拉米夫定联合阿德福韦酯治疗活动性乙型肝炎肝硬化的疗效观察

目的观察拉米夫定联合阿德福韦酯治疗活动性乙型肝炎肝硬化的临床疗效。方法将96例活动性乙型肝炎肝硬化患者分成A、B、C3组,每组32例。A组采用拉米夫定联合阿德福韦酯治疗,B组予拉米夫定治疗,C组予阿德福韦酯治疗,疗程均为48周。观察治疗中3组ALT复常率、HBVDNA阴转率、HBeAg/抗HBe血清转换率等变化情况,及随访2年的耐药发生率。结果 A组HBVDNA转阴率在第12周、24周优于C组（P〈0.05）;ALT复常率第12周优于B组（P〈0.05）、C组（P〈0.01）;第24周优于C组。随访2年,A组耐药发生率最低。结论拉米夫定与阿德福韦酯联合用药较单独用药疗效更佳。     

阿德福韦酯治疗黎族CHB患者疗效与HBV基因型的关系

目的评价阿德福韦酯治疗黎族慢性乙型肝炎（CHB）患者疗效与乙型肝炎病毒（HBV）基因型的关系。方法 42例HBeAg阳性、HBVDNA〉105copies/ml、ALT〉2倍正常值上线的黎族CHB患者,每天口服阿德福韦酯胶囊10mg,治疗48周。在治疗前及治疗后48周,动态观察HBeAg、HBVDNA和ALT的变化。结果 42例患者中,HBVC型是优势基因型（57.14%）,其次为B型（38.10%）,也有D型（2.38%）和C＋D型混合感染（2.38%）的存在。经阿德福韦酯胶囊治疗48周后,B型患者HBeAg阴转率（37.50%）、病毒应答率（56.25%）和血清ALT复常率（62.50%）均高于C型的29.17%、50.00%和54.17%,但两组比较差异无统计学意义（P〉0.05）。结论 HBVC型是海南岛黎族HBeAg阳性CHB患者的优势基因型,HBV基因型可能对阿德福韦酯的治疗效果无影响。     

乙型肝炎病毒基因B和C型与阿德福韦酯疗效关系的研究

目的探讨乙型肝炎病毒（HBV）基因B和C型与阿德福韦酯的疗效关系。方法选取应用阿德福韦酯10mg/d进行抗病毒治疗12、24、36、48周的136例慢性乙型肝炎患者作为研究对象,用聚合酶链反应（PCR）-微板核酸杂交-酶联免疫吸附试验（ELISA）法检测分析基因型,评价阿德福韦酯治疗不同基因型HBV的疗效。结果 136份样本中,HBV基因B型39份,HBV基因C型97份。在治疗12、24、36、48周时,B基因型患者丙氨酸氨基转移酶（ALT）的变化、血清HBVDNA水平下降比例≥2log10及完全抑制情况与C基因型患者相比差异均无统计学意义（P〉0.05）。结论本研究所观察的样本中,阿德福韦酯的抗病毒疗效与HBV基因B型和C型均无相关性。     

乙型肝炎病毒基因型与国产阿德福韦酯片疗效相关性的研究

目的 探讨我国患者HBV基因B和C型与国产阿德福韦酯片(ADV)疗效间的关系.方法 采用随机、有限双盲、安慰剂(PLB)对照、多中心临床研究方法.筛选合格的HBeAg阳性的慢性乙型肝炎(慢乙肝)患者按照2:1的比例,随机分为试验组(ADV+ADV组:ADV 10 mg/d,治疗48周,疗程48周,共145例)、对照组(PLB+ADV组:PLB 10 mg/d,24周后改用ADV 10 mg/d,治疗24周,共71例).用PCR-RFLP(PCR-限制性片段长度多态性)的方法检测患者血清中乙肝病毒基因型.结果 HBV基因型主要为C型,占66.7%,B型占25.2%.B型多见于广州患者,较C型患者明显年轻(26.98岁 vs 31.71岁,P=0.001),既往接受抗病毒治疗的明显较少.感染B基因型患者48周血清中HBV DNA与基线相比平均下降(-3.86±1.44)log10拷贝/ml(ADV+ADV组)和(-3.63±2.10)log10拷贝/ml(PLB+ADV组),与C基因型患者的(-3.87±1.24)log10拷贝/ml(ADV+ADV组)和(-3.41±1.82)log10拷贝/ml(PLB+ADV组)相比,无明显差别,P＞0.05.B和C基因型患者的血清学应答(HBeAg阴转率和HBeAg/HBeAb血清转换率)间也无统计学意义.结论 感染乙肝病毒B基因型和C基因型的HBeAg阳性慢性乙肝患者,应用国产阿德福韦酯片10 mg/d治疗均可取得显著的抗乙肝病毒复制作用,疗效在不同基因型间差异无统计学意义.     

阿德福韦治疗拉米夫定耐药慢性乙肝患者的疗效

目的拉米夫定是临床上最早应用于慢性乙型肝炎治疗的抗病毒药物,但是随着治疗时间的延长,有部分患者会对拉米夫定产生耐药性,从而影响了临床治疗的效果,而对耐药患者的治疗成为临床上亟待解决的问题。本研究选用阿德福韦联合拉米夫定和阿德福韦单药治疗拉米夫定耐药的慢性乙型肝炎,以观察阿德福韦的疗效和安全性。方法选取经拉米夫定治疗后产生YMDD耐药的慢性乙型肝炎患者62例,将患者随机分成两组:A组采用阿德福韦(10mg,每日1次口服)联合拉米夫定(0.1g,每日1次口服)治疗72周;B组采用阿德福韦单药治疗72周。治疗期间分别于治疗的第12周、24周、48周、72周检测乙肝病毒标志物检测(HBV-M),HBV DNA定量、肝功能,并记录。结果第12、24、48、72周时A组ALT复常率为59.3%、71.9%、78.1%、87.5%,B组为33.3%、36.7%、40.0%、53.3%;A、B组的HBV-DNA阴转率分别为56.3%、62.5%、71.9%、90.6%;30.0%、33.3%、40.0%、53.3%;A组HBe Ag阴转率、HBe Ab转换率为50.0%、65.6%、75.0%、90.6%;B组为20.0%、26.7%、46.7%、66.7%。应用SPSS 19.0统计软件进行统计学分析,判定为差异有统计学意义(P<0.05)。结论 1阿德福韦联合拉米夫定的疗效,要明显优于阿德福韦单药治疗;2提示阿德福韦能有效抑制拉米夫定耐药株的复制,阿德福韦联合拉米夫定和阿德福韦单药治疗对拉米夫定耐药的慢性乙型肝炎都具有较强的抗病毒作用;3阿德福韦联合拉米夫定治疗拉米夫定耐药的慢性乙型肝炎可以降低耐药的发生。     

乙型肝炎病毒基因型与拉米夫定治疗疗效关系的研究

目的探讨乙型肝炎病毒(HBV)基因型与拉米夫定治疗疗效的关系及其机理。方法对拉米夫定治疗的228例慢性乙型肝炎患者的临床资料进行收集和整理,分析HBV基因型与拉米夫定治疗疗效的关系;并对各HBV基因型影响拉米夫定疗效的可能因素进行探讨。结果HBV基因型B型对拉米夫定治疗的应答率为40.6%,C基因型的应答率为21.2%,两组应答率差异有显著性(P<0.05);B基因型的HBeAg的血清转换率为26.3%,C基因型为12.4%,统计学方法处理有显著性差异(P<0.05)。拉米夫定治疗期间的YMDD变异发生率B基因型组为13.2%,C基因型组为37.4%,两组差异有显著性统计学意义(P<0.05)。结论拉米夫定治疗慢性乙型肝炎患者,HBVB基因型的疗效优于C基因型,其疗效机理可能与拉米夫定治疗后C基因型容易发生YMDD变异有关。     

阿德福韦联合双环醇治疗慢性乙型肝炎疗效观察

目的研究阿德福韦酯联合双环醇治疗慢性乙型肝炎的疗效。方法77例慢性乙型肝炎患者随机分为两组,试验组（39例）每日口服阿德福韦酯10mg、双环醇75mg;对照组（38例）每日仅口服阿德福韦酯10mg。两组均连续用药48周。观察治疗前后血清氨基转移酶、病毒学指标、肝脏影像学指标的改变。结果治疗48周后,试验组ALT复常率（87.18%）显著高于对照组（65.79%）,HBV-DNA转阴率（64.10%）显著高于对照组（39.47%）,影像学指标改善优于对照组,差异均有统计学意义（P〈0.05）。结论阿德福韦酯与双环醇联合应用治疗慢性乙型肝炎能取得更好的生化学应答、病毒学应答和影像学改善。     

HBVB／C混合基因型对慢性乙型肝炎干扰素α抗病毒疗效的影响

目的探讨慢性乙型肝炎（CHB）患者B／C混合基因型乙型肝炎病毒（HBV）感染与干扰素α（IFN—α）治疗效果的相关性。方法经IFN—α治疗的HBeAg阳性B／C混合基因型CHB患者,采集治疗基线及治疗12周后血清,扩增HBV全基因组并进行克隆,每份标本17—20个克隆测序并进行序列分析及分子进化分析。结果2例HBeAg阳性B／C混合基因型感染CHB患者,优势病毒株均为C型毒株。经IFN-α治疗后,1例发生完全病毒学应答,1例发生部分病毒学应答并且治疗后B基因型病毒株完全清除。完全应答者与部分应答者治疗前C基因型准种复杂度为0．5562VS0．6305,部分病毒学应答者治疗后全基因组准种复杂度高于治疗前C基因型准种复杂度（0．6305VS0．7200）,全基因组核苷酸水平的平均遗传距离高于治疗前（0．00454VS0．00648核苷酸替换／位点）。结论（1）B／C混合基因型感染CHB患者优势病毒株为C型毒株。（2）B基因型病毒株对干扰素的敏感性高于C基因型,B／C混合基因型感染患者治疗后病毒准种复杂度及准种多样性升高。     

乙型肝炎相关性终末期肝移植后乙型肝炎复发19例:同一治疗机构43个月资料回顾

背景:目前,肝移植后乙型肝炎复发的治疗效果欠佳,有关肝移植受者乙型肝炎复发后的抗病毒治疗经验及研究,国内外较少报道。目的:应用阿德福韦酯+拉米夫定+乙型肝炎免疫球蛋白抗病毒治疗方案,探讨肝移植后乙型肝炎病毒复发的抗病毒治疗效果及肝功能改善情况。方法:回顾性分析了2005-01/2008-10于解放军南京军区福州总院肝移植中心行肝移植治疗的208例乙型肝炎相关终末期肝病患者。所有患者肝移植后给予拉米夫定+乙型肝炎免疫球蛋白预防乙型肝炎病毒复发,术后随访6~43个月,共有19例复发,其中乙型肝炎病毒e抗原阳性13例,明确有YMDD变异8例。19例复发患者均在原有的抗病毒治疗方案基础上加用阿德福韦酯治疗。结果与结论:19例乙型肝炎复发患者在治疗12,24,48周时,乙型肝炎病毒DNA、谷丙转氨酶与前次比较明显下降(P0.01)。治疗48周时谷丙转氨酶复常率、乙型肝炎病毒e抗原阴转率、乙型肝炎病毒DNA阴转率分别为84%,77%,79%。说明联合应用阿德福韦酯+拉米夫定+乙型肝炎免疫球蛋白抗病毒治疗能有效抑制乙型肝炎病毒复制,治疗肝移植后乙型肝炎复发。     

活动性乙肝肝硬化采用拉米夫定联合阿德福韦酯治疗的临床效果报道

目的：探讨活动性乙肝肝硬化患者的治疗过程中,应用拉米夫定联合阿德福韦酯治疗的临床效果。方法将我院2011年4月~2013年4月收治的70例活动性乙肝肝硬化感染患者随机分为观察组与对照组各35例,观察组患者应用拉米夫定联合阿德福韦酯治疗,对照组仅应用拉米夫定治疗。结果观察两组患者HBV-DNA转阴情况,观察组转阴28例,转阴率为80%,对照组转阴18例,占51.4%。对比两组患者HBV-DNA转阴率,观察组转阴率明显高于对照组(P<0.05),具有统计学意义。结论活动性乙肝肝硬化患者的治疗过程中,应用拉米夫定联合阿德福韦酯治疗具有较好疗效,值得临床推广。     

Association between functional alterations of senescence and senility and disorders of gait and balance

OBJECTIVES:

Declines in cognition and mobility are frequently observed in the elderly, and it has been suggested that the appearance of gait disorders in older individuals may constitute a marker of cognitive decline that precedes significant findings in functional performance screening tests. This study sought to evaluate the relationship between functional capacities and gait and balance in an elderly community monitored by the Preventive and Integrated Care Unit of the Hospital Adventista Silvestre in Rio de Janeiro, RJ, Brazil.

METHODS:

Elderly individuals (193 females and 90 males) were submitted to a broad geriatric evaluation, which included the following tests: 1) a performance-oriented mobility assessment (POMA) to evaluate gait; 2) a mini-mental state examination (MMSE); 3) the use of Katz and Lawton scales to assess functional capacity; 4) the application of the geriatric depression scale (GDS); and 5) a mini-nutritional assessment (MNA) scale.

RESULTS:

Reductions in MMSE, Katz and Lawton scores were associated with reductions in POMA scores, and we also observed that significant reductions in POMA scores were present in persons for whom the MMSE and Katz scores did not clearly indicate cognitive dysfunction. We also demonstrated that a decline in the scores obtained with the GDS and MNA scales was associated with a decline in the POMA scores.

CONCLUSIONS:

Considering that significant alterations in the POMA scores were observed prior to the identification of significant alterations in cognitive capacity using either the MMSE or the Katz systems, a prospective study seems warranted to assess the predictive capacity of POMA scores regarding the associated decline in functional capacity.     

男性乳腺发育症临床病理分析及雌,孕激素受体检测

对１１３例男性乳腺发育症进行临床病理分析。同时检测其中３０例乳腺组织中雌激素受体和孕激素受体分布情况，结果发现两者阳性率分别为８０．０％和８３．３３％。结合文献讨论了男性乳腺发育症的发生与高血清激素浓度及乳腺组织高受体水平的关系。     

纳米水平分子成像与诊疗一体化研究进展与挑战

分子成像能以非侵入性的方式重现活体细胞的生理功能和生物学过程,提高疾病的早期和特异性诊断水平。纳米颗粒/材料具有物理性质可控性高、易于表面修饰、血液循环时间长和可功能化等优点,在疾病诊断与治疗中显示出巨大潜力。但如何阐明纳米材料多功能间的内在联系、解决其代谢及安全性等关键机制难题、实现纳米颗粒/材料多功能性到临床多功能...     

壬基酚与卵清蛋白的结合与鉴定

目的：合成壬基酚与卵清蛋白的偶联物。方法：在磷酸盐（PBS，pH=8．0）缓冲液中利用甲醛通过曼尼希反应连接壬基酚与卵清蛋白（OVA）；通过抗体芯片技术与紫外扫描鉴定偶联物。结果：壬基酚与OVA偶联成功，壬基酚单克隆抗体对偶联物的识别浓度小于2．68μg／ml。结论：本方法可用于壬基酚与卵清蛋白的偶联，且方法简单易实现。     

Pathology and genetics of phaeochromocytoma and paraganglioma

Phaeochromocytoma and paraganglioma (PHEO/PGL) are rare tumours with an estimated annual incidence of 3 per million. Advances in molecular understanding have led to the recognition that at least 30–40% arise in the setting of hereditary disease. Germline mutations in the succinate dehydrogenase genes SDHA, SDHB, SDHC, SDHD and SDHAF2 are the most prevalent of the more than 19 hereditary genetic abnormalities which have been reported. It is therefore recommended that, depending on local resources and availability, at least some degree of genetic testing should be offered to all PHEO/PGL patients, including those with clinically sporadic disease. It is now accepted that that all PHEO/PGL have some metastatic potential; therefore, concepts of benign and malignant PHEO/PGL have no meaning and have been replaced by a risk stratification approach. Although there is broad acceptance that certain features, including high proliferative activity, invasive growth, increased cellularity, large tumour nests and comedonecrosis, are associated with an increased risk of metastasis, it remains difficult to predict the clinical behaviour of individual tumours and no single risk stratification scheme is endorsed or in widespread use. In this review, we provide an update on advances in the pathology and genetics of PHEO/PGL with an emphasis on the changes introduced in the WHO 2017 classification of endocrine neoplasia relevant to practising surgical pathologists.     

Alterations of regular and mature monocytes are distinct,and dependent of intensity and duration of exercise

Circulating monocytes comprise functionally distinct regular (CD14^bright+) and mature (CD141^low+) cells. Cell surface receptors were determined by three colour flow cytometry in 8 healthy control subjects. Compared to regular monocytes, mature monocytes had lower levels of the high affinity Fcy receptor 1 (CD64), complement receptor 3 (CDllb), CD45RO and higher levels for HLA-DR, LFA-1 (CD11a/CD18), interleukin-2 receptor (CD25), CD45RA and the Fc receptor 3 (CD16). Both regular and mature monocytes were measured before and up to three hours after four different types of exercise (Ex) in endurance trained athletes (n=9-16). Immediately after anaerobic exercise of I min with a maximal lactate concentration (la_max) of I2.3 (SD I.4) mmol · l^–1 and exhaustive exercise of 24 (SD 8) min with a maximal lactate concentration (la_max) of 7.4 (SD 2.6) mmol· l^–1 mature monocytes increased more than regular monocytes. Exhaustive endurance exercise of 87 (SD 21) min [la_max 3.7 (SD I.0)] led to a similar increase of regular and mature monocytes. 15–33 min after a 100km run regular monocytes increased significantly, whereas mature monocytes decreased. Up to three hours after the end of all exercises mature monocytes fell below pre-exercise values. In conclusion, duration and intensity of exercise alter distinct maturation stages of monocytes differently. It is probable that the avidity of adhesion molecules like LFA-1 to their endothelial ligands is increased to enable the firm attachment to the endothelium.     

Pre- and postnatal development of catecholamine-containing and cholinesterase-positive nerves of the rat cornea and iris

Summary Glyoxylic acid-induced fluorescence technique and a copper thiocholine method were used to investigate the ontogenesis of the catecholamine-containing and cholinesterase-positive nerves of the rat iris and cornea.First fluorescent nerve fibres appeared in the iris on the 18th gestation day and in the cornea on the 19th day. A rapid increase in the density of the adrenergic nerve fibres of the iris continued to the age of three weeks, while the number of such fibres were small in the cornea.Acetylcholinesterase-positive fibres appeared both in the cornea and in the iris on the 19th gestation day. Their density increased more rapidly in the iris, especially in the sphincter muscle, than in the cornea.Non-specific cholinesterase activity was localized in the Schwann cells and the reaction was more intense during development than in the nerves of the cornea of adult rats.     

韧带和肌腱的生物力学和力学生物学研究

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