Urgency to treat patients with chronic hepatitis C in Asia

Chronic hepatitis C (CHC) infection poses a global healthcare burden, being associated with serious complications if untreated. The prevalence of hepatitis C virus (HCV) infection is highest in areas of Central, South, and East Asia; over 50% of HCV patients worldwide live in the region, where HCV genotypes 1b, 2, 3, and 6 are the most prevalent. Treatment outcomes for chronic hepatitis C vary by ethnicity, and Asian patients achieve higher sustained virologic response rates following interferon (IFN)‐based therapy than non‐Asians. However, low efficacy, poor safety profile, and subcutaneous administration limit the use of IFN‐based therapies. Superior virologic outcomes have been observed with different classes of direct‐acting antivirals (DAAs) alone or in combination, and several all‐oral DAA regimens are available in Asia. These regimens have shown excellent efficacy and favorable tolerability in clinical trials, yet there is a need for further studies of DAAs in a real world context, particularly in Asia. Furthermore, IFN‐free treatment may not be accessible for many patients in the region, and IFN‐based regimens remain an option in some countries. There is a need to improve current clinical practices for HCV management in Asia, including effective screening, disease awareness, and prevention programs, and to further understand the cost‐effectiveness of IFN‐free regimens. The evolution of potent treatments makes HCV eradication a possibility that should be available to all patients. However, access to these therapies in Asian countries has been slow, primarily because of economic barriers that continue to present a hurdle to optimal treatment.     

Development of clinical genetics in Asia

This Special Issue on Clinical Genetics in Asia highlights a collection of articles showing the growth, development, and current status of clinical genetics in Asia. In this Introduction, the Guest Editors share on the themes of this issue to provide useful insights into the rapid growth of genomics and clinical genetics in this region. The contents of this Issue cover a range of topics from the history and development of clinical genetics in Asia to studies on disorders with clinical significance or phenotype differences in the Asian populations to the status of precision medicine. The goal is to provide a glimpse of how significantly the field of genetics in Asia has developed in recent years with the aspiration that this can serve as a catalyst to increase international collaboration and cooperation in combating genetic diseases. We hope that this issue shows Asia's readiness and willingness to be a part of more international conversations about genetics in future.     

亚洲健康人群CYP2C79等位基因发生率的合并分析

目的 对亚洲人群CYP2C19等位基因发生率的相关文献进行合并分析,为个体化药物治疗和药物基因组学研究提供依据。方法 计算机检索PubMed、EMbase、Cochrane图书馆、CNKI、WanFang Data、VIP和CBM等数据库,纳入CYP2C19等位基因发生率的相关文献。按照纳入与排除标准筛选文献、提取数据后进行合并分析。结果 共纳入41篇文献,包含17个国家9 841例健康亚洲人的CYP2C19等位基因的信息。按东亚（中国、韩国和日本）、东南亚（越南、泰国、马来西亚、新加坡、缅甸、印度尼西亚和菲律宾）、南亚（印度）和西亚（巴勒斯坦、黎巴嫩、沙特阿拉伯、土耳其、伊朗和约旦）分区域进行分析,主要研究结果如下：CYP2C19＊1、＊2和＊3等位基因的发生率,中国人群（n=4 170）分别为61.3%、32.1%和6.6%;东亚人群（n=5 879）分别为61.0%、31.2%和7.8%;东南亚人群（n=1 985）分别为67.6%、28.8%和3.7%;南亚人群（n=679）分别为64.0%、35.2%和0.8%;西亚人群（n=1 298）分别为87.3%、12.1% 和0.6%;亚洲以上四个地区17个国家9 841例CYP2C19＊1、＊2和＊3等位基因的总发生率分别为66.0%、28.4%和5.5%。结论 CYP2C19各等位基因的发生率在我国及亚洲不同区域之间均存在较大差异（P〈0.05）,且遗传变异也会受地域环境的影响。     

Medical Eschatologies: The Christian Spirit of Hospital Protocol

ABSTRACT

If much has been written of the forms of bodiliness reinforced by hospitals, less attention has been paid to the medicalization of the soul. The medical management of death institutionalizes divisions between body and soul, and matter and spirit, infusing end-of-life care with latent Christian theological presumptions. The invisibility of these presumptions is partly sustained by projecting religiosity on those who endorse other cosmologies, while retaining for medicine a mask of secular science. Stories of conflict with non-Christian patients force these presumptions into visibility, suggesting alternative ethics of care and mourning rooted in other understandings. In this article, I explore one such story. Considering the story as an allegory for how matter and spirit figure in contemporary postmortem disciplines, I suggest that it exposes both the operation of a taboo against mixing material and spiritual agendas, and an assumption that appropriate mourning is oriented toward symbolic homage, rather than concern for the material welfare of the dead.     

亚洲和美洲的并殖吸虫的螺类宿主

本评述涉及全球（非洲除外）的并殖吸虫螺类宿主。５８种螺的名录中有６７％螺报道于中国。多属圆口螺科（ｐｏｍａｔｉｏｐｓｉｄａｅ）的圆口螺亚科（Ｐｏｍａｔｉｏｐｓｉｎａｅ）的洱海螺族（Ｅｒｈａｉｉｎｉ）或拟钉螺亚科（Ｔｒｉｃｕｌｉｎａｅ）。文中对一些名称和概念上的问题作了澄清。     

Perspectives on Australian Animal Health Aid Projects in South‐East Asia

Future food security poses many challenges and with increasing prosperity and demand for meat, the emerging but largely unregulated trade in livestock and their products from developing countries in South‐East Asia and particularly the Mekong region, pose enormous risks of transboundary disease epidemics. However this is a challenge that should be met as substantial improvements in large ruminant production through appropriate knowledge‐based interventions can potentially move the largely rural smallholder populations of Lao PDR and Cambodia from subsistence to a productivity focus, offering a new pathway for poverty alleviation. Large development projects have been implemented in the Mekong region to facilitate this process and research is needed to define problems, identify and test solutions, and then suggest the most appropriate delivery mechanisms for promulgating the interventions that are most sustainable. Animal health aid projects are needed to improve livestock productivity, minimize risk to trade and human health and enhance the capacities of countries where there are significant gaps in the provision of veterinary services. Improving large ruminant production, particularly through forages technology and infectious disease risk management including village‐level biosecurity, provides a potential driver of foot and mouth disease (FMD) control and eventual eradication in the region. A perspective on issues involved in Australian aid projects addressing regional animal health research and development and a checklist of strategies to consider when designing and managing such projects is provided.     

The equivalence of English and Chinese SF-36 versions in bilingual Singapore Chinese

Objective: To assess the equivalence of English and Chinese versions of the SF-36. Methods: Using a crossover design with block randomisation and stratification by age, identical English or Chinese questionnaires containing the English (UK) and Chinese (HK) SF-36 versions were administered 3–16 days apart to 168 free-living, bilingual, ethnic Chinese volunteers in Singapore. Item level equivalence of both versions was assessed by comparing item means and orderings within each scale. Scale level equivalence was assessed by comparing internal consistency (Cronbach's ), results of factor analysis and mean scale scores (using paired t-tests and intra-class correlations). Results: Item and scale level comparisons supported the equivalence of both versions. For both the versions, item means, item ordering and Cronbach's were similar, and factor analysis yielded two factors with similar factor loadings. There was no clinically important difference in mean scale scores for seven of eight scales, and intra-class correlations were excellent/good for five scales (0.69–0.77) and moderate for three scales (0.55–0.57). Conclusion: English (UK) and Chinese (HK) SF-36 versions are equivalent in bilingual Singapore Chinese. Our data suggest that SF-36 scores from English- and Chinese-speaking subjects may be combined in studies using the SF-36, increasing the power and representativeness of such studies.