The epidemiological effects of native and mutated YMDD motif in the HBV genome under the selective pressure of lamivudine were investigated. YMDD wild and mutation motif in HBV genome were detected by flow through reverse dot blots (FT-RDB) with KaiPuTM DNA HybriMax Rapid Hybridization Machine based on the principle of "Flow-through hybridization" and by the traditional Reverse Dot Blot assay. Sera from 1021 suspected lamivudine-resistant chronic HBV carders after more than 8 months of lamivudine therapy and the corresponding archived sera were collected and assayed. We found 35.94% were single type infections with 8.03% YMDD, 7.93% YIDD and 19.98% YVDD. It was also found that 64.06% were mixed infections including 1.96% YMDD and YIDD, 51.62% YMDD and YVDD, 1.96% YIDD and YVDD, 8.52% YMDD, YIDD and YVDD. The levels of infections containing YVDD motif reached 82.08%. The pretreatment infectious status were: YMDD single infection was 36.93%; YIDD single infection was 6.07%; YVDD single infection was 17.04%; YMDD and YIDD mixed infection was 0.97%; YMDD and YVDD mixed infection was33.99%; YIDD and YVDD mixed infection was 0.98%; YMDD, YIDD and YVDD mixed infection was 4.02%. Infections containing YVDD motif were only 56.03%. The 34.32% mutation rate of YMDD motif to YVDD was significantly higher than the 10.97% of YMDD to YIDD (U=10.98, P<0.05), as estimated by Mann-Whitney U-test for non-parametric data. HBV containing YVDD motif might have an evolutionary ascendancy and become the dominant type under the selective pressure of lamivudine.

Purpose:To observe the curative effect and the clinical-benefit-response of patients with advanced pancreatic cancer who used a combine of Gemcitabine,5-FU and PDD.Methods:The treatment with Gemcitabine (800 mg/m 2) was followed by 5-FU(600 mg/m 2) and DDP (30 mg/m 2),administered on days 1,8 and 15 of 28-day schedule. The curative effect was estimated according to the standard of WHO and the clinical benefit response was evaluated at the same time. The standard of CBR included pain,physical states and body weight. Results:Twenty-five (25/29) patients received over two cycles chemotherapy. 6(24%) partial response (PR), 12 (48%) stable disease and 7(28%) progressive disease were observed. According to the standard of CBR, 18(62.1%) patients achieved the clinical-benefit-response level. Therapy was well tolerated. The main toxicities included that the alimentary tract reactions and the marrow depression. Grade 3-4 thrombocytopenia was reported in 8 (27.6%) patients. Conclusions:The combination of GEM, 5-FU and DDP is a moderatedly active treatment with tolerable side-effects. It has definite response rate and high CBR rate in pancreatic cancer.

Objective To evaluate the clinical value of Sharp-van der Heijde score (SHS)in rheumatoid arthritis (RA).Methods Clinical and X-ray of hands data in 200 patients with RA met the ACR criteria were collected in this study.Clinical DAS28,anti-cyclic citrullinated peptide antibody (aCCP)and imaging SHS were used to evaluate the activity of RA quantitatively before and after treatment.Results A moderate correlation existed between SHS and DAS28 (r s =0.61,P =0.00),but there was no significant cor-relation either between SHS and aCCP (r s = -0.1 5,P =0.03)or between aCCP and DAS28 (r s =0.14,P =0.05 ).Significant differences before and after treatment was existed in SHS (t=24.27,P =0.00)and DAS28 (t=1 5.98,P =0.00)respectively.And there was a moderate correlation between the difference in SHS before and after treatment and aCCP (r s =0.66,P =0.00).Conclu-sion The SHS,DAS28 and the aCCP in RA are closely related.Combination of three methods will help to develop the clinical pro-grams,evaluate the efficacy and prognosis.

[Objective]To explore the roles of TIDC(tumor infiltrating dendritic cell)and TIL-T(tumor infiltrating T lymphocyte)in tumor immunity of EBV-associated gastric carcinoma(EBVaGC)and their clinical significance.[Methods]TIDC and TIL-T in EBVaGC(n=49)and EBVnGC(EBV-negative gastric carcinoma)(n=20)were detected by immunohistochemistry method and then their subtypes and their relationships with clinical and pathological factors were analyzed.[Results]Mild infiltration was detected in 29 of 49(59.2%)EBVaGCs and 18 of 20(90%)EBVnGCs,while marked infiltration of TIDC was detected in 20 of 49(40.8%)EBVaGCs and 2 of 20(10%)EBVnGCs.And the difference between the two groups was significant (P=0.013).The number of TIL-T in EBVaGC was hisher than that in EBVnGC(P=0.017),and most of them were CTLs.The number of TIL-T was positively correlated with that of TIDC(r=0.386,n=49,P=0.006).The degree of TIL-T infiltration in EBVaGC had negative relationship with the lymph node metastasis(P＜0.001),while TIDC had no relationship with the clinical features.[Conclusion]TIDC and TIL-T may play important roles in the tumor immunity of EBVaGC;TIDC may contribute to the TIL-T recruitment in EBVaGC.

AIM:To investigate the effect of cigarette smoking condensate on histone deacetylase 2 (HDAC2) and inflammatory mediators in mouse myoblast C 2C12 cells.METHODS:C2C12 cells were treated with cigarette smoke extract (CSE).HDAC2 siRNA was transfected into the cells using Lipofectamine TM 2000.The levels of interleukin-8 (IL-8) and tumor necrosis factor-α( TNF-α) in the culture supernatants were measured by ELISA , and the expression of HDAC2 at mRNA and protein levels was determined by real-time PCR and Western blotting .RESULTS:The expression of HDAC2 at mRNA and protein levels in CSE group was lower than that in control group (P<0.05).The supernatant levels of IL-8 and TNF-αin CSE group were significantly higher than those in control group ( P<0.05 ) .When the cells were transfected with HDAC2 siRNA followed by CSE stimulation , the expression of HDAC2 at mRNA and protein levels was de-creased , and the supernatant levels of IL-8 and TNF-αwere significantly increased as compared with CSE group and control group (P<0.05).CONCLUSION: Under the oxidative stress condition , C2C12 cells generate high levels of IL-8 and TNF-αby down-regulating the expression of HDAC2.

Maternity insurance is a policy support of China for women of child-bearing age.Given its good outcomes since it is enforced clinically,such insurance has been confronted with challenges as well.Doctors and nurses of Ob/Gyn departments serve as both protectors of parturient women's interests and practioners of the economic and social interests of the hospital.This paper summarized the experiences of maternity insurance of the Ob/Gyn department of the hiospital in rencent 6 years.The hospital has had 2026 inpationts covered by maternity insurance,without any medical disputes and harvesting a cash surplus of 657145 yuan.Such doctors and nurses are found to play a key role in ensuring a good doctor-patient relationship,and serve as clinival references for the single-disease management and teaching of the hospital.

Objective To investigate the relationship of angiotensin converting enzyme (ACE I/D) gene I/D polymorphism with vitiligo.Methods PubMed,the Cochrane Library,China academic journal full-text database and VIP database and Wan fang database were searched according to the inclusion and exclusion criteria,and the quality of included studies was assessed.The data were quantitatively analyzed by Stata 12.0 software.Results Nine articles were included.Meta analysis results showed that the susceptibility of vitiligo difference was statistically significant in the total population of ACE I/D genotype (DD + II)vs.DI (OR=0.759,95％ CI:0.643 ～0.896,P=0.001),the (DD+DI) vs.II (OR=1.523,95％ CI:1.153 ～2.011,P =0.003).The genotype subgroup analysis showed the D vs.I (OR =1.381,95％ CI:1.054 ～1.810,P=0.019),DDvs.II (OR=1.830,95％ CI:1.110～3.017,P=0.018),(DD+ II) vs.DI (OR=0.814,95％ CI:0.667 ～0.994,P=0.043),and the (DD+ID) vs.II (OR=1.690,95％ CI:1.147 ～2.489,P =0.008) in Asian.The difference was statistically significantly related to vitiligo.Arab genotype (DD + II) vs.DI (OR =0.545,95％ CI:0.354 ～ 0.840,P =0.006) was associated with vitiligo occurrence.Begg's inspection publication bias analysis showed all genetic types did not exist any publication bias.Conclusions The ACE gene I/D polymorphism may be associated with vitiligo susceptibility.

Objective To investigate the efficacy and safety ofQingre Huoxue Mixture in the treatment of blood heat type psoriasis vulgaris.Methods The patients were divided into treatment group and control group according to random number table method, with 52 cases in treatment group and 50 cases in the control group, 10 cases failed to complete the trial. Treatment group was givenQingre Huoxue Mixture, and the control group received oral administration of compoundQingdaiCapsule. The treatment lasted for 8 weeks. PASI score, TCM syndrome integrals, DLQI score, serum IFN-γ and IL-10 were detected, and hematuria routine and liver and kidney function were under safety testing before and after treatment.Results After treatment, PASI score, DLQI score and TCM syndrome integrals in the treatment group decreased significantly (P<0.001); the expression of serum IFN-γ decreased significantly (P<0.001); the expression of serum IL-10 increased significantly (P<0.001), with the total effective rate of 100% (52/52). After the treatment, TCM syndrome integrals in the both groups decreased significantly (P<0.001). After the treatment, the rash burning and itching scores in the treatment group were lower than the control group, with statistical significance (P<0.001). In terms of safety, the treatment group had no abnormal indicators.ConclusionQingre Huoxue Mixture has obvious curative effect, which can reduce the patients with psoriasis, improve the life quality of patients, and improve the clinical symptoms of rash burning and itching, reduce serum IFN-γ, and increase serum IL-10.

Prominent problems of clinical teaching in Tibet University school of medicine were analyzed and countermeasures were proposed from aspects of management system construction, facul-ty construction, curriculum construction, base construction and quality evaluation system construction. The aim was to increase students' opportunity, enhance students' learning interest and improve stu-dents' ability of analysis and problem solving so as to improve the practical effects of clinical teaching. All countermeasures taken above laid the foundation for future clinical work and provided help for clinical medical personnel in Tibetan border areas.

Objective To discuss the degenerative factors, the spinal segment distribution, and the mechanism in hyperextension injury of cervical spine. Method Eighty-nine patients with hyperextension injury of cervical spine were retrospectively analyzed by observing the degenerativelesion, the spinal cord segment with high signal in T2WI, and the location of facial trauma. Results Fifty-eight cases showed the disc hemiation which was the most common lesion, followed by 8 cases showing the calcification of the posterior longitudinal ligament. Besides, 7 cases presented the developmental stenosis of spinal canal, and also, 6 cases showed disc hemiation combined with the yellow ligament hypertrophy. The intervertebral level of the spinal cord with high signal in T2WI were distributed as follows:4 cases were at C2/3, of which onesuffered the forehead trauma; 12 cases were at C3/ 4, of which 10 had the forehead trauma, and one had the zygomatic trauma; 12 cases were at C4/5, of which 5 had the forehead trauma, one had both the zygomatic and the forehead trauma, and one had both the forehead and with the lower jaw trauma; 11 cases were at CS/6,of which 3 had the forehead trauma, 3 had the zygomatic trauma, and 2 had the lower jaw trauma. The location of the spinal cord with single high signal in T2WI did not correspond with the intervertebral disc level in 4 cases. For 10 cases the high signal in T2WI was found at two discontinuous segments. For 2 cases the 1 high signal in T2WI was found at over two segments. For 6 cases the high signal in T2WI was found at over three segments. Conclusions Disc hemiation is the most common underlyding factor in cervical hyperextension injury. The spinal level with high signal in T2WI was correlative to the impacted facial site. The shear force at the inflection point with or without the anterior-posterior compression force accounted for the cervical hyperextension injury.