Nucleos(t)ide analogues (NAs) have been widely used in clinical practice as first-line antiviral drugs.In recent years, many clinical studies have found that some patients cannot reach a satisfactory therapeutic outcome.This article introduces the antiviral indications and follow-up of chronic hepatitis B and summarizes the influence of baseline characteristics, HBV genotype, HBV mutation and drug resistance, patients'' medication compliance, presence or absence of other diseases or viral infection, and serum vitamin D level on the antiviral effect of NAs.It is pointed out that appropriate timing for antiviral therapy, patient education before treatment, regular follow-up during treatment, and timely identification of comorbidities and drug resistance help to improve the antiviral effect of NAs and delay the progression of liver diseases.

Objective To explore the causation as well as the prevention and treatment of unsuspected gallbladder carcinoma (UGC) during laparoscopic cholecystectomy (LC). Methods Clinical data of 16 cases of UGC encountered during 6 031 cases of LC (0.26%) in this hospital were retrospectively reviewed. Results Out of the 16 cases of UGC, 9 were diagnosed intraoperatively and the other 7 were identified by histopathologic examination after surgery. The median survival time was 20.3 months. Of the 15 cases with primary tumor over T 2 stage: open operation was performed in 10 cases and the other 5 cases didn’t undergo open surgery after the diagnosis was clarified, the postoperative survival time being (19.9?4.9) and (9.8?2.8) months, respectively; 9 cases underwent radical or aggressive radical cholecystectomy and 6 didn’t undergo redical resection, the postoperative survival time being (21.6?5.3) and (7.8?2.6) months, respectively. Conclusions Recognition and precautions about gallbladder carcinoma should be strengthened before LC. The resected gallbladder should be routinely examined and frozen-section examination should be applied promptly if there have any suspicions of malignancy. Once the UGC is diagnosed, radical or aggressive radical resection should be adopted as early as possible, and necessary measures should be taken to prevent implantation and metastasis of carcinoma.

Objective To investigate the effect of continuous blood purification ( CBP) on the level of blood lactic acid and 6 h lactic clearance in the patients with severe sepsis. Methods 48 patients with severe sepsis were cho-sen in ICU, and they were randomly divided into two groups: control group ( n=20 ) and CBP group ( n=28 ) . Their arterial blood lactic acid level was tested on admission and was retested 6, 24, 48 and 72 h after treatment. The patients’6 h blood lactic clearance rate and the corresponding APACHEIIscore were calculated. The level of arterial blood lactic acid and the score of APACHE IIwere compared at different time. 6 h blood lactic clearance, the period of stay in ICU and the 28-days mortality were compared too. Results The level of lactic acid and the score of APACHE II after 24 h were lower in CBP group, and the period of stay in ICU was shorter in CBP group than that in control group at different time ( P<0.05 ) . 6 h blood lactic clearance was higher than that in control group (P<0.05). Moreover, the 28-days mortality had no significant difference in CBP group. Conclusion The CBP plays an important role in clearing the blood lactic acid and it can reduce the severity of the sepsis as well as shorten the period of stay in ICU.

Objective　To discuss the technique,advantages and follow-up results of subfascial endoscopic perforator surgery.Methods　Subfascial Endoscopic Perforator Surgery was performed for 23 patients wth chronic venous insufficiency.Over two years postoperative follow-up was done.Results　21 in 23 cases with ulcers healed.Only one case had wound infection.Conclusion　Subfascial Endoscopic Perforator Surgery is a safe and effective procedure in treating venous insufficiency.

Objective To investigate the changes of liver function and white blood cell of patients with liver cirrhosis,portal hypertension and secondary hypersplenism underwent laparoscopic splenectomy(LS) and open splenectomy(OS).Methods We analyzed 76 clinical data of patients with liver cirrhosis,portal hypertension and secondary hypersplenism,among those 27 underwent LS,49 OS from Mar 2003 to Mar 2006 retrospectively.Blood samples were obtained and analyzed preoperatively and postoperatively on days 1,3, and 7,including alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),directed bilirubin(DBil) and white blood cell(WBC).Results Between LS and OS,the serum levels of Tbil and Dbil had significant difference on the 1st postoperative day(P

Objective To investigate the safety and feasibility of lapraroscopic Heller myotomy combined with Dor fundoplication surgery. Methods Three cases with achalasia have been treated with laproroscopic Heller-Dor surgery since February, 2005. Before surgery, patients were examined for generally esophageal barium meal and esophageal manometry. Results The operation time ranged from 110 and 120 minutes with the bleeding volumes between 40 to 50 ml, and the hospitalized time for patients post operation was 6 to 7 days. During a month after surgery, the patients showed the normal lower esophageal sphincter pressure and remnant pressure, increased the rate of relaxation,disappeared reversed peristalsis and gastroesophageal reflux, and no recurred symptoms. Conclusions In comparison to conventional surgery, Heller-Dor procedure results in smaller wound, less pain, fewer complications, faster recovery, shorter hospitalized days, and better therapeutic effectiveness. The Heller-Dor procedure is safe and feasible.

0 05). No other embolisms or severe complications occurred in the two groups. Conclusions No substantive differences were detected between outcomes of embolization with PVA and PLES.

Objective To discuss the clinical application of lapraroscopic subtotal cholecystectomy in the acute cholecystitis with severe inflammatory and fibrous adhesions at calot triangle.Methods Retrospective analysis of the clinical data,surgical approaches,and short term and long term complications of 74 cases of acute cholecystitis in the period from January 2002 to September2005 in our hospital.Results In the 74 cases operated by subtotal cholecystectomy using laparoscopy,during laparoscopic procedure,71(95.9%) operations were successful;a case of Mirizzi syndrome could not be confirmed to have the residual stones in cystic duct and another case of the same syndrome was not confirmed to have the duodenum fistula.These two cases were then dealt with by conventional surgery and constituted 2.7% of the total cases.One case was dealtd with by second surgery because of the residual stones of cystic duct after lapraroscopic subtotal cholecystectomy and constituted 1.3% of the total cases.One case was found with minor bile leakage and constituted 1.3% of the total cases.Cholangiography was conducted 41 cases during operation,of whom,39 cases were normal and 2 cases failed.No death occurred with the operation of the lapraroscopic subtotal cholecystectomy.Conclusion It is safe and effective to apply laparoscopic subtotal cholecystectomy to treat acute cholecystitis with severe inflammatory and fibrous adhesions at calot triangle.

Objective To observe the clinical effect of Yangjinhua Powder Capsule(Flos Daturae Powder Capsule)in the treatment of Parkinson's disease(PD).Methods Of the 51 PD patients,15 who came for the first visit were administered Yangjinhua Powder Capsule only,and 36 who had been taking western medicine were given Yangjinhua Powder Capsule without stopping using the original medicine.The Unified Parkinson Disease Rating Scale(UPDRS)was used to score the patients before treatment,7 days,3 months,and 6 months after treatment respectively,and as well to evaluate the total effect and untoward reactions.Results After treatment,29(56.86%)patients were remarkably improved;11(21.57%)patients were improved;and 2(3.92%)patients were slightly improved.Totally 42 patients were improved.The total effective rate was 82.35%.After 7 days' treatment,the improvement of tremor was significant(P

Adolescent ; Adult ; Aged ; Child ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; complications ; surgery ; Humans ; Hypertension, Portal ; mortality ; surgery ; Male ; Middle Aged ; Renal Veins ; surgery ; Splenic Vein ; surgery ; Time Factors