阿德福韦酯抗病毒疗效与乙型肝炎病毒基因型的关系

应答无显著差异,提示HBV基因型可能对ADV的疗效无影响.     

无抽搐电痉挛与电痉挛治疗对记忆影响的对照研究

目的：探讨无抽搐电痉挛对记忆的影响。方法：将入组病例随机分为两组，分别施行无抽搐电痉挛治疗与电痉挛治疗，以修订韦氏记忆量表（ＷＭＳ）与简明精神病评定量表（ＢＰＲＳ）作为评定工具，比较两组之间的记忆水平及疗效。结果：无抽搐电痉挛对记忆无明显影响，电痉挛对记忆的影响持续两周以上，电痉挛对记忆的影响可能与大脑短时间缺氧有关。结论无抽搐电痉挛不影响患者记忆，治疗时患者不感到痛苦，易于接受，可替代电痉挛治疗     

脑干胶质瘤引起双眼内斜视一例

病例报告:男性,11岁,因双眼内斜视,头晕伴呕吐40天于1997年5月16日入院。患者于40天前上午无明显诱因出现双眼内斜视,伴头晕呕吐,呕吐呈非喷射状,呕出胃内容物少许,无咖啡样液体。有视物成双现象,无视物旋转,无耳鸣。之后,逐渐出现双下肢无力,行走不稳。于病后2周在湘阴县人民医院行CT检查无异常发现。起病以来,无发热、头痛,无大小便失禁、食纳差、有饮水呛咳、吞咽困难现象。体重无减轻。学习成绩、智力无改变,视力无明显下降,无其它特殊病史可询。     

排忧解难

接受“无抽搐”治疗前要注意些什么？ Q：我的父亲是一个抑郁症患者。医生说要采用“无抽搐”的治疗方法。接受这种治疗,患者会痛苦吗？在治疗前我们家属需要怎样配合？     

延迟小剂量尿激酶治疗脑梗塞

静脉溶栓治疗是脑梗塞的有效治疗方法之一 ,然而大多数患者入院时已超过溶栓“治疗时间窗”,我们自 1998年至今对发病超过该时间窗的急性脑梗塞患者应用小剂量尿激酶静脉点滴 ,治疗效果满意 ,现报导如下。1　资料与方法1.1　病例选择与分组所有病例均符合全国第四届脑血管病学术会议制订的脑梗塞的诊断标准 〔1〕,并符合以下几点 :1均为颈内动脉系统病变 ;2血压在 16～ 2 6 / 11～ 13k Pa;3无脑出血史 ,近 6个月无脑梗塞史 ;4无出血性疾病 ;5无昏迷 ;6年龄 <75岁 ;7发病在 72 h内 ;82 4h内未用过其它抗凝剂 ;9无严重心、肝、肾疾病 ;10头颅…     

慢性前列腺炎封闭治疗的临床分析

目的探讨慢性前列腺炎封闭治疗的经验及临床效果。方法回顾性分析2009年1月至2010年我院经会阴部行前列腺穿刺封闭治疗慢性前列腺炎患者41例的临床资料。结果 20例伴有排尿困难、尿频的患者中,排尿症状完全消失者为16例,2例症状减轻,2例无明显变化。18例伴有耻骨上区、会阴部坠胀不适的患者中,症状消失者8例,症状减轻者5例,无明显变化者5例。10例滴白,伴性功能减退患者中,症状消失者2例,无明显变化者8例。无一例患者出现发热或畏寒。结论慢性前列腺炎封闭治疗效果好、并发症少,手术操作简便。     

慢性前列腺炎封闭治疗的临床分析

目的 探讨慢性前列腺炎封闭治疗的经验及临床效果.方法 回顾性分析2009年1月至2010年我院经会阴部行前列腺穿刺封闭治疗慢性前列腺炎患者41例的临床资料.结果 20例伴有排尿困难、尿频的惠者中,排尿症状完全消失者为16例,2例症状减轻,2例无明显变化.18例伴有耻骨上区、会阴部坠胀不适的患者中,症状消失者8例,症状减轻者5例,无明显变化者5例.10例滴白,伴性功能减退患者中,症状消失者2例,无明显变化者8例.无一例患者出现发热或畏寒.结论 慢性前列腺交封闭治疗效果好、并发症少,手术操作简便.     

整体护理提高小儿高压氧治疗成功率的探讨

目的：总结小儿高压氧安全治疗的护理方法与体会。方法对73例小儿在高压氧的治疗前、中、后进行有效护理。结果无1例中途治疗失败而出舱,无并发症。结论有效护理对小儿高压氧治疗提高成功率。     

肺原发性脑膜瘤一例

患者男 ,5 0岁。因无明显诱因咯痰带血 10ｄ ,于 2 0 0 1年1月 11日到我院就诊。患者有 2 0余年吸烟历史 ,2 0支 /日 ,嗜好饮酒 ,平素身体健康 ,发病后无消瘦乏力。入院时全身皮肤粘膜无黄染 ,浅表淋巴结不肿大。胸廓无畸形 ,双侧肺扩张度均等 ,语颤无增强或减弱 ,呼吸音清、未闻及音。Ｘ线检查见右肺下野与心右缘重合处有一片状致密阴影 ,双侧肋膈角清晰。ＣＴ检查见右肺下叶后基底段有软组织块影 ,密度略有不同 ,周边见短毛刺 ,增强后有强化 ;纵隔未见肿大淋巴结。Ｂ超检查腹腔脏器无异常。中枢神经系统检查未见异常。临床诊断“右肺周…     

不明原因的低血钾

患者男性67岁,因进行性肌无力就诊.1月前曾被诊断为高血压,未予治疗.无恶心、呕吐、腹泻或利尿剂使用史,有良性前列腺肥大史(BPH),无其他疾病或家族史.血压165/95mmHg,心率76次/分,呼吸14次/分,体温36.5 ℃,体重65kg,身高164cm,除对称性上下肢无力外,查体无异常.血液检查示:低钾血症,(K+2.2mmol/L),代谢性     

Genotypic dominance and novel recombinations in HBV genotype B and C co-infected intravenous drug users

Pathogenic differences among hepatitis B virus (HBV) genotypes have been documented. However, the interaction between different HBV genotypes remains unclear. Herein, we chose HBV genotypes B (HBV/B) and C (HBV/C) co-infected intravenous drug users to study this issue. HBV genotype was determined in 40 HBsAg, anti-HCV, and anti-HDV co-positive intravenous drug users by using genotype-specific primers. The distribution of HBV genotype was as follows: HBV genotype B alone in 29 (72.5%); HBV genotype C alone in 4 (10.0%); and mixed HBV genotype B and HBV genotype C in 7 (17.5%). The interaction between HBV genotype B and HBV genotype C within the same individual was further studied in the seven intravenous drug users with HBV genotype B and HBV genotype C co-infection. By direct sequencing of the pre-S region, only HBV genotype B was detected. When 10-21 clones of the pre-S region were propagated from each intravenous drug user and sequenced, most of the clones were HBV genotype B. Novel recombinations between HBV genotype B and HBV genotype C occurred in four clones (M7-5, M1-10, M1-21, and M1-24) from two intravenous drug users (M7 and M1). The recombination breakpoints were estimated at nucleotide 3120-3171 for M7-5, at nucleotide 3060-3191 for M1-10, and at nucleotide 2910-2950 for M1-21 and M1-24 by SimPlot program. The recombination sites of these HBV/pre-S C-B and B-C recombinants may be within the pre-S1 region. The results in this study suggest that HBV/B is the dominant strain in HBV genotypes B and C co-infected intravenous drug users in Taiwan, and recombinations between different HBV genotype are not unusual. The impact of recombination on the evolution of HBV and their clinical significance remains to be studied.     

乙型肝炎病毒D基因型系统进化树分析

目的：研究HBV D基因型不同毒株全基因进化关系。方法：用聚合酶链式反应（PCR）、克隆及核酸序列测定的方法，测定了1例中国人慢性无症状携带者感染的乙型肝炎病毒D基因型全基因序列。此D基因型毒株全基因序列GenBank Accession为AF280817，将GenBank中已发表的HBV D基因型30株的全序列进行了系统进化树分析。结果：中国株HBV D基因型与源于瑞典（Sweden）的4株HBV D基因型全基因的进化距离最近；地中海地区及欧洲国家系HBV D基因型分布的优势地域，亚洲并非HBV D基因型分布的优势地域。结论：HBV D基因型病毒株传入来源、迁移的方向不同以及病毒株在具有不同遗传和免疫特质的宿主中的长期选择是形成HBV D基因序列病毒进化差异的原因。     

中国30个地区HBV基因型分布特点和临床意义

目的 了解中国乙型肝炎病毒感染者中HBV基因型的分布特点和临床意义.方法 应用型特异性引物聚合酶链反应法,对中国30个省市自治区共2922份HBV感染者血清标本进行基因型检测,同时检测相关病毒学及肝功能生化指标,分析基因型分布特点及临床意义.结果 2922例HBV感染者中,B、C、B/C、D基因型分别占15.9%、83.5%、0.41%、0.21%,未发现其他基因型.北方地区C基因型占绝大多数,南方地区浙江、江苏地区以C基因型为主,广东、湖南、湖北、江西以B基因型为主.B基因型较C基因型HBV感染者平均年龄小(P<0.001);C基因型HBV感染者HBeAg阳性率较B基因型高(P=0.023);B基因型HBV感染者乙型肝炎病毒载量较C基因型高(P=0.038);C基因型HBV感染者CHE、ALB较低,差异有统计学意义(P值分别为0.016).结论 中国HBV基因型以B、C基因型为主,仅少量的B/C和D基因型.北方地区以C基因型为主,南方地区C基因型明显减少,部分南方地区以B基因型为主.C基因型HBV感染者年龄较大、HBeAg阳性率高、HBV DNA载量低,病情较重.     

中国30个地区HBV基因型分布特点和临床意义

目的 了解中国乙型肝炎病毒感染者中HBV基因型的分布特点和临床意义.方法 应用型特异性引物聚合酶链反应法,对中国30个省市自治区共2922份HBV感染者血清标本进行基因型检测,同时检测相关病毒学及肝功能生化指标,分析基因型分布特点及临床意义.结果 2922例HBV感染者中,B、C、B/C、D基因型分别占15.9%、83.5%、0.41%、0.21%,未发现其他基因型.北方地区C基因型占绝大多数,南方地区浙江、江苏地区以C基因型为主,广东、湖南、湖北、江西以B基因型为主.B基因型较C基因型HBV感染者平均年龄小(P<0.001);C基因型HBV感染者HBeAg阳性率较B基因型高(P=0.023);B基因型HBV感染者乙型肝炎病毒载量较C基因型高(P=0.038);C基因型HBV感染者CHE、ALB较低,差异有统计学意义(P值分别为0.016).结论 中国HBV基因型以B、C基因型为主,仅少量的B/C和D基因型.北方地区以C基因型为主,南方地区C基因型明显减少,部分南方地区以B基因型为主.C基因型HBV感染者年龄较大、HBeAg阳性率高、HBV DNA载量低,病情较重.     

中国30个地区HBV基因型分布特点和临床意义

目的了解中国乙型肝炎病毒感染者中HBV基因型的分布特点和临床意义。方法应用型特异性引物聚合酶链反应法,对中国30个省市自治区共2922份HBV感染者血清标本进行基因型检测,同时检测相关病毒学及肝功能生化指标,分析基因型分布特点及临床意义。结果2922例HBV感染者中,B、C、B／C、D基因型分别占15．9％、83．5％、0．41％、0．21％,未发现其他基因型。北方地区c基因型占绝大多数,南方地区浙江、江苏地区以c基因型为主,广东、湖南、湖北、江西以B基因型为主。B基因型较c基因型HBV感染者平均年龄小（P〈0．001）;C基因型HBV感染者HBeAg阳性率较B基因型高（P=0．023）;B基因型HBV感染者乙型肝炎病毒载量较c基因型高（P=0．038）;C基因型HBV感染者CHE、ALB较低,差异有统计学意义（P值分别为0．016）。结论中国HBV基因型以B、c基因型为主,仅少量的B／C和D基因型。北方地区以c基因型为主,南方地区c基因型明显减少,部分南方地区以B基因型为主。c基因型HBV感染者年龄较大、HBeAg阳性率高、HBVDNA载量低,病情较重。     

Determination of hepatitis B virus genotype G by polymerase chain reaction with hemi-nested primers

Hepatitis B virus (HBV) has been classified into six genotypes designated A-F by sequence divergence in the entire genome exceeding 8%. Very recently, the seventh genotype was reported and named genotype G. HBV genotype G is distinct from genomes of the other six genotypes in that it possesses an insertion of 36 nucleotides in the core gene, and has been found so far in France and the United States. A method for determining HBV genotype G was developed by polymerase chain reaction (PCR) with primers deduced from the 36-nucleotide (nt) insertion in five isolates of HBV genotype G the sequences of which have been deposited in DNA databases. The validity of this method, for specifically detecting HBV genotype G, was verified on a panel consisting of 142 HBV isolates of six major genotypes and four of genotype G. A total of 540 sera containing HBV in Japan covering symptom free carriers and patients with a spectrum of chronic liver disease were tested by this method, but not a single HBV genotype G sample was found. A possible method for serological determination of hepatitis B surface antigen of genotype G is suggested, without amplification or sequencing nucleotides, which would expand epidemiological and clinical researches on HBV genotype G.     

Response to antiviral treatment in patients infected with hepatitis B virus genotypes E–H

No data on antiviral response of HBV genotypes E–H are available so far although these HBV genotypes contribute significantly to the global HBV burden. Of 49 patients with HBV genotypes E–H, 23 received interferon (IFN)‐alpha, 12 nucleos(t)ide analogues and 14 patients were untreated. HBV genotype was determined by direct sequencing of the HBV S gene. Sustained virological response in IFN‐treated patients was defined as normalization of ALT and decrease of HBV‐DNA <4,000 IU/ml 6 months after treatment. Virological response with nucleos(t)ide analogues was assumed in patients with a HBV‐DNA <200 IU/ml after 48 weeks of treatment. HBV genotype E was found in 61.2% (n = 30), HBV genotype F in 8.2% (n = 4), HBV genotype H in 10.2% (n = 5) of patients. Among patients with HBV genotype G (20.4%; n = 10) there were four HBV genotype G/A and three HBV genotype G/C co‐infections. Patients had Caucasian (43%), African (55%), or Asian (2%) background. End of treatment response was 70% (16/23) and sustained virological response was 35% (8/23) for patients treated with IFN‐alpha. Sustained virological response was 36% for HBV genotype E (n = 5/14), 50% for HBV genotype F or H (n = 2/4), and 20% for HBV genotype G (n = 1/5). Virus suppression at week 48 was achieved in 67% of patients treated with nucleos(t)ide analogues. According to the present preliminary data HBV genotypes E, F, and H appear to be sensitive to IFN‐alpha. Lower rates of response to IFN‐alpha in patients with HBV genotype G might be related to the frequent occurrence of double infection. J. Med. Virol. 81:1716–1720, 2009. © 2009 Wiley‐Liss, Inc.     

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。     

High prevalence of occult hepatitis B virus infection in Taiwanese intravenous drug users

The epidemiology and impact of occult HBV infection in intravenous drug users remain largely unknown. The aim of the study was to investigate the prevalence of occult HBV infection among intravenous drug users in Taiwan. Molecular assays were used to determine the level of serum HBV DNA and the genotype in 304 intravenous drug users negative for both HBsAg and anti-HCV. Of 304 intravenous drug users, 125 (41.1%) were positive for serum HBV DNA. The genotype distribution of HBV was as follows: B, 55 (44%); C, 29 (23%); and mixed B and C infections, 41 (33%). The mean and median serum HBV DNA levels in 125 intravenous drug users with occult HBV infection were 4.0 +/- 0.6 and 4.0 log(10) copies/ml, respectively. The mean serum HBV DNA level in carriers with mixed genotype B and C infections was significantly higher than those infected with HBV genotype B or genotype C alone (mean, 4.2 +/- 0.6 log(10) vs. 3.9 +/- 0.5 log(10), and 3.9 +/- 0.7 log(10) copies/ml, P = 0.01 and 0.05, respectively). The amino acid sequence determination of HBV surface gene in 20 intravenous drug users with occult HBV infection selected at random showed no mutation of amino acid at codon 145. In conclusion, the prevalence of occult HBV infection and mixed HBV genotype infections are not uncommon in intravenous drug users residing in an HBV endemic areas. In addition, intravenous drug users with occult mixed genotype B and C infections have significantly higher viral loads than those with occult infection of single HBV genotype.     

Distribution of HBV genotypes and mutants among hepatitis B infected patients from northern Poland

Hepatitis B virus (HBV) infection is one of the major global epidemiological problems. The aim of our study was to determine the distribution of HBV genotypes in Poland since the data concerning the spread of HBV viruses in the central-eastern region of Europe is still very limited. HBV DNA was extracted from 58 serum samples. To quantify the level of HBV DNA the Roche Amplicor HBV Monitor Assay was used. To genotype and assign HBV subtypes DNA sequencing methods were performed. The HBV virus from 43 serum samples from hepatitis B infected patients was genotype A (74.1%), 12 cases had genotype D (20.7%), and 3 had the rare in Europe genotype F (5.2%). Prediction of HBV serological subtypes based on HBsAg sequencing showed almost 100% occurrence of subtype adw2 in the group of genotype A samples, three different subtypes in genotype D (ayw2, ayw3, and ayw4), and equal distribution of subtype adw4q- in all 3 cases of genotype F, also the most prevalent subtype in the Amerindians. Our results coincide with the general European HBV prevalence. However, HBV genotype F, which is not a common genotype in European countries, was detected and so was relatively high occurrence of genotype D, which may reflect historical and ethnical migration events in Poland in the past.