Objective To investigate the value of serum hepatitis B virus(HBV)RNA for predicting hepatitis B virus e antigen(HBeAg)clearance and seroconversion after nucleoside(acid)analogs(NAs)treatment in patients with chronic hepatitis B(CHB).Methods Serum samples were collected from 178 CHB patients who received NAs monotherapy in Weihai Hospital affiliated to Shandong University of Traditional Chinese Medicine from February 12,2017 to February 21,2019.Serum HBV RNA levels were analyzed by real-time fluorescence-based quantitative PCR at baseline and after NAs treatment.Results The patients with HBeAg clearance and seroconversion showed significantly lower serum HBV RNA levels at baseline,6 months and 12 months of treatment compared with those without HBeAg clearance and seroconversion(P＜0.001).During follow-up,the patients with lower baseline HBV RNA levels had higher rate of cumulative HBeAg clearance(Log Rank x2=11.282,P=0.001)or seroconversion(Log Rank x2=10.739,P=0.001)than the patients with higher baseline HBV RNA levels.Cox regression model analysis indicated that serum HBV RNA levels at baseline,6 months and 12 months of treatment were an independent predictor for HBeAg clearance and seroconversion in CHB patients(P＜0.05).The area under the ROC curve(AUC)of baseline serum HBV RNA level was 0.808(95％CI:0.743-0.872)for predicting HBeAg clearance and 0.824(95％CI:0.763-0.885)for predicting seroconversion.The AUC of HBV RNA level at 6 months of treatment was 0.830(95％CI:0.765-0.894)for predicting HBeAg clearance and 0.732(95％CI:0.657-0.808)for predicting seroconversion.The AUC of HBV RNA level at 12 months of treatment was 0.737(95％CI:0.641-0.833)for predicting HBeAg clearance and 0.757(95％CI:0.671-0.842)for predicting seroconversion.The AUC of baseline HBV RNA level combined with HBV RNA decline at 6 months of treatment was 0.856(95％CI:0.795-0.917)for predicting HBeAg clearance and 0.864(95％CI:0.802-0.926)for predicting seroconversion.The AUC of baseline HBV RNA level combined with HBV RNA decline at 12 months of treatment was 0.881(95％CI:0.826-0.936)for predicting HBeAg clearance and 0.848(95％CI:0.784-0.911)for predicting seroconversion.Conclusions Serum HBV RNA levels have high predictive value for HBeAg clearance and seroconversion after NAs therapy in CHB patients,suggesting that HBV RNA levels are helpful for identifying non-responders and informing combination therapy.

Online teaching become the major teaching method for international students,how to adjust and optimize the online teaching mode,and explore a new teaching method suitable for international students has become an urgent problem for international students'education.According to the characteristics of the strong independent learning ability of international students,also paying attention to the impact of the time difference on the teaching quality,we adjusts and transforms the course content and teaching mode in this teaching reform,and the mode of teacher-lecturing+students'self-study+teacher-student discussion and feedback is adopted to study and practice the online teaching of Medical Immunology course.This teaching reform has fully activated the drive of international students'learning,and made international students get the ability of lifelong learning.At the same time,through the reasonable arrangement of teaching content and learning mode,the time difference existing in the teaching process of international students is well resolved,makes up for the poor effect of online lectures,and achieves good teaching effect.

Objective To establish and evaluate the predictive value of the risk prediction model for lung infection within postoperative 1 year in kidney transplant recipients. Methods Clinical data of 197 kidney transplant recipients were retrospectively analyzed. All recipients were divided into the infection group (n=42) and non-infection group (n=155) according to the incidence of lung infection within postoperative 1 year. The incidence and risk factors of lung infection after kidney transplantation were analyzed. Risk prediction model was established by multiple logistic regression analysis. Forty-five kidney transplant recipients who met the inclusion criteria, including 8 cases in the infection group and 37 cases in the non-infection group, were selected to verify the predictive effect of the established model. Results The incidence of lung infection within 1 year after kidney transplantation was 21.3% (n=42), including 38 cases (90%) of pneumonia severity index (PSI) class Ⅰ, 1 case (2%) of PSI class Ⅲ and 3 cases (8%) of PSI class Ⅴ. Lung infection occurred within 1 month after operation in 13 cases, within postoperative 2-6 months in 22 cases and after postoperative 6 months in 7 cases. Nineteen recipients were diagnosed with bacterial infection, 7 cases of fungal infection, 10 cases of viral infection and 6 cases of mixed infection. Smoking history, diabetes mellitus history, pulmonary disease history and albumin level of < 35 g/L were the independent risk factors for lung infection after kidney transplantation (all P < 0.05). The equation of risk prediction model for postoperative lung infection in kidney transplant recipients was logit (lung infection within postoperative 1 year in kidney transplant recipients)=-1.891+1.063×smoking history (yes=1, no=0)+1.398×diabetes mellitus history (yes=1, no=0)+1.732×pulmonary disease history (yes=1, no=0)+1.269×albumin level (< 35 g/L=1, ≥35 g/L=0). The area under the curve (AUC) of receiver operating characteristic (ROC) was 0.788, the sensitivity was 0.786, the specificity was 0.645, and the Youden index was 0.431, respectively. Hosmer-Lemeshow goodness-of-fit test demonstrated that the predicted value of this model yielded relatively high consistency with the observed value. The AUC in the verification group was 0.834. Hosmer-Lemeshow goodness-of-fit test validated high degree of calibration of this model. Conclusions The risk prediction model, consisting of smoking history, diabetes mellitus history, pulmonary disease history and albumin level as predictors, may effectively predict the incidence of lung infection within postoperative 1 year in kidney transplant recipients.

In response to the teaching requirements under the new situation of medical education reform, the Department of General Surgery of the First Affiliated Hospital of Harbin Medical University has actively carried out the SPOC (small private online course). Through special seminars, online platform exchanges and skill operation exercises, students can accurately grasp the learning focus and learn the subject knowledge efficiently, which has realized the teaching goals of situational, problematic, multi-dimensional and task-based teaching and learning. It is a new type of online and offline interactive teaching model, which is worth further promotion.

OBJECTIVE:To provide reference for confirming the protective effect of the establishment of PIVAS on antineoplastic drugs(ADs)occupational exposure to nursing staff in clinical departments,and to provide the basis for the formulation of ADs dispensing guideline and occupational exposure protection regulations. METHODS:By questionnaire survey and deriving data of lab examination index,the occurrence of abnormal menstruation,bad birth outcome,alopecia,blood toxicity, liver and renal toxicity in nursing staff of clinical departments with different ADs contact frequencies(non-exposure group as group A,low-exposure group as group B,high-exposure group as group C)were investigated and analyzed in our hospital before and after the establishment of PIVAS. The residual of ADs [methotrexate(MTX)and 5-Fluorouracil(5-FU)] in PIVAS environment were investigated by HPLC. RESULTS:A total of 160 questionnaires were sent out before the establishment of PIVAS,and 151 were effectively collected with effective recovery of 94.38%. After the establishment of PIVAS,150 questionnaires were sent out,and 144 were effectively collected with effective recovery of 96.00%. Questionnaire results showed that the incidence of abnormal menstruation,abnormal menstruation period,dysmenorrhea,spontaneous abortion,infertility and offspring low birth weight,the severity of hair loss in group C were significantly higher than group A,with statistical significance(P<0.05 or P<0.01). The incidence of above 6 conditions in group C were 5.14,6.10,3.81,4.04,6.15,8.08 times higher than in group A.At same time, the incidence of the offspring low birth weight and the severity of hair loss in group B were significantly higher than group A,with statistical significance(P<0.05 or P<0.01);the incidence of the former in group B was 6.21 times higher than in group A.After the establishment of PIVAS,the incidence of abnormal menstruation,abnormal menstruation period,dysmenorrhea,spontaneous abortion,infertility and offspring low birth weight,the severity of hair loss were decreased significantly in group C,with statistical significance(P<0.05). The severity of hair loss in group C was significantly higher than group A,and there was no statistical significance in above indexes,compared with group A(P>0.05). At the same time,there was no statistical significance in the incidence of the offspring low birth weight and the severity of hair loss between group B and A(P>0.05). Results of lab examination index investigation showed that before the establishment of PIVAS,WBC and PLT of group C were significantly lower than group A,and the incidence of abnormal liver function was significantly higher than group A,with statistical significance(P<0.05 or P<0.01). After the establishment PIVAS,WBC,PLT and RBC of group C,and PLT of group B were increased significantly compared to before the establishment PIVAS;the incidence of abnormal liver function in group C was decreased significantly compared to before the establishment PIVAS,with statistical significance(P<0.05 or P<0.01). There was no statistical significance in above indexes between group C and A(P>0.05),and PLT of group B was even significantly higher than group A(P<0.05). Results of investigation of ADs residues in PIVAS environment showed that there were different degrees of MTX and 5-FU residue on the surface of different objects. The residues of ADs from high to low were biological safety cabinet worktops,the floor just below biological safety cabinet,transfer box,transfer window and door handle and infusion bags. CONCLUSIONS:Nursing staff of clinical department with high ADs contact frequency face higher relevant health risks. The establishment of PIVAS can effectively protect the ADs occupational exposure of nursing staff in clinical departments,thereby reducing the above risks.At the same time,there are still different degrees of ADs residues on the surface of different objects in the PIVAS environment,and transshipment out of PIVAS is possible. It is suggested that the awareness of protection against occupational exposure risk caused by ADs residues in PIVAS environment should be improved;unified guideline for ADs dispensing and occupational exposure protection regulations should be formulated as soon as possible,so as to reduce occupational exposure risk associated with ADs for nursing staff in PIVAS and clinical departments.

Objective:To analyze the general patterns and characteristics of torsade de pointes(Tdp) associated with ibutilide and provide feasible suggestions and preventive measurements combined with the experience of pharmaceutical monitoring. Methods: The cases of TdP associated with ibutilide were retrieved from the literatures reported at home and abroad during January 1990 and April 2017,and the clinical data including gender,age,original diseases, dosage of drugs, injection time, TdP occurrence time, potassi-um,QTc and ECG monitoring before and after the medication, complications, treatment drugs and methods and conversion outcome were statistically analyzed. Results: A total of 9 cases were enrolled in the analysis. After the treatment with ibutilide withdrawal, electroversion and potassium and magnesium supplement, all the patients converted to sinus rhythm.Conclusion: Ibutilide must be prescribed very carefully in senile female patients complicated with extended QTc,low potassium,organic heart disease and heart fail-ure. With dosing interval,injection time or injection speed not compatible with the specification,the occurrence of TdP is significantly different,suggesting that clinical pharmacists strengthen the monitoring of injection time,speed,dosing interval and blood concentra-tion of ibutilide according to the instruction strictly.

Objective The objective of this study was to investigate the analgesic effect of flurbiprofen axetil and its effect on immune factors after cervical cancer surgery.Methods Ninety patients with cervical cancer undergoing laparoscopic surgery were ran-domly divided into three groups with 30 patients in each group in Zhongshan Hospital Affiliated to Dalian University from January 2016 to June 2017.The indexes of assessment were visual assessment of visual analog scale(VAS)pain assessment and postoperative adverse reaction at 2,12,24 and 48 h after operation.The levels of CD4,CD8,IL-1,IL-6,CD4/CD8 and PGEs in the serum at 12,24 and 48 h after operation were measured.Results The VAS scores in the A group were significantly lower than those in the B and C groups dur-ing 12 and 24 h after operation(P<0.05).But there were no significant differences in the levels of CD4,CD8,IL-1,IL-6,CD4/CD8 and PGEs amongst the three groups(P>0.05).The levels of IL-1 and IL-6 at 2,12 and 24 h after operation were significantly higher than those in the baseline(P<0.05).However,the levels of IL-1 and IL-6 in the C group was significantly higher than those in the A and B groups(P<0.05).Compared to before operation,the ratio of CD4/CD8 was decreased and the level of PGE2 was increased in the three groups after operation.After 24 h operation,the ratio of CD4/CD8 in the B group were significantly lower than that in the C group(P<0.05).The level of PGE2 at 12 h after operation was significantly increased in the B and C groups(P<0.05).Conclusion The combination of flurbiprofen axetil and sufentanil in the laparoscopic surgery of cervical cancer can improve postoperative analgesia and reduce adverse reactions,effectively reduce the secretion of inflammatory mediators and minor affect on cellular immune function.

Objective To analyze the mechanism of imipenem resistance in Pseudomonas aeruginosa clinical isolates. Methods? Antibiotic?resistance?was?analyzed?using?VITEK32?system.?Metallo?β-lactamase?activity?was?determined?by?double-disc?synergy?test.?Amp?C?β-lactamase?activity?was?determined?by?Kirby-Bauer?disc?method.?OprD?protein?was?analyzed?by?sodium?dodecyl sulphate-polyacrylamide gel electrophoresis. PCR was performed to amplify gene oprD. The amplified products were subject?to?sequencing?analysis.?The?phylogenetic?relationship?was?determined?using?random?amplified?polymorphic?DNA?(RAPD)?method. Results Membrane protein OprD was analyzed in 7 clinical isolates of imipenem-intermediate P. aeruginosa. Two strains were devoid of OprD proteins and the corresponding oprD genes were found disrupted by the insertion element ISRP10 in the coding regions. Five strains had OprD proteins with different sizes. Sequence analysis showed that the peptides ranged from 427 to 443 amino acids. Multiple amino acid substitutions and / or deletions were found within the Loop 1 through Loop 8 of the OprD secondary structures. Conclusions ISRP10 inactivation and amino acid substitutions in oprD gene confer imipenem resistance in the clinical isolates of P. aeruginosa.

To establish a consumables supermarket management system to realize the informatized management of the consumables supermarket. The system used SOA as the main architecture, and IIS manager as the pub-lishing tool. The system had the workload, materials and financial resources decreased while the efficiency in-creased, and made the supervisor master the sale information timely. Consumables supermarket informatized management may decrease the hospital's needs for current capital as well as the links, while increase the hospital effi-ciency greatly.

OBJECTIVETo find a sensitive index of early injury of the nervous system in lead-exposed workers and to provide a scientific basis for establishing an efficient occupational health surveillance route.

METHODSA total of 317 lead-exposed workers (blood lead levels: 26.90∼ 912.80 µg/L, determined with the atomic absorption spectrum) were divided into four groups according to the normal blood lead level (201 µg/L), acceptable upper limit of blood lead (400 µg/L), and diagnostic value (600 µg/L). The motor nerve conduction function was examined and analyzed by one-way ANOVA.

RESULTSThe distal latency and amplitude of the median nerve were significantly different between groups. The median distal latency of the highest blood lead group (>600 µg/L) was 3.63 ms, which was significantly longer than the average level (3.30 ms), and the median nerve amplitude of the highest blood lead group was 5.63 µV, significantly lower than the average level (7.27 µV). No significant difference was found between different groups in motor conduction velocity. Significant difference was found in ulnar nerve amplitude between groups. The ulnar nerve amplitude of the highest blood lead group was 4.31 µV, significantly lower than the average level (4.87 µV). No significant differences were observed in other parameters between groups.

CONCLUSIONThe distal latency and amplitude of the median nerve can be used as a sensitive index for the diagnosis of early subclinical motor nerve injury in lead?exposed workers.

Adult ; Humans ; Lead ; blood ; Lead Poisoning ; blood ; physiopathology ; Neural Conduction ; drug effects ; Occupational Exposure