Objective To investigate the efifcacy of interferon alpha (IFNα) followed by nucleotide analogues (NAs) treatment in patients with negative hepatitis B e antigen (HBeAg), undetectable serum HBV-DNA and low hepatitis B surface antigen (HBsAg) levels.Methods The enrolled HBeAg-negative chronic hepatitis B patients had undetectable HBV-DNA level (HBV-DNA<1000 copies/mL for at least 12 months) and low HBsAg level (HBsAg≤2000 U/mL) with long-term NAs treatment. These patients switched their therapy sequentially from NAs regimens to IFNα for 48 weeks. The treatment response was evaluated in terms of serum HBV DNA load, serological HBV markers, liver function tests and routine blood test before treatment and 12, 24 and 48 weeks of treatment. The patients were followed up for 24 weeks after treatment. The primary endpoint was HBsAg loss or seroconversion and HBsAg<10 U/mL. Logistic regression analysis was conducted to examine relevant predictive factors. Receiver operating characteristic curve was used to evaluate the value of prior HBeAg seroconversion and on-treatment HBsAg dynamics in predicting HBeAg seroconversion than in HBsAg persistence group (χ2=9.527,P=0.002). HBsAg loss was more likely in the patients who had HBsAg decline at least 0.5 log U/mL from baseline at week 12 of treatment (χ2=16.576,P<0.001). The area under the ROC curve for prediction of HBsAg loss was 0.810 (95 %CI, 0.686 to 0.935,P<0.001).Conclusions The HBeAg-negative chronic hepatitis B patients with positive virological response and low HBsAg level after NAs treatment are more likely to achieve HBsAg clearance when switched to IFNα treatment. Prior HBeAg seroconversion and on-treatment HBsAg dynamics are useful in predicting and guiding IFNα sequential therapy.

Objective To characterize the manifestations of non-Hodgkin's lymphoma in nervous system with in-flammation-like presentation. Methods We reviewed clinical and laboratory data obtained from 3 cases of non-Hodgkin's lymphoma in nervous system with inflammation-like presentation.Those data include clinical manifestations,CSF examina-tions neuroimaging,pathology of biopsies,treatment and prognosis.Results The clinical manifestations of NHL in nervous system were variable and the findings of cerebrospinal fluid and imaging were not characteristic.Parital relief of symptoms by steroid cortisone could be achieved in some cases which maght further increased the difficulty in differentiating NHL from CNS inflammation.Several signs including no evidence of CNS inflammation,multiple organ involyements,especially the organ involvements outside CNS,and deterioration after a transient relief of symptoms by steroid cortisone,strongly suggest the possibility of NHL.Condusions We should increase physicians'awareness to NHL to reduce the misdiagnosis even though the final diagnosis relies on pathological examination.

ObjectiveTo explore and analyze the distribution of NAT2 gene in Han population in Shenzhen andprovidethebasisfortreatmentof NAT2-relatedmetabolicdiseasesandcancer research. MethodThe study diluted the DNA sample(d0 ng/μl) as follows: 1 × 100, 1 × 101, 1 × 102, 1 ×103 , 1 × 104, to verify the sensitivity of detection of NAT2 gene polymorphism by real-time PCR. Mutation locus of 282,341,481, 590 and 857 of NAT2 in 554 normal samples were detected and genotyped by realtime PCR with Taqman probes. Forty-seven cases among 554 healthy controls were detected by DNA sequencing to verify the sensitivity, specificity and accuracy of this assay. ResultsThe lowest detection limit was 10-4 ng/μl. The frequencies of each allele of NAT2 were: *4 allele 64. 6％ (358/554), *5 allele 6. 3％ (35/554), *6 allele 25. 3％ ( 140/554), *7 allele 30. 0％ ( 166/554), * 11 allele 0. 6％ (3/554) The frequencies of main genotypes of NAT2 were as the follows : NAT2 *4/* 6 12.3％ ( 68/554 ), *6/* 78. 3％ (46/554), * 13/* 13 or * 12/* 12 or *4/* 4 7.6％ (42/554), *4/* 7 8. 1％ (45/554), * 7/* 1 312. 3％ (68/554), * 12 7.2％ (40/554), *6/* 13( * 12)5.6％ (31/554). The samples with 7 genotypes account for 89. 6％ (496/554) of the total cases.Rapid acetylation and Intermediate type accounting for 40. 5％ (224/554) and 46. 7％ (259/554) respectively were the main phenotypes of NAT2 in Han people in Shenzhen. In addition, the accuracy, specificity and sensitivity of the PCR were compared to direct DNA sequencing. The accuracy of 282, 341,481, 590 and 857 were 88.2％ (30/34), 87.5％ (7/8), 80. 0％(4/5), 100. 0％ ( 22/22 ) and 93.8％ ( 15/16 ) respectively. The specificities were 100. 0％ ( 13/13 ),94. 9％ ( 37/39), 100. 0％ ( 42/42 ) , 96.0％ ( 24/25 ) and 96. 8％ ( 30/31 ) respectively. The sensitivities were 91.5％ ( 43/47 ), 93.6％ ( 44/47 ), 97.6％ ( 46/47 ) 97.9％ ( 46/47 ) and 95.7％ ( 45/47 ),respectively. ConclusionsThe sensitivity, specificity and accuracy of real-time PCR established in this study is good. It can be widely used for clinical and scientific research. The major alleles of NAT2 of Han population in Shenzhen are * 4, *6, * 7. The most common slow acetylation genotype is *6/* 7. This study can provide a basis for NAT2-related metabolic diseases and cancer research.

Objective To determine the clinical implications of internal mammary node biopsy for neoplasm stage,treatment,and prognosis in patients with breast cancer.Methods Internal mammary node biopsy via intercostal space was performed in 229 cases of breast cancer.Anatomical location of internal mammary nodes was recorded.Results Internal mammary node biopsy was successfully finished in 220 patients.There were 56 cases (24.45％ ) with internal mammary nodes metastasis,126 cases (55.02％ ) with axillary nodes metastasis,43 cases (34.13％ ) with regional metastases in both the axillary and internal mammary lymph nodes and 13 cases ( 12.62％ ) with internal mammary node metastasis only.Internal mammary node metastasis rate in patients with the number of positive axillary nodes ≥4 was 49.32％ (36/73).pN stage migration was seen in 56 patients with positive internal mammary nodes.There was no statistic relation between internal mammary nodes metastases and tumor location ( x2 =0.661,P =0.719).70.7％ patients with medial/central tumors and 50.7％ patients with the number of positive axillary nodes ≥4 were free from internal mammary node radiotherapy on account of internal mammary node biopsy.There was no complication such as pneumothorax or haemorrhagia.Conclusions Internal mammary node biopsy from intercostal space is a reliable surgical technique and can improve pN stage in some breast cancer patients.With internal mammary node biopsy,patients with a negative internal mammary node can be prevented from radiation to internal mammary nodal areas.

Objective To compare the safe zone and safe angles between males and females for screw placement on the medial iliosciatic plate for acetabular posterior column using 3D reconstruction technique.Methods Normal pelvic CT scans of 52 adults (27 males and 25 females;aged from 18 to 74 years,averaging 47.2 years) were obtained to create pelvic 3D models.After the acetabulum was thickened by 5 mm,the width (d) of the safe zone for placement of the medial iliosciatic plate was measured.After the vertical distance (w) between the vertex of the obturator canal and the greater sciatic notch was measured,the ratio (r) of d/w was calculated.The recombined innominatum model was cut through the center of the acetabulum with a plane perpendicular to the quadrilateral plate and the greater sciatic notch.The cross-section was marked as M.In males,4 points at distances of 1.0 cm,1.5 cm,2.0 cm and 2.5 cm anterior to the greater sciatic notch were marked.At the 4 points,the angulations (∠ a,∠b,∠ c and ∠ d) between the quadrilateral plate and the tangent line of the outer edge of the thickened acetabulum model were measured on the cross-section M.In females,3 points at distances of 1.0 cm,1.5 cm and 2.0 cm anterior to the greater sciatic notch were marked before ∠a,∠b,and ∠c were measured.The differences in the above parameters were compared between males and females.Results The width (d) of the safe zone for placement of the medial iliosciatic plate was 28.56 ±2.44 mm in males and 24.36 ±2.47 mm in females;the ratio (r) was 0.61 ± 0.07 in males and 0.54 ± 0.05 in females.The safe angulations for screw placement in males,∠ a,∠b,∠cand ∠d,were 88.04°±3.18°,77.81°±3.85°,68.01°±4.11°and56.81°±4.81° while those in females,∠a,∠b and ∠c,were 91.29°±4.52°,76.23°±3.82° and 62.79°±3.51°,respectively.There were statistically significant differences between males and females in values of d,r,∠ a and ∠ c (P ＜ 0.05).Conclusions In fixation of acetabular posterior column fractures using medial iliosciatic plate,the differences between males and females should be taken into account.Besides,specific safe angles should be chosen according to the position of the plate.

Objective To explore the best operation method in the patients with papillary thyroid microcarcinoma.Methods A total of 139 patients with papillary thjroid microcarcinoma were treated at our institute between Jan.2000 and Jan.2010.The data on the clinicopathological characteristics of patients and treatment were collected.Results The mean tumor size was (0.45 ± 0.24) cm.Of the 139 patients,30.2％ had multifocal tumors,19.4％ had bilateral tumors,42.4％ neck lymph node metastases.The number of eases of lymph node metastasis in level Ⅵ,Ⅱa,Ⅲ and Ⅳ was 58(41.7％),3(2.2％),10(7.9％),5(3.6％),respectively.Only one had lymph node metastasis in Level Ⅲ Microscopic extrathyroid extension was associated with neck lymph node metastases in papillary thyroid microcareinoma patients (x2 =38.39,P ＜0.001).No one developed permanent hypoparathyroidism.The median follow-up time was 103 (range,30-154) months,and local recurrence in the thyoid was diagnosed in 2 patients who underwent hemi-or subtotal thyroidectomy.Follow-up of 10 years was done in 16 cases,and the survival rate of 139 patients for 10-year was 100％.Conclusions It suggested that patients with papillary thyroid microcarcinoma has uniform clinicopathologic characteristics and the pattern of lymph node metastasis from those with papillary thyroid carcinoma.Total thyroidectomy plus level Ⅵ dissection is the optimal surgical treatment of papillary thyroid microcarcinoma.

Objective To evaluate the safety and feasibility of INTRABEAM in breast conserving surgery for early stage breast cancer.Methods Clinical data of 43 cases of early breast cancer undergoing INTRA-BEAM intraopetative radiotherapy from Jan.2013 to Dec.2014 were retrospectively analyzed.All cases underwent breast conserving surgery combined with 20 Gy INTRABEAM intraoperative radiotherapy.The postoperative incision,incidence of local complications and acute radiation injury were recorded after surgery.Breast recovery,the cosmetic effects,early overall survival,recurrence-free survival,and non-metastatic survival were followed up.Results All cases were given breast conserving surgery associated with INTRABEAM intraoperative radiotherapy (20 Gy),with median radiotherapy time of 31 mins ranging from 25 to 39 mins.Five cases underwent postoperative whole breast irradiation.Major early complications included incision infection (1 case),postoperative effusion (5 cases),radiation area skin pain (4 cases).The short-term follow-up survey showed that the satisfaction rate was 93.0％.The overall survival rate,recurrence free survival rate and metastasis free survival rate was 100％ respec tively.Conclusion Breast conseving surgery combined with INTRABEAM intraoperative radiotherapy for early breast cancer patients is safe and feasible.

Objective To evaluate the safety of the da Vinci Si surgical system in thyroid surgery and to accumulate operation experience .Methods The da Vinci Si surgical system consists of a surgeon's console, a patient-side robotic cart, and high-definition 3D vision system.The robot arm tips were introduced via a single axillary incision or small chest wall ports and attached to the arms of the robot .The surgeon , sitting at the con-sole, manipulated the EndoWrist instruments and endoscope view that transfer the surgeon 's movements to the arm tips.The so called EndoWrist'technology offers seven degrees of movements ( up, down, left, right, twist, et al) , thus exceeding the capacity of a surgeon's hand in open surgery .The da Vinci Si surgical system was used to perform thyroidectomy in two small pigs .The animals were intubated and kept anesthetized with halothane .Re-sults Four surgical procedures were done using the da Vinci Si system from beginning to the end , including 2 thyroidectomies and 2 thymectomies .No conversions to open or laparoscopic procedure was used .The procedure length was 61 minutes and 50 minutes, respectively.Conclusions Robotic thyroidectomy can be performed safe-ly by the experienced surgeons after short-term da Vinci Si surgical system training .The learning curve for robotic thyroidectomy is shorter .

Objective To investigate the role of high mobility group box l protein (HMGB1) in the pathogenesis of ankylosing spondylitis (AS). Methods Enzyme-linked immuno sorbent assay (ELISA) was used to test the levels of plasma HMGB1 levels in 58 patients with active AS [bath ankylosing spondylitis disease activity index (BASDAI)>6, or 6>BASDAI>4 and erythrocyte sedimentation rate (ESR)>22 mm/1 h, 6>BASDAI>4 and hypersensitive C reactive protein (hsCRP)>9 mg/L], 73 cases of stable AS (BASDAI<4) and 70 healthy control. Twelve patients who were treated with TNF-alpha antagonist for 6 month were followed-up. Their plasma levels of HMGB1 were detected before and after treatment. Quantitative data were described by, while qualitative data were described by case number. Variance analysis or rank sum test was adopted for the difference between measurement data groups, LSD method was adopted for further pair-wise comparison. The correlation between variables was analyzed by using Spearman correlation analysis. Results The levels of plasma HMGB1, ESR, hsCRP, White blood cell WBC, GR, Mo and GLOB were significantly higher in the AS patients than those in the healthy control group (P<0.001), and the level of plasma HMGB1 in the AS patients was significantly positively correlated with BASDAI, Bath ankylosing spondylitis functional index (BASFI), ESR, hsCRP, WBC, GR, Mo, and GLOB (r=0.288, 0.174, 0.308, 0.243, 0.261, 0.301, 0.279, 0.289; P=0.004, 0.047, 0.000, 0.005, 0.003, 0.000, 0.001 ,0.001). The level of plasma HMGB1, BASDAI, BASFI, ESR, hsCRP, WBC, GR, GLOB were significantly higher in the active AS group than in the stable group (Z=-3.598,-9.456,-5.907, -2.562, -3.178, 4.134, -2.574, -4.582; P=0.000, 0.000, 0.000, 0.012, 0.002, 0.000, 0.011, 0.000). The level of plasma HMGB1 was not found statistically poor in the patients with different expressions of HLA-B27, or hip involvement and history of vuvitis (P>0.05). The plasma HMGB1 level, BASDAI, BAIFI, ESR, hsCRP and GLOB in the 12 followed-up patients were significantly decreased (P=0.034, 0.002, 0.002, 0.005, 0.004, 0.004) after being treated with biological agents for 6 months. Conclusion HMGB1 might play a vital role in the pathogenesis of ankylosing spondylitis,and the HMGB1 might be used as a clinical indicator to evaluate the activity of AS and to assess the clinical efficacy.

Spinocerebellar ataxias (SCAs), formerly known as autosomal dominant cerebellar ataxia, are a group of hereditary heterogeneous neurodegenerative disease that contains many subtypes. Spinocerebellar ataxia type 23 (SCA23), one type of SCAs, is caused by mutant prodynorphin (PDYN) gene. A 22-year-old patient was diagnosed with sporadic SCA23 due to gene detection, with a novel identified mutation, PDYN c.647C>T (p.P216L). Located in the dynorphin A-coding-region of PDYN gene, the pathogenic mechanism of the mutation may be relevant to the pathological changes caused by the variant including neurological dysfunction and death of cells. Mild improvement with the patient has been witnessed after active balance and speaking exercise.