venous thrombosis after stroke, help to improve the mental state of patients, and promote physical recovery of stroke patients. It has of high value for clinical application.

Objective To study the effect of RNA interference on the expression of CTGF in skin fibroblasts of systemic sclerosis(SS). Methods Four CTGF specific siRNAs and a negative control siRNA were designed and then synthesized by in vitro transcription. siRNAs labeled with carboxyfluorescein-6-succimidyl ester (FAM) were transiently transfected into SS skin fibroblasts. Forty-eight hours after the fibroblasts were treated with siRNAs, the mRNA and protein expression of CTGF was detected by semiquantitative RT-PCR and Western blot analysis, respectively. Results The mRNA and protein expression of CTGF in fibroblasts was significantly down-regulated by 4 and 3 CTGF specific siRNAs (both P