ABSTRACT
Purpose: Through an observation on HBeAg-positive chronic hepatits B (CHB) patients in Telbivudine (LDT) treatment for 104 weeks, we tried to explore valuable early predictors for HBeAg seroconversion during the treatment. Materials and Methods: A prospective study lasting for 104 weeks was conducted, and the patients enrolled were administered with LDT 600 mg daily. The medical evaluation went every 12 weeks, then the age distribution, baseline ALT level, early HBVDNA, HBsAg and HBeAg levels at baseline, week 12 and 24 as well as the decrease of the three indicators at week 12 and 24 were analyzed for their predictive values for HBeAg seroconversion at week 104. Result: Thirty-three patients fi nished the observation. All patients got ALT normalisation and 28 patients (84.84%) got complete virological response (HBV DNA < 291 copies/ml) at week 104. Poor virological response and virologic breakthrough was observed in two (6.06%) and three patients (9.09%), respectively. Nine patients (27.27%) got HBeAg seroconversion. HBeAg levels and its decrease levels at week 12 and 24 showed signifi cant differences between patients with and without HBeAg seroconversion. And the HBsAg levels at week 12 and 24 showed tendencies of signifi cant differences in two groups. HBeAg level at week 24 was confi rmed related to its longer term seroconversion in regression analysis. The patients with HBeAg level < 2.1 S/CO at week 24 would be more possible to get HBeAg seroconversion at week 104, with sensitivity, specifi city, positive and negative predictive value of 95.83%, 88.89%, 95.8% and 88.9%, respectively. Conclusion: Good effi cacy of long-term LDT treatment in biological and virological response and its advantage in serological response was confi rmed again in our study. The HBeAg level at week 24 showed signifi cant value in prediction for HBeAg seroconversion at week 104 compared to other serological markers in the early period.
ABSTRACT
Gas gangrene is an emergency condition,which usually develops after injuries or surgery.This study was designed to investigate clinical characteristics,appropriate therapy,and effective control of nosocomial cross-infection of gas gangrene in Wenchuan earthquake victims.Data on diagnosis,treatment,and prevention of confirmed,suspected,or highly suspected gas gangrene were collected.Sixty-seven (2.41％) cases of suspected gas gangrene were found,in which 32 cases were highly suspected of gas gangrene and 5 cases were confirmed by culture of Clostridium perfringens.Thereof,injury sites were mainly located on the limbs,and typical indications,including crepitation,severe localized pain,swelling,wound discoloration,dark red or black necrotic muscle,foul smell as well as different degrees of systemic toxic performance were common among them.After hospitalization,all patients were isolated and had surgery quickly to remove dead,damaged or infected tissue.The wounds were also exposed for drainage and washed or padded with 3％ liquid hydrogen peroxide for disinfection before all diagnostic test results were available.Additionally,high doses of antibiotics (mainly penicillin) were given for the prevention of infection,and supportive therapy was applied for corresponding symptoms control.Among those cases,no fatality was reported.In summary,in post-disaster emergency relief,the diagnosis of gas gangrene should be primarily based on clinical manifestations; while patient isolation,wound debridement and disinfection,as well as antibiotics treatment,is the main measures for proper treatment and control of nosocomial infection for gas gangrene.