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Objective:To establish an index system for evaluating the employment quality of medical students in universities.Methods:Literature review and expert consultation methods were used to formulate preliminary evaluation indicators. Nine experts were selected to conduct three rounds of correspondence through Delphi method, and the indicators and the weights of the first, second and third levels were determined. Excel 2016 and SPSS 22.0 were used to make data entry and analysis.Results:The effective recovery rate of the questionnaire was 100.0%, the average expert authority coefficient was 0.749(>0.700), and the expert coordination coefficients were 0.228 and 0.212 ( P<0.001). Finally, an evaluation index system for the employment quality of medical students in universities was constructed, which was composed of 5 first-level indicators, 31 second-level indicators and 66 third-level indicators. Among them, the weights of the first-level indicators were 0.283, 0.250, 0.200, 0.108 and 0.158, respectively. Conclusion:The employment quality evaluation index system for medical students constructed in this study is systematic, comprehensive and multi-dimensional, which can provide a reference for the evaluation on medical graduate employment quality, and its scientificity and practicability need to be further explored in empirical research.
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This study firstly reviews the history and current situation of course construction, then combines closely with the objectives and the summary of current situation of the standardized residency training, and finally puts forward concrete countermeasures from the several angles, such as teaching objectives, teaching team development, teaching content and forms, as well as evaluation mechanism, advocating the promotion of problem-based learning (PBL), medical simulation teaching (MST), literature discussion and other teaching methods, encouraging the integration of humanities education and clinical guidelines into teaching, and adopting objective structured clinical examination + standardized patient (OSCE+SP) assessment method and conducting two-way assessment, so as to assist in the education development of the standardized residency training.
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The main lysosomal protease cathepsin D (cathD) is essential for maintaining tissue homeostasis via its degradative function, and its loss leads to ceroid accumulation in the mammalian nervous system, which results in progressive neurodegeneration. Increasing evidence implies non-proteolytic roles of cathD in regulating various biological processes such as apoptosis, cell proliferation, and migration. Along these lines, we here showed that cathD is required for modulating dendritic architecture in the nervous system independent of its traditional degradative function. Upon cathD depletion, class I and class III arborization (da) neurons in Drosophila larvae exhibited aberrant dendritic morphology, including over-branching, aberrant turning, and elongation defects. Re-introduction of wild-type cathD or its proteolytically-inactive mutant dramatically abolished these morphological defects. Moreover, cathD knockdown also led to dendritic defects in the adult mushroom bodies, suggesting that cathD-mediated processes are required in both the peripheral and central nervous systems. Taken together, our results demonstrate a critical role of cathD in shaping dendritic architecture independent of its proteolytic function.
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Objective@#To explore the association between the efficacy of peg-IFN and the complexity of TP and RT regions of hepatitis B virus (HBV) in chronic hepatitis B.@*Methods@#Patients with HBeAg positive, HBV DNA positive chronic hepatitis B were given peg-interferon 180 μg once a week for subcutaneous injection, and baseline information was collected from baseline and after 12 weeks’ treatment. The baseline HBV DNA TP and RT fragments were amplified, database, high-throughput sequencing, and the average genetic distance calculation.@*Results@#Data of 108 patients were analyzed by logistic regression. RT area fragment Markov distance and TP area fragment Shannon quotient for HBV DNA response were calculated. ALT level is good for HBeAg response. HBsAg level is bad for HBsAg response.@*Conclusions@#The complexity of the baseline TP and RT regions may be associated with the efficacy of peg-interferon therapy for CHB.
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Objective@#To investigate the differences in frequency and function of natural killer cells (NK) between chronic hepatitis B (CHB) and acute hepatitis B (AHB).@*Methods@#Patients with AHB and those with CHB in immune active (IA) phase were enrolled. The frequencies of NK, CD56dimNK, CD56brightNK and the expression of functional molecules IFNAR2 and NKp46 on the surface of NK cells were detected respectively among patients with CHB in IA phase, patients with AHB, and those recovered from AHB. At the same time, their correlations with ALT, HBV DNA and HBV markers were analyzed.@*Results@#Between IA and AHB, the frequencies of NK cells and NKp46dim NK cells in AHB cases were significantly lower than those in IA cases, but the frequency of NKp46high NK cells in AHB was higher than that in IA. For patients who recovered from AHB, the frequency of NK cells and NKp46dim NK cells increased; the varied ranges of frequencies of CD56dimNK, IFNAR2+ NK and NKp46+ NK cells were on the rise, while the frequency of NKp46high NK cells decreased after the recovery from AHB, and the varied ranges of CD56brightNK and IFNAR2MFI, NKp46MFI decreased. In AHB, HBVDNA loads were positively correlated with ALT levels. Before and after the recovery of AHB: ΔHBV DNA and ΔALT, Δ NK/LY (%) were positively correlated; ΔALT and ΔNKp46highNK/NK(%), ΔNKp46MFI, ΔIFNAR2MFI were positively correlated.@*Conclusions@#In CHB immune active phase, the activity of peripheral blood NK cells was too weak to remove the virus, but NK cells play an important role in eliminating the viruses and mediating liver tissue inflammation in AHB.
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Chronic hepatitis B (CHB) is a chronic inflammation of liver which infected with the hepatitis B virus (HBV). The chronic inflammation of liver will lead to cirrhosis, complications of liver decompensation from cirrhosis, hepatocellular carcinoma (HCC) and even death.There are two kinds of drugs are available for the treatment: interferon(IFN)which including IFN-αand pegylated IFN, and nucleoside analog(NAs) which including lamivudine, adefovir dipivoxil, entecavir, telbivudine and Tenofovir disoproxil fumarate.We will describe the mechanisms of the CHB, INF and NAs to state the effect on the clinical outcome(cirrhosis, complications from cirrhosis, hepatocellular carcinoma and death) of the therapy of antiviral therapies.
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Objective@#To observe the changes of peripheral blood image of chronic hepatitis C (CHC) patients treated with pegylated interferon (Peg-IFN) and ribavirin, and explore the relationship between the changes and serum virological respose (SVR).@*Methods@#Patients with CHC treated with Peg-IFN α-2 a and ribavirin in the Second Division of Liver Disease in Beijing Ditan Hospital were monitored for peripheral blood cells routine examination and Liver function, kidney function, thyroid function at baseline and week 2, 4, 8, 12, 24, 36, 48, and week 12, 24, 48 after the end of treatment for chronic hepatitis C, and HCV RNA.@*Results@#The decrease of peripheral blood cell counts began to appear at week 2 of treatment. For CHC patients without cirrhosis, white blood cells, lymphocyte, hemoglobin and platelets at week 2, while minimum values were seen at week 36, and the neutrophils reached the minimum value to at week 24. Significant recovery of the peripheral blood changes was seen at the end of treatment (48 weeks), and reached pre-treatment levels at week 48 after the end of treatment. For CHC patients with cirrhosis, white blood cells, lymphocytes, hemoglobin and platelets significantly decreased at week 2, while neutrophils reached a minimum value at 2 weeks. And hemoglobin and platelets reached a minimum value at 24 weeks, and the white blood cells reached the minimum value at weeks 24-36 besides lymphocyte reached the minimum value at week 36. Significant recovery was seen at the end of treatment (48 weeks), and the blood cell counts reached pre-treatment levels at 48 weeks after the end of treatment. For patients with CHC, hemoglobin decreased by more than 27.47% at week 4, which means that the patient would have a predictive significance for SVR, as well as the of PLT reduction by more than 36.96% at week 8.@*Conclusions@#During the treatment with Peg-interferon and ribavirin, the variation of blood picture has some predicting effect, which predicts the result of antiviral treatment.
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Objective@#To investigate the differences in function of plasmacytoid dendritic cells (pDC) and CD4+ T helper cells (CD4+ Th cells) between acute hepatitis B (AHB) and chronic hepatitis B (CHB).@*Methods@#In this study, patients with AHB and those with CHB in immune active (IA) phase were enrolled. The frequencies of pDC, CD86+ pDC, CD4+ T cells and their subsets, surface functional molecules were detected respectively among patients with chronic HBV infection in IA phase, patients with AHB, those recovered from AHB. Meanwhile, their correlations with ALT, HBV DNA and HBV markers were analyzed.@*Results@#The ALT level in AHB was significantly higher than that in IA, and inflammation was more obvious in AHB. Between IA and AHB, CD86+ pDC frequency and the mean fluorescence intensity of functional molecule CD86 (CD86MFI) were higher in IA than those in AHB, but the frequency of CD4+ T cells in AHB was higher than that in IA. For patients who got over AHB, the frequency of CD86+ pDC increased; Th1 were on the rise, while the frequencies of CD4+ T and Th2 decreased after the recovery of AHB, and Th2 / Th1 ratio decreased..In AHB, HBVDNA loads were positively correlated with ALT levels and Th2 frequencies.@*Conclusions@#In CHB immune active phase, CD86+ pDC with stimulating function played an important role, but the cellular immune response of CD4+ T cells decreased. In AHB inflammatory stage, CD4+ T cells played a strong cellular immune response, which result ed in viral clearance. Th2 cells regulation of CD4+ T cells played a dominant role, which was involved in the inflammatory response, and the cytotoxic role of Th1 cells during the recovery period was dominant, playing a strong cellular immune response, then the virus were completely eliminated.
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Objective@#To observe the changes of peripheral blood picture of CHB with Peg-IFN, and explored the relationship between the changes and decline of HBV DNA, clearance of HBsAg.@*Methods@#Patients with CHB treated with Peg-IFN α-2 a in the Second Division of Liver Disease in Beijing Ditan Hospital were monitored for blood routine examination and Liver function, kidney function, thyroid function of baseline and weeks 2, 4, 8, 12, 24, 36, 48, and weeks 12, 24, and 48 after the end of treatment for chronic hepatitis B, and HBV DNA, HBsAg.@*Results@#The decrease of peripheral blood cells began to occur at week 2 of treatment. For CHB with HBeAg negative patients, white blood cells, lymphocyte, neutrophils, hemoglobin and platelets significantly decreased at 2 weeks, while a minimum value occurred at 48 weeks. The recovery was obvious at the end of treatment (48 weeks), and reached pre-treatment levels at 48 weeks after the end of treatment. For CHB with HBeAg positive patients, white blood cells, neutrophils, hemoglobin and platelets significantly decreased at 2 weeks, while a minimum value was found at 36-48 weeks. The recovery was obvious at the end of treatment (48 weeks), and reached pre-treatment levels at 48weeks after the end of treatment. For patients with CHB, hemoglobin declined by more than13.64% at 36th week, which means that the patient would have a predictive significance for decrease of HBV DNA, and drops of more than 0.33% at 2nd week means that the patient would have a predictive significance for clearance of HBsAg.@*Conclusions@#During the treatment with interferon, the variation regularity of blood picture for predicting result have a certain effect, which may help predict and monitor the change of blood picture in clinical work.
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Objective@#To investigate the change of hepatitis B surface antibody (HBsAb) titer and its long-term protection and infection rates between 1 and 3-year-old children whose mothers were chronic hepatitis B pregnant woman with HBeAg positive and high viral load after successful blocking of mother-to-child transmission.@*Methods@#One-year-old children whose mothers were hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive, with HBV DNA≥106IU/ml were enrolled, then were followed up till 3 years old, and tested the five serological markers of hepatitis B and biochemical parameters at the age of one and three years respectively, and analyzed HBsAb titer, positive rate, negative rate and infection rate of 1 to 3-year-old children without enhanced vaccination; meanwhile, data of HBsAb titers at the age of 7 months were collected HBsAb titer, positive rate, and negative rate were analyzed.@*Results@#Totally 264 1-year-old children were enrolled into the study, including 178 children without enhanced vaccination between seven months and 1 year of age, and 114 children without enhanced vaccination between 1 year and 3 years of age. Our result showed that there were no infected children at the age between 1 and 3 years. HBsAb titer decreased from 7 months to 1 year old and dropped from 1 000 IU/L to 509.43 IU/L (P<0.05), and the antibody was still protective. From 1 year to 3 years old, HBsAb titer dropped from 466.72 IU/L to 67.3 IU/L (P< 0.05); at the age of 3 years, 60.52 % children were either weakly positive or negative, but still protective, but significantly less than those who had the reinforced vaccination. As a result , the children without the enhanced vaccination between 1 and 3 years of age were still at high risk.@*Conclusions@#If the antibody was protective at 7 months, children were not easily infected between 1 year and 3 years of age. At the age of 3, the antibody dropped to low or no responsive levels, and the children were still at high risk. It is necessary to take protective measures and supplement the vaccine.