HCV NS3Ag: a reliable and clinically useful predictor of antiviral outcomes in genotype 1b hepatitis C virus-infected patients

Since hepatitis C virus (HCV) non-structural 3 (NS3) protease inhibitor (PI) combined with pegylated interferon/ribavirin (PR) has been approved for chronic HCV genotype (GT) 1b infection, a reliable and clinically useful predictor combining with serum HCV RNA to predict early virologic response, breakthrough, and relapse is important during HCV antiviral treatment. We evaluated the role of HCV NS3 antigen (HCV NS3Ag) on the prediction of virologic response in patients with HCV GT1b during PR or PR/simeprevir (triple) therapy. Three hundred patients were recruited, and HCV RNA and HCV NS3Ag were tested at baseline and weeks 2, 4, 12, 24, 48, and 72. NS3Ag and HCV RNA were significantly related (r² = 0.67) in the whole patient selection. The kinetic pattern of HCV RNA and HCV NS3Ag during triple treatment was similar. HCV NS3Ag levels in the triple group closely followed those of HCV RNA; the r² values were 0.756 (baseline), 0.837 (2 weeks), 0.989 (4 weeks), and 0.993 (12 weeks), respectively. For patients treated with PR, the positive and negative predictive values (PPVs and NPVs) for viral response were 96.31 % and 67.19 %, respectively, at week 4 by using the decrease of NS3Ag (dHCV NS3Ag) combined with HCV RNA. At week 12, the PPV was similar at 94.16 %, while the NPV reached 87.26 %. The PPV and NPV for the prediction of relapse and breakthrough were 90.6 % and 76.7 %, respectively. HCV NS3Ag is a valuable marker and could be a supplementary predictor of HCV RNA for the prediction of antiviral response, breakthrough, or relapse during HCV antiviral treatment.     

肝衰竭诊疗:进展与展望

肝衰竭( liver failure)是各种肝病中发展最快、病情危重、病死率很高的疾病类型.本文就其近年主要的诊疗进展做一回顾和展望. 1 肝衰竭命名与分类的发展 在2000年全国病毒性肝炎会议制定的《病毒性肝炎防治方案》中,把"重型肝炎"分为三型,即急性重型肝炎、亚急性重型肝炎、慢性重型肝炎[1].     

失代偿期乙型肝炎肝硬化抗病毒治疗耐药增加肝细胞癌风险研究

目的分析失代偿期乙型肝炎肝硬化患者队列肝细胞癌(hepatocellular carcinoma,HCC)发生的危险因素及抗病毒方案的优化。方法选择2008年1月—2011年10月随访2年的193例乙型肝炎肝硬化患者队列,包括拉米夫定(LAM)组29例、阿德福韦(ADV)组57例、替比夫定(LDT)组30例、恩替卡韦(ETV)组38例及对照组39例。按HCC发生前是否耐药将接受抗病毒治疗患者分为耐药组(31例)和无耐药组(123例),分析各组Child-Pugh评分、病毒学指标、耐药率、HCC发生率、患者生存率及安全性。结果各抗病毒治疗组在随访2年时Child-Pugh评分较基线均显著下降(P均<0.05);血清HBVDNA水平明显低于基线值,各组HBeAg血清学转换率和HBeAg阴转率差异无统计学意义;ETV组累计2年耐药率低于LAM组、ADV组和LDT组(P均<0.05);抗病毒治疗各组及对照组间累计2年HCC发生率、患者生存率差异无统计学意义,但耐药组HCC发生率明显高于无耐药组和对照组(P均<0.05);在2年随访中各组均未出现严重肌病等不良反应。结论 ETV治疗失代偿期乙型肝炎肝硬化疗效优于其他单药治疗,抗病毒治疗耐药可增加HCC发生风险。     

AIDS相关肺部疾病研究进展

HIV感染相关肺部疾病是引起AIDS患者发病和死亡的重要原因,其疾病谱甚广,包括感染性和非感染性肺部疾病。本文对AIDS患者常见肺部疾病的研究进展进行综述。     

Vaccines and the risk of acute disseminated encephalomyelitis

BackgroundIt is important to examine the risk of Acute disseminated encephalomyelitis (ADEM) after vaccination.MethodsWe conducted a nested case–control study between January 2011 and December 2015. Four controls per case were matched for age, gender, address. An independent expert committee validated the diagnoses of cases and controls. Data on vaccinations were obtained from computerized vaccination records. The analyses were conducted with the use of conditional logistic regression.ResultsThe analyses include 272 cases of ADEM and 1096 controls. No increase in the risk of ADEM was observed for vaccination against hepatitis B, influenza, polio(live), diphtheria, pertuss(acellular), tetanusis, measles, mumps, rubella, Japanese Encephalitis, meningitis, hepatitis A, varicella and rabies vaccines. Vaccine was associated with a statistically significant increase in risk in the 31–60-day exposure interval (OR, 4.04 [95% CI, 1.07–12.69]), but not the 0–30 and 61–180-day interval. There was no association between vaccine received and the recurrence of ADEM.ConclusionsFindings from the present study do not demonstrate an association of vaccines with an increased risk of ADEM and its recurrence among either paediatric (≤18 years) or adult (>18 years) individuals within the 180 days after vaccinations. The finding in children in the 31–60 day risk interval is likely coincidental and was not confirmed in separate self-control analyses.     

肝硬化少见并发症的诊治

乳糜性及血性腹水、肝性胸水、少见病原菌感染的自发性腹膜炎、肝硬化心肌病、门静脉性肺动脉高压、肝硬化神经系统损伤等肝硬化少见并发症,临床医生尚缺乏充分的认识和/或及时有效的诊治。现介绍上述肝硬化少见并发症的临床特征、治疗及预后,以提高临床医生的认识和诊疗水平。     

沙盘推演案例教学法在新发感染病教学课程中的应用

目的观察沙盘推演案例教学法在新发感染病课程教学中的应用效果。方法选取2020年12月16日-12月25日于我院学习新发感染病的本科医学生80名，根据教学方法的不同，将学生随机分为对照组(n=40)和观察组(n=40)。对照组采用传统教学方法，观察组采用沙盘推演案例教学法，设计教学问卷，比较两组教学质量，并调查学生感兴趣的教学方法及对教学的满意度。 结果在教学质量方面，观察组学生在对新发感染病定义的认识、传播途径、流行的影响因素、防治对策等方面评分高于对照组，但差异未见统计学意义；观察组的新发传染病概论总分数高于对照组(514.4±75.9 vs. 463.4±77.3)，差异有统计学意义 (P<0.05)，观察组与对照组之间在对新型冠状病毒肺炎(89.5±21.6 vs. 93.1±20.6)及其他新发感染病(67.0±18.4 vs. 62.0±18.0)方面的认识程度评分差异无统计学意义。观察组学生对教学方法的满意度（97.5%）高于对照组（87.5%）。学生最感兴趣的教学方法是多种教学方式的组合(60%)，不拘泥于传统教学方式。 结论在新发感染病教学中采用沙盘推演案例教学法的教学模式效果理想，能提高一定的教学质量,但对于具体的新发感染病认知并不优于传统教学方法，故认为可将沙盘推演案例教学法与传统教学相结合同时应用。     

Advancing Medical Radiation Technologist-Led Scholarship: Practical Advice for Ensuring Success

Although it is true that the process of translating a research idea into a publishable scientific review article or a fundable research grant proposal takes time, hard work, and commitment, a success in such work is immensely satisfying. The aim of this article is to provide some practical advice to scholars aspiring to scientific writing and/or research in the medical radiation technologies. The importance of developing effective mentor/mentee relationships and, an understanding of research design and the evidence-based decision making process, to success in scholarship, is discussed. Suggestions for the development of these attributes are provided.     

医院SCI科技论文精细化管理的应用与探讨——基于文献计量学的可视化分析

目的  探讨医院科技论文精细化管理在提升科技论文发文数量与质量中的意义和价值。方法  以医院科技论文管理办法发布时间和管理特点为依据，将2011-2020年分为2011-2014年“粗犷”、2015-2016年“简单”、2017-2018年“绩效”、2019-2020年“精细”4个阶段，以Web of Science核心数据库（WOS）为数据来源，检索2011-2020年首都医科大学附属北京佑安医院和北京市肝病研究所为第一单位发表的SCI科技论文，利用文献计量学软件对各区段发表科技论文数量、影响力和主题演化进行可视化分析。结果  2011-2020年WOS共收录618篇论著和综述类论文，其中2011-2014年平均发文量为32篇；2015-2016年为53篇；2017-2018年为71篇，2019-2020年为112篇，发文量逐级递增。2011-2020年间标准化论文被引频次（NTC）>5的科技论文共有13篇，2011-2014年4篇、 2015-2016年0篇、2017-2018年5篇、2019-2020年4篇，论文影响力在逐级提升。主题演化分析显示，乙肝病毒、肝衰竭、肝硬化、肝细胞癌、艾滋病的临床和基础科学研究贯穿于2011-2020年，2011-2014年“粗犷”与2015-2016年“简单”阶段多集中于临床研究，2017-2018年“绩效”与2019-2020年“精细”阶段中临床与机制研究相融合，研究领域向多学科拓展。结论  科技论文的精细化管理促进了医院科技论文发表数量和影响力的提升，提升了医院的科研能力和创新水平，促进了医院优势学科发展和多学科的交叉融合。     

Nucleic acid vaccines for hepatitis B and C virus

Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections accounts for an important global health problem affecting over 250 million people all around the world. They can cause acute, transient and chronic infections in the human liver. Chronic infection of liver can lead to its failure or cancer. To deal with this problem, alternative approaches or strategies to inhibit these infections have already been started. DNA and mRNA-based vaccination will increase the efficacy and reduce toxicity in patients with Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections. Gene vaccines represent a promising alternative to conventional vaccine approaches because of their high potency, capacity for rapid development, low-cost manufacture and safe administration. MRNA-based vaccination is a method to elicit potent antigen-specific humoral and cell-mediated immune responses with a superior safety profile compared with DNA vaccines. Exploring the intricacies of these pathways can potentially help the researchers to explore newer vaccines. In this study, DNA and mRNA-based vaccination are introduced as an approach to treat Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections. DNA and mRNA-based vaccines as one of the most successful therapeutics are introduced and the clinical outcomes of their exploitation are explained.