Objective To evaluate the effects of nucleos (t)ide analogues initial treatment on virology and complications in hepatitis B virus (HBV) related decompensated liver cirrhosis.Methods From May 2012 to October 2013,a total of 209 patients with HBV related decompensated liver cirrhosis of 18 hospitals in China were enrolled.According to antiviral medicine taken by them,they were divided into entecavir (ETV) group (n =161),lamivudine (LAM) monotherapy or combined with adefovir (ADV)group (n=48,LAM 22 cases,LAM+ADV 26 cases).During the 12-month follow up period,ChildPugh scores,the level of HBV DNA and complications of liver cirrhosis were documented every three months,the safety evaluation was also carried out.The t-test or chi-square test was performed for statistical analysis.Results In ETV group,before treatment and 12 months after treatment,Child-Pugh scores were 7.91±2.05 and 5.75±1.72,respectively,and the latter was lower than the former (t=10.130,P＜0.01); in LAM alone or combined with ADV group,Child-Pugh scores were 8.08±2.23 and 5.85±1.44,respectively,and the latter was lower than the former (t=5.480,P＜0.01).However there was no significant difference in Child-Pugh scores between the two groups in different time points (both P＞0.05).The undetectable rates of HBV DNA gradually increased along with the treatment period.After 12 months treatment,the undetectable rate of HBV DNA of ETV group was 91.0％ (61/67),and that of LAM alone or combined with ADV group was 87.5％ (35/40),there was no significant difference between the two groups (P＞0.05).Before treatment and 12 months after treatment,the incidences of ascites were 59.4％ (82/138) and 15.0％ (12/80) in ETV group,the latter was lower than the former (x2 =40.740,P＜0.01) ; the incidences of ascites in LAM alone or combined with ADV group were 62.2％ (28/45) and 8.1％ (3/37),and the latter was lower than the former (x2=25.290,P＜ 0.01).After 12 months treatment,the rates of esophageal varices disappearance of ETV group and LAM alone or combined with ADV group were 26.6％ (33/124) and 25.0％ (7/28),accordingly the rates of gastric varices disappearance were 2.5％ (1/40) and 1/19,and the difference was not statistically significant between the two groups (both P＞0.05).There was no significant difference in serum urea nitrogen,serum creatinine and estimated glomerular filtration rates between the two groups before treatment and at different time points after treatment (all P＞0.05).Conclusion The efficacy and safety of ETV and LAM alone or combined with ADV are similar in patients with HBV related decompensated liver cirrhosis,however,the long-term efficacy should be identified by further clinical observation.

T4 cells were isolated twice separately from peripheral blood of the same donor.After activation by lectin,the isolated cells were culturedwith the medium containing self-made IL-2 for a long period.The culturedcells were identified for OKT antigens by immuno-fluorescent technique onday 10 and 22 of the cultivation,and the appearance of both T4 and T8antigens on the same cell (double marker cell)could be detected in about60-80%of cultured cells.The double marker T cells decreased in numberand the percentage of single marker T cells,either T4 or T8 cells,increasedgradually along with the cultivation.The function of double marker T cellswere investigated and the suppressor activity of these cells on PWM indu-ced antibody production response by cooperation between B cells and fresh T4cells was found.These results suggest that human peripheral blood T4 andT8 cells are not terminaly differentiated cells,because T4 and T8 antigencan be coexpressed on the same cell during the earlier cultivation.Afterlong period of activation,T4 and T8 double marker cells may change intoeitherT4 or T8 cells.

OBJECTIVE:To establish a method for content determination of cyproheptadine hydrochloride in fuyan cream.METHODS:Ultraviolet spectophotometry was applied to determine the contents of cyprohepatadine hydrochloride as well as its adjuvant as two coexisting components without isolation and extraction,the wavelengths were286nm and258nm res_ pectively,linear regression and simultaneous equations were used to analyze the results.RESULTS:Cyproheptadine hydrochlor_ ide and its adjuvant showed good linear relationship in the range of2.52～25.2and2.5022～25.022?g/ml respectively,the average recovery of cyproheptadine hydrochloride was98.61%(RSD=1.08%).CONCLUSION:The present method is simple,convenient,reproducible and reliable,which is suitable for rapid determination for fuyan cream.

Objective:To evaluate the effect of orexin A on morphine-induced gastrointestinal dysfunction in mice.Methods:Forty SPF C57B/6 mice, aged 6-8 weeks, half male and half female, weighing 18-22 g, were divided into 5 groups ( n=8 each) using a random number table method: control group (group C), morphine group (group M) and morphine + different doses of orexin A groups (MOH, MOM and MOL groups). Normal saline 8 ml/kg was subcutaneously injected daily in group C, morphine 6 mg/kg was subcutaneously injected daily in the other four groups, and orexin A 75, 50 and 25 μg/kg were subcutaneously injected daily for 10 days at the same time in MOH, MOM and MOL groups.The fetal water content was calculated and averaged daily.After the last administration, the mice were gavaged with black nutrient paste, and the gastric emptying rate and small intestinal propulsion rate were detected 30 min later.Blood samples were collected from the orbit, and the concentration of serum gastrin (GAS) was detected by enzyme-linked immunosorbent assay.The mice were then sacrificed, and colon tissues were removed for determination of c-kit positive cell area (by immunohistochemistry) and expression of c-kit, substance P (SP) and neural nitric oxide synthase (nNOS) in colon tissues (by Western blot). Results:Compared with group C, the rate of fecal water content, gastric emptying rate, small intestinal propulsion rate and serum GAS concentration were significantly decreased, the area of c-kit positive cells was decreased, and the expression of c-kit and SP was down-regulated, and the expression of nNOS was up-regulated in group M ( P<0.05). Compared with group M, the small intestinal propulsive rate and serum GAS concentration were significantly increased, and the area of c-kit positive cells was increased, and the expression of c-kit was up-regulated in group MOH, the rate of fecal water content, gastric emptying rate, small intestinal propulsion rate and serum GAS concentration were significantly increased, the area of c-kit positive cells was increased, and the expression of c-kit and SP was up-regulated, and the expression of nNOS was down-regulated in group MOM, and the serum GAS concentration and c-kit positive cell area were significantly increased in group MOL ( P<0.05). Conclusions:Orexin A 50 μg/kg can effectively alleviate the gastrointestinal dysfunction induced by morphine in mice, and the mechanism may be related to promotion of GAS secretion, interstitial cells of Cajal growth and SP release and inhibition of NO release.

"Internet + Nursing Service" is an on-site nursing service carried out by means of the Internet. This paper analyzes the research progress and development of "Internet + Nursing Service" at home and abroad, and analyzes the risks and problems faced by my country's development of "Internet + Nursing Service", and puts forward targeted recommendations with a view to providing a reference for the in-depth development of "Internet + Nursing Service" in China.

Objective:To observe the application effect of simulation medicine teaching in clinical practice teaching of respiratory department.Methods:A total of 96 five-year undergraduate students of clinical medicine specialty from Batch 2018 were randomized into in two groups in average. The traditional teaching group conducted bedside teaching according to traditional teaching outline, and the simulation medicine group used simulated medical teaching method. The performances of theoretical knowledge and skill operations and the teaching satisfaction with the department were evaluated between the two groups. SPSS 22.0 was used for t test and chi-square test. Results:There was no significant difference in theoretical knowledge between the two groups, but the results of skill operation test and satisfaction with the department of the simulation medicine group were significantly better than those of the traditional teaching group, and the difference was statistically significant [(80.92±5.99) vs. (87.71±4.95), P<0.050; χ2=26.14, P<0.05]. Conclusion:Simulation medicine teaching is better than traditional teaching in clinical practice teaching of respiratory department, which can improve students' clinical skills and operation level, cultivate good clinical thinking for students, and improve their learning interests.

Objective:To study the efficacy and influencing factors of ursodeoxycholic acid (UDCA) in the treatment of cholesterol gallstone, so as to provide reference for the treatment of cholesterol gallstone by internal medicine.Methods:From March 1, 2017 to March 31, 2018, at outpatient department of gastroenterology of 9 Beijing medical centers including Peking University People′s Hospital, the Sixth Medical Center of PLA General Hospital, Beijing Huaxin Hospital, PLA Rocket Force Characteristic Medical Center, Peking University Aerospace Center Hospital, Beijing Youan Hospital of Capital Medical University and Beijing Tiantan Hospital of Capital Medical University, Beijing Tongren Hospital of Capital Medical University, and Beijing Shijitan Hospital of Capital Medical University, the data of patients with cholesterol gallstone treated by UDCA were collected. The inclusion criteria were that the largest diameter of stone was ≤10 mm and the stone was not detected under X-ray. The treatment plan was taking UDCA orally for 6 months at a dose of 10 mg·kg -1·d -1. The basic information of patients, the ultrasound examination results before treatment and 6 months after treatment, and scores of biliary abdominal pain and dyspepsia symptom were collected. Univariate and multivariate logistic regression were used to analyze the influencing factors of the efficacy in gallstrone dissolution by UDCA, and Wilcoxon signed rank test was used for statistical analysis. Results:A total of 215 patients were enrolled. The complete dissolution rate of gallstone was 19.5% (42/215) and partial dissolution rate was 50.7% (109/215), and the total effective rate was 70.2% (151/215). The complete dissolution rate of sandy stone was significantly higher than that of lumped stones (37.0%(17/46) vs. 14.8%(25/169); OR=3.377, 95% confidence interval (95% CI) 1.621 to 7.035, P=0.001). In lumped stones, the complete dissolution rate of the stones with diameter ≤5 mm was significantly higher than that of the stones with diameter >5 mm (37.5%(9/24) vs. 11.0%(16/145); OR=4.837, 95% CI 1.823 to 12.839, P=0.002). The complete dissolution rate of patients with higher body mass index ( OR=0.872, 95% CI 0.764 to 0.995, P=0.043) and longer disease course ( OR=0.942, 95% CI 0.912 to 0.973, P<0.001) was low. The results of multivariate logistic analysis indicated that long disease course of gallstone ( OR=0.940, 95% CI 0.908 to 0.974, P=0.001), rough gallbladder wall ( OR=0.438, 95% CI 0.200 to 0.962, P=0.040) and lumped stone ( OR=0.236, 95% CI 0.101 to 0.550, P=0.001) were independent risk factors of influencing the efficacy of stone dissolution by UDCA. As for lumped stones, the independent risk factors included long disease course of gallstone ( OR=0.926, 95% CI 0.877 to 0.978, P=0.006) and stone diameter >5 mm ( OR=0.142, 95% CI 0.043 to 0.470, P=0.001). After 6 months of UDCA treatment, score of biliary abdominal pain decreased from 0 (0 to 6) to 0 (0 to 0) and the score of dyspepsia symptom decreased from 1 (0 to 2) to 0 (0 to 0), and the differences between before treatment and after treatment were statistically significant ( Z=-8.50, and -9.13, both P<0.001). Conclusions:UDCA has a certain efficacy in cholesterol gallstone dissolution and can ease biliary abdominal pain and dyspepsia symptom. Long disease course of gallstone, rough gallbladder wall and stone diameter >5 mm are independent risk factors of poor efficacy in gallstone dissolution by UDCA.

Objective To investigate whether the therapy of combining budesonide with pulmonary surfactant,compared with only surfactant,has an effect on the incidence of bronchopulmonary dysplasia,mortality and other complications in preterm infants.Methods The preterm infants in accordance with the inclusion criteria,who were born during from 12/2016 and 2/2018,were randomly divided into the combination treatment group (treated with the combination of budesonide and pulmonary surfactant) and control group (treated with only surfactant).Ninety eight preterm infants were enrolled this trial,48 of whom are in budesonide group and 50 are in control group.The basic data were not have statistic significant between two groups except for birth weight (P ＞ 0.05).The incidence of bronchopulmonary dysplasia,the mortality and other complication of premature were compared.Results There was a statistic significance in the incidence of bronchopulmonary dysplasia between the budesonide group and control group (42％ vs 66％,P＜0.05);The severity of bronchopulmonary dysplasia and case fatality rate between two groups have no satistical difference.The complications of preterm infants in two groups also have no statistical difference apart from the incidence of PDA (15％ vs 38％,P ＜ 0.05).Conclusion Budesonide combined with pulmonary surfactant can reduce the incidence of bronchopulmonary dysplasia and does not increase mortality and the rate of other complications in preterm infants.

Objective: To evaluate the consistency of ultrasonic cardiac output monitor (USCOM) and electric impedance (ICON) in cardiac function monitoring in preterm infants compared with echocardiography (ECHO). Methods: All enrolled children were monitored with ECHO, USCOM and ICON on the 2nd and 7th day after birth.Heart rate (HR) and cardiac index (CI) were recorded. Results: On the second day after birth, the CI measured by ECHO was (3.26±0.68) L/(min·m²), the CI measured by USCOM was (3.21±0.66) L/(min·m²), and the CI measured by ICON was (3.67 ±0.69) L/(min·m²), with an average percent error of 27.9% and 42.3%, respectively.On the 7th day after birth, the CI measured by ECHO was (3.53±0.57) L/(min·m²), the CI measured by USCOM was (3.47±0.59) L/(min·m²), and the CI measured by ICON was (3.73±0.67)L/(min·m²), with an average percent error of 25.8% and 28.3%, respectively. Conclusion Comparing USCOM with ECHO in cardiac output monitoring of preterm infants, the consistency is good at each time point after birth.Compared with ECHO, ICON has poor consistency in early postnatal cardiac index monitoring, but dynamic monitoring has a certain reference value after one week of birth.