Significance of Prior Hepatitis B Virus Infection in the Development of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C

To clarify the clinical significance of prior hepatitis B virus (HBV) infection in the development of C-viral hepatocellular carcinoma (HCC), we conducted two studies: (1) Two hundred thirty-four patients with C-viral HCC and 320 patients with C-viral chronic liver disease without HCC admitted to our hospital between 1990 and 1994 were analyzed for the association of hepatitis B core antibody (HBcAb) positivity with HCC by multivariate logistic regression analysis, and this revealed HBcAb positivity as an independent risk factor for development of HCC adjusted for age and sex. (2) Four hundred fifty-nine patients with biopsy-proven hepatitis C virus-related chronic liver disease between 1986 and 1998 were enrolled in the cohort study and followed for the development of HCC. During an average follow-up of 6.6 ± 3.3 years, HCC developed in 63 patients, 37 of 160 patients positive for HBcAb and 26 of 299 patients negative for HBcAb. Multivariate Cox proportional regression analysis showed that the incidence of HCC increased by age, advanced stage of liver fibrosis, mean alanine aminotransferase value of more than 80 IU/liter, and positivity of HBcAb. Sustained virological responders after interferon therapy revealed a reduced risk for HCC development. In conclusion, prior HBV infection was shown to be one of the independent risk factors for development of HCC in C-viral chronic liver disease.     

Severe exacerbation of hepatitis after short‐term corticosteroid therapy in a patient with “latent” chronic hepatitis B

Abstract: We present a case of severe exacerbation of hepatitis after short‐term corticosteroid therapy for chronic inflammatory demyelinating polyneuropathy (CIPD) with “latent” chronic hepatitis B showing no HBV‐related antigens and antibodies. After corticosteroid pulse therapy for CIPD, the patient had severe exacerbation of hepatitis twice. Although she did not show any hepatitis B virus (HBV)‐related antigens or antibodies, sequences of HBV were detected in serum and liver by a nested polymerase chain reaction. A sequence analysis of HBV at the second exacerbation showed that the G‐to‐A point mutation at nucleotide 1896 that converted codon 28 from tryptophan (TGG) to a stop codon (TAG) in the precore region resulted in amino acid change, which has been frequently observed in fulminant hepatitis and severe hepatitis in Japan.     

开展监护室专科护士临床实践对普通护士核心能力的影响

目的 通过开展监护室专科护士临床实践,比较实践前后监护室普通护士的核心能力得分情况,来了解监护室专科护士临床实践对普通护士核心能力产生的影响。方法 以整群抽样法选择上海中山医院外科监护室60名普通护士为实验组、肝外科监护室60名普通护士为对照组,在外科监护室中开展专科护士临床实践,于实践前后分别对两组进行核心能力测评,比较分析两组在实践前后核心能力的得分情况。结果 实践前,两组核心能力得分在各维度上差异无统计学意义(P>0.05)。实践后,实验组在核心能力各个维度的得分均有提升,且高于对照组,差异有统计学意义(P<0.05)。结论 开展监护室专科护士临床实践可以有效提高普通护士的核心能力。     

股骨头坏死保头手术治疗的研究进展

股骨头坏死是多因素导致的病理生理过程。未经有效治疗的股骨头坏死患者中约80%在发病4年内出现股骨头塌陷。股骨头坏死的治疗方案应根据患者的病因和病程制定,早中期患者多可通过保头手术预防或延缓病情进展。保头手术主要包括髓芯减压术、植骨术、多孔钽棒置入术、截骨术、细胞因子或干细胞移植术。本文就上述治疗方法的研究进展作一综述。     

Prevention of perinatal hepatitis B transmission in Haimen City,China: Results of a community public health initiative

In regions where hepatitis B virus (HBV) is endemic, perinatal transmission is common. Infected newborns have a 90% chance of developing chronic HBV infection, and 1 in 4 will die prematurely from HBV-related liver disease. In 2010, the Hepatitis B Foundation and the Haimen City CDC launched the Gateway to Care campaign in Haimen City, China to improve awareness, prevention, and control of HBV infection citywide. The campaign included efforts to prevent perinatal HBV transmission by screening all pregnant women for hepatitis B surface antigen (HBsAg), following those who tested positive, and administering immunoprophylaxis to their newborns at birth. Of 5407 pregnant women screened, 185 were confirmed HBsAg-positive and followed until delivery. At age one, 175 babies were available for follow up testing. Of those, 137 tested negative for HBsAg and positive for antibodies to HBsAg, indicating protection. An additional 34 HBsAg-negative babies also tested negative for antibodies to HBsAg or had indeterminate test results, were considered to have had inadequate immune responses to the vaccine, and were given a booster dose. A higher prevalence of nonresponse to HBV vaccine was observed among babies born to hepatitis B e antigen (HBeAg)-positive mothers and mothers with high HBV DNA titers. The remaining 4 babies tested positive for HBsAg and negative for antibodies, indicative of active HBV infection. The mothers of all 4 had viral loads ≥8 × 10⁶ copies/ml in the third trimester. Although inadequate response or nonresponse to HBV vaccine was more common among babies born to HBeAg-positive and/or high viral load mothers, these risk factors did not completely predict nonresponsiveness. All babies born to HBV-infected mothers should be tested upon completion of the vaccine series to ascertain adequate protection. Some babies of HBeAg-positive mothers with high viral load may still become HBV infected despite timely immunoprophylaxis with HBV vaccine and HBIG.     

HCV-RNA检测在提高HCV感染患者检出率的试验研究

目的:探讨组合检测丙肝抗体和丙肝核心抗原并联合丙肝RNA在丙肝临床诊断中的意义。方法:对13 117例患者进行HCV抗体和HCV抗原组合检测,对两种方法中的阳性标本进行HCV-RNA确证检测。结果:13 117例患者中,丙肝抗体阳性188例,丙肝核心抗原阳性52例,其中丙肝抗体和核心抗原均阳性者48例,单独核心抗原阳性4例,总阳性数192例。丙肝抗体阳性188例中HCV抗体阳性标本中有121例HCV-RNA阳性,检出率为64.4%;有48例HCV-c Ag阳性,检出率为25.5%(48/188)。丙肝抗体和核心抗原均阳性者HCVRNA阳性45例,检出率为93.75%;单独核心抗原阳性4例中有3例HCV-RNA阳性,检出率75%。结论:抗-HCV和HCV-c Ag组合作为HCV感染初筛实验联合HCV-RNA确证检测,对HCV感染患者阳性检出率更高,假阳性率更低,可作为临床对HCV感染患者早期诊断和治疗的有效检验程序。     

PMMA-PAN核壳结构复合乳胶的制备与表征

采用疏水引发剂引发的半连续无皂乳液聚合法,合成了Z均流体力学直径约70 nm的聚甲基丙烯酸甲酯（PMMA）纳米乳胶。以PMMA纳米乳胶为种子,采用疏水引发剂引发的种子乳液聚合法,制备了PMMA 聚丙烯腈（PAN）核壳结构复合乳胶。采用动态光散射、傅里叶红外光谱、扫描电镜和透射电镜表征了各种乳胶粒的组成、尺寸、结构和微观形态。研究了反应温度、单体用量和表面活性剂用量对PMMA-PAN复合乳胶粒的结构和形态的影响。结果表明：PMMA PAN复合乳胶粒为核壳结构,其壳层厚度可通过改变单体用量进行调整。     

Effectiveness of Evidence-based Pneumonia CPOE Order Sets Measured by Health Outcomes

Objective

Evidence-based sets of medical orders for the treatment of patients with common conditions have the potential to induce greater efficiency and convenience across the system, along with more consistent health outcomes. Despite ongoing utilization of order sets, quantitative evidence of their effectiveness is lacking. In this study, conducted at Advocate Health Care in Illinois, we quantitatively analyzed the benefits of community acquired pneumonia order sets as measured by mortality, readmission, and length of stay (LOS) outcomes.

Methods

In this study, we examined five years (2007–2011) of computerized physician order entry (CPOE) data from two city and two suburban community care hospitals. Mortality and readmissions benefits were analyzed by comparing “order set” and “no order set” groups of adult patients using logistic regression, Pearson’s chi-squared, and Fisher’s exact methods. LOS was calculated by applying one-way ANOVA and the Mann-Whitney U test, supplemented by analysis of comorbidity via the Charlson Comorbidity Index.

Results

The results indicate that patient treatment orders placed via electronic sets were effective in reducing mortality [OR=1.787; 95% CF 1.170-2.730; P=.061], readmissions [OR=1.362; 95% CF 1.015-1.827; P=.039], and LOS [F (1,5087)=6.885, P=.009, 4.79 days (no order set group) vs. 4.32 days (order set group)].

Conclusion

Evidence-based ordering practices have the potential to improve pneumonia outcomes through reduction of mortality, hospital readmissions, and cost of care. However, the practice must be part of a larger strategic effort to reduce variability in patient care processes. Further experimental and/or observational studies are required to reduce the barriers to retrospective patient care analyses.     

An occult finding in heparin drip order set

Background: In 1998, the Institute of Medicine (IOM) noted that the American healthcare system had many problems. A major concern was the pervasiveness of medical errors. Electronic medical records (EMR) were introduced for myriad of reasons, one being to reduce these errors. Within the EMR, order sets have been shown to reduce variation in clinical practice and improve the quality of care. However, the lack of standardization in these sets enables peculiar orders, such as fecal occult blood test (FOBT) in the heparin drip order set at our hospital, to be surprisingly included. Our study was conducted to evaluate the consequences associated with having FOBT in this order set. Methods: A retrospective study of 898 adult hospitalized patients over a 6-month period, who had a heparin drip ordered at a single academic center, was conducted. The main focus of our study was the 130 patients for whom the FOBT was sent. Results: Fifteen percent (n = 130) of patients started on IV heparin had FOBT sent, of which 33 (25%) came back positive. Approximately one-third (36%) of the positive results were documented by a provider, either in a progress note or discharge summary. In eight instances of a positive FOBT (24%), the heparin drip was stopped. For 10 patients with a positive test (30%), gastroenterology was consulted, and 4 (12%) patients had inpatient endoscopy. Five patients with positive FOBT died while in the hospital (15%) as compared to seven patients (7%) in the negative FOBT group, p < 0.05. Conclusions: Most patients started on heparin did not have FOBT tested, and the results changed management infrequently, even when positive. The regular review of all order sets is imperative to ensure that they remain evidenced-based and sensible.