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Objective:To explore the obstacles of the promotion of nursing quality homogenization management under the mode of multiple hospital areas, and to make the best response strategies and management ideas according to the obstacles, so as to achieve the goal of nursing quality management with the same quality and high efficiency.Methods:Based on the theory framework of 5M1E analysis, this study made an interview outline. Through focus group interview and personal interview, 44 nurses of different positions and levels were interviewed. The interview materials were sorted out and analyzed by Colaizzi seven step analysis method, and the themes were extracted to obtain the obstacles to the promotion of nursing quality homogeneity management.Results:The factors that hinder the management of nursing quality homogeneity included: the lack of understanding and thinking on the management of nursing quality homogeneity, the incomplete integration of quality control organization system in different hospital areas, the lack of comprehensiveness of nursing quality management system and standard unification, the differences in the implementation of quality control system, standard and plan, the difference in information system, the disunity of quality control index extraction, the physics of treatment room, etc. There were six aspects of environmental layout differences.Conclusion:The homogenization of nursing quality management under the mode of "one hospital, multiple districts" is of great significance. Hospitals need to formulate feasible countermeasures and development ideas according to the obstacles of homogenization management, so as to promote the development of nursing quality management and provide patients with the same quality of nursing services.
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OBJECTIVE:To investigate the effects of methimazole combined with acupoint application on hormone levels and bone metabolism indexes of patients with hyperthyroidism. METHODS:150 hyperthyroidism patients were randomly divided into group A(50 cases),group B(50 cases)and group C(50 cases). Based on routine treatment,group A was given Methimazole tab-lets orally,with initial dose of 20-40 mg,1-2 times a day;2-6 weeks later,reducing and maintaining at 2.5-10 mg if the disease condition was improved;maintaining 20-40 mg if no improvement. Group B was acupoint application,one piece,pasting on Zu-sanli,Sanyinjiao,Shenmen,Taichong,Neiguan points 1 h after breakfast. Group C received Methimazole tablets(same usage and dosage as group A)+acupoint application(same usage and dosage as group B). Treatment courses of 3 groups lasted for 2 months. The levels of TSH,FT3,FT4,T3,T4,T,E2,LH,FSH,CT,BGP and PTH were observed in 3 groups before and after treat-ment,and the occurrence of ADR was also observed. RESULTS:Before treatment,there was no statistical significance in the lev-els of above indexes among 3 groups(P>0.05). After treatment,the levels of TSH and PTH in 3 groups were significantly higher than before,and the group C was significantly higher than the group A and B. The levels of FT3,FT4,T3,T4,T,E2,LH, FSH,CT and BGP in 2 groups were significantly lower than before,and the group C was significantly lower than the group A and B;there was statistical significance (P0.05). There was no statistical significance in the incidence of ADR among 3 groups (P>0.05). CONCLUSIONS:Based on rou-tine treatment,methimazole combined with acupoint application can significantly improve the thyroid function,correct the disorder of sex hormones and abnormal bone metabolism in hyperthyroidism patient,without increasing the incidence of ADR.
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Objective@#To investigate the effect of hepatitis B core antigen (HBcAg) in promoting the invasion of hepatitis B virus (HBV)-related hepatocellular carcinoma cell line HepG2.2.15 and the role of Toll-like receptor 4 (TLR4) in the mechanism.@*Methods@#TLR4 mRNA and protein expression in HepG2 cells and HepG2.2.15 cells was measured by reverse transcription real-time PCR and Western blot analysis, respectively. HepG2.2.15 cells were transfected with TLR4 specific small interfering RNA (siRNA) to silence TLR4 expression, and stimulated by recombinant HBcAg in culture. The invasion of cells was measured by Transwell invasion assay. The expression of TLR4 signaling pathway-related proteins in the cultured cells and proinflammatory cytokines in the supernatant was also determined. The student’s t-test, one-way ANOVA, and SNK-q test were used for statistical analysis.@*Results@#TLR4 mRNA and protein expression in HepG2.2.15 cells was significantly higher than that in HepG2 cells. TLR4 siRNA transfection remarkably down-regulated TLR4 expression in HepG2.2.15 cells. Inhibiting TLR4 expression and/or HBcAg stimulation did not affect the proliferation of HepG2.2.15 cells. However, HBcAg stimulation significantly increased the invasion ability of HepG2.2.15 cells and the secretion of proinflammatory cytokines [including interferon (IFN)-γ, interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-α]. Inhibiting TLR4 expression significantly reduced HBcAg-induced cellular invasion. Meanwhile, HBcAg stimulation elevated the expression of MyD88 and TRIF in HepG2.2.15 cells. TLR4 silencing inhibited HBcAg-induced increase in the expression of MyD88, while it showed no significant impact on TRIF expression.@*Conclusion@#HBcAg can promote the invasion of HepG2.2.15 cells. The TLR4/MyD88 signaling pathway may be involved in this process by inducing the expression of proinflammatory cytokines.
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Objective@#to compared with clinical data between nonalcoholic fatty liver disease (NAFLD) and Chronic HBV infection with NAFLD, and to explore the relationship between HBV infection and hepatic steatosis.@*Methods@#A total of 81 patients with clinical data in the Department of Infectious Diseases in Henan Provincial People’s Hospital from June 2013 to June 2016 were enrolled and divided into NAFLD group and HBV combined NAFLD group.Comparison of The levels of liver function (ALT, AST, ALP, GGT), blood lipid (TC, TG, HDL, LDL), blood glucose (GLU), uric acid (UA), hepatic fibrosis (S) and inflammation (G) And hepatic steatosis (F), and to explore the relationship between HBV infection and hepatic steatosis. The independent samples t-test or Wilcoxon two –sample test was used for comparison of continuous data,and the chi-square test was used for comparison of categorical data. Multinomial Logistic regression was used to analyze The risk factors of hepatic steatosis, P < 0.05 was considered statistically significant.@*Results@#A total of 81 subjects were enrolled, with 31 in the NAFLD group and 36 in the HBV with NAFLD group. Baseline level comparison: ALT (t = -4.379, P < 0.01)、AST (t = -3.847, P < 0.01) 、GGT (t = -2.763, P < 0.01) and F (χ2 = 20.341, P < 0.01), There were significant difference (P < 0.05); There were no significant differences in the levels of blood lipids, blood glucose, uric acid, inflammation and fibrosis. e antigen status of liver steatosis is a risk factor, hepatitis B viral load and liver steatosis has nothing to do.@*Conclusion@#In addition to HBV infection-related indicators, it is difficult to distinguish between NAFLD and NAFLD combined with HBV differences; HBV infection and hepatic steatosis have a certain relationship.
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Objective@#To investigate the influence of hepatitis B virus X gene (HBx) on apoptosis of hepatic cells mediated by Fas in HePG2 cells.@*Methods@#HBx eukaryotic vector pcDNA3.1(+)-X was transfected into HEPG2 cells with lipofectamine, and the null vector pcDNA3.1(+) and untransfected HEPG2 were used as normal controls. The cells were collected 72 h after transfection, and the expression of HBx mRNA and protein was determined using RT-PCR and Western blot, respectively. The mRNA expression of apoptosis-related genes Bcl-2 and Bax mRNA was also determined using RT-PCR. Cytotoxicity and apoptosis were evaluated using CCK-8 and flow cytometry, respectively, after HepG2-HBx and HepG2-3.1 cells were treated with stimulatory monoclonal antibody anti-Fas CH11. The t test was used for pairwise comparison.@*Results@#The cell line HepG2-HBx was successfully established, as confirmed by RT-PCR and Western blot, and RT-PCR results showed that HepG2-HBx cells had significantly higher expression of Bcl-2 mRNA than HepG2-3.1 and HepG2 cells (P < 0.05), but had significantly lower expression of Bax mRNA than HepG2-3.1 and HepG2 cells (P < 0.05); CCK-8 and flow cytometry showed that anti-Fas CH11 had a lower cytotoxicity to HepG2-HBx cells and allowed for a lower apoptosis rate of HepG2-HBx cells compared with HepG2-3.1 and HepG2 cells.@*Conclusions@#HBx can inhibit apoptosis of hepatic cells mediated by the Fas pathway.
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Objective@#To investigate the coagulation function in patients with acute-on-chronic liver failure (ACLF) patients using thromboelastography (TEG), and to comprehensively and dynamically evaluate patients’ bleeding and coagulation status.@*Methods@#The clinical data of ACLF patients were collected, and TEG was used to evaluate whole blood clotting kinetics in these patients. Routine biochemical parameters were measured, and complications were evaluated. The t-test was used for comparison of continuous data, the chi-square test was used for comparison of categorical data, and the Pearson correlation coefficient was used for correlation analysis. P < 0.05 was considered statistically significant.@*Results@#A total of 60 patients (39 male and 21 female patients) were enrolled, with a mean age of 47.20±16.20 years. The TEG results showed that all patients had normal thrombokinetics, but TEG parameters were correlated with coagulation function, markers of systemic inflammatory response syndrome, laboratory markers, and prognosis. The patients with a higher R value had higher risks of infection (6.23±2.91 vs 4.74±1.12, P = 0.009), hepatorenal syndrome (5.64±2.54 vs 3.21±1.43 P < 0.01), and bleeding (6.71±3.51 vs 4.80±1.63, P = 0.01), and the patients with a lower K value (0.72±1.36 vs 1.64±1.43, P = 0.02), an increased α-angle (63.33°±10.02° vs 56.62°±12.13°, P = 0.03), and an increased MA (56.83±11.07 vs 50.40±10.81, P = 0.03) had increased risks of hepatic encephalopathy.@*Conclusion@#ACLF patients have low coagulation function, and TEG truly reflects the "rebalance" status of this low level. Abnormal TEG parameters suggest increased risk of complications in these patients, indicating a poor prognosis.
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Objective To investigate the role of serum and glucocorticoid regulated protein kinase (SGK) 1 in the inflammatory responses mediated by toll like receptors.Methods Mice were injected with lipopolysaccharide (LPS,1 mg/kg) 2 h after the pretreatment of EMD638683 (10 mg/kg) or phosphate buffered saline (PBS) as control.At the time points of 3 and 24 h,pro-inflammatory cytokines (interleukin [IL]-6,IL-12 and tumor necrosis factor [TNF]-α) in serum were measured using enzymelinked immunosorbent assay (ELISA).Livers and lung were harvested at 6 h and 24 h after the injection of LPS,embedded by optimum cutting temperature (OCT) and then stained with hematoxylin and eosin (HE).Peripheral blood mononuelear cell (PBMC) were isolated and stimulated by LPS with or without the pretreatment of EMD or LY294002.Cytokines (IL-6,IL-12 and TNF-α) were measured using ELISA.IKKα/β,IKBα and nuclear factor (NF)-κB p65 were detected by Western bolt.Data were analyzed by one way analysis of variance.Results In the model of LPS-induced endotoxin sepsis,inhibition of SGK1 induced secretion of pro-inflammatory cytokine (IL-6 [t=3.007,P＜0.05],IL-12[t=4.413,P＜0.05] and TNF-α[t=5.403,P＜0.05]),increased inflammatory cells infikration into the liver and lung within 6 h,and induced serious multiple organ damage with collapse of alveoli and fatty degeneration of liver.After 24 h,pharmacological inhibition of SGK1 with EMD638683 increased proinflammatory cytokine (IL-6 [t=18.540,P＜0.01],IL-12[t=16.520,P＜0.01] and TNF-α[t=34.880,P＜0.01]) production in human PBMC upon LPS stimulation and inhibited the phosphorylation of IKKα/ β/IKBα and nuclear factor (NF)-κB p65.Conclusions SGK1 suppresses the toll like receptor 4 mediated inflammatory responses via NF-κB.
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Objective To assess on the effect of the different catheterization on patients with oral poisoning gastric lavage systematically and objectively. Methods A computerized search of PubMed, the Cochrane Library, EMBASE, Springer Link, Science Direct,China Biology Medicine (CBM),China National Knowledge Internet(CNKI), Wanfang Data and VIP database was performed for relevant randomized controlled trials (RCTs) which investigated the effects of the oral intubation gastric lavage on patients with oral poisoning relative to nasogastric lavage, retrieval to January 2016, and back into the study of references. According to include and exclude standard to screening literature, literature which met inclusion criteria was selected for quality evaluation and data extraction. Meta-analysis and trial sequential analysis were performed by using Rev-Man 5.3 and TSA soft-ware to estimate the required information size (RIS). Results 13 studies incorporated into Meta-analysis including a total o 1 296 patients. Meta-analysis results showed that the oral intubation gastric lavage group was better than nasogastric lavage in shortening the time of intubation [MD=-9.05, 95% CI(-12.86--5.23), P=0.00], improving the rate of intubation for the first time [MD=1.36, 95% CI (1.14-1.62), P =0.00], mucosal bleeding complication [MD=0.11, 95% CI (0.04-0.64), P=0.010], nausea and vomiting [MD=0.60, 95%CI (0.37-0.98), P=0.04], kinking [MD=0.14, 95% CI (0.02-0.80), P=0.03], reflex cardiac arrest [MD=0.24, 95% CI (0.08-0.71), P=0.01] and asphyxia [MD=0.45, 95% CI (0.26-0.80), P=0.007], the difference were statistically significant. But no significant difference existed in gastric tube fall off. Conclusions The oral intubation gastric lavage could shorten intubation time of patients, improve the first time intubation rate and reduce certain complications. It suggests that the oral intubation be extensively applied to care patients with oral poisoning.
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Objective To investigate the virological response in hepatitis C virus (HCV)genotype 1b relapsers after 48 weeks of peginterferon/ribavirin (peg-IFN/RBV)combination retreatment,and to explore the predictive value of interleukin (IL )-28B rs12978960 genetic polymorphismon virological response.Methods From 2012 to 2014,genotype 1b chronic hepatitis C (CHC)relapsers in He′nan Provincial People′s Hospital were retreated with combined peg-IFN/RBV for 48 weeks and followed up for 24 weeks off-treatment.Host IL-28B genetic polymorphism was detected.Predictive factors associated with virological response and sustained virological response (SVR)were analyzed.Independent-samples t test was conducted in continuous variables,whileχ2 test or Fisher exact probability test was conducted in counts data.Results A total of 61 patients finished 48 weeks of peg-IFN/RBV combination therapy and were further followed up for 24 weeks off-treatment.Mean age was (46.7 ±12.4)years.Thirty-seven patients (60.7%)were male and 49 were rs12978960 CC genotype.After 48 weeks of retreatment with peg-IFN/RBV and 24 weeks of off-treatment follow-up,40 patients (65 .6%)achieved SVR.Rapid virological response (RVR)and SVR of younger patients were both significantly higher than those of older patients (100.0% vs 67.4% and 85 .0% vs 47.6%,respectively;both P =0.006).IL-28B rs12978960 genotype was predictive to RVR and SVR.Patients with RVR and SVR had higher carriage rates of IL-28B rs12978960 CC genotype compared with those without RVR and SVR (both P <0.05 ).Patients with CC genotype had higher rates of RVR (34.1 % vs 0;χ2 = 10.625 ,P =0.006 ),end-of-treatment virological response (84.1 % vs 70.6%;χ2 =5 .563,P =0.039 )and SVR (77.3% vs 35 .3%;χ2 =9.572,P =0.007)than those with CT/TT genotype.However,there were no statistical differences of extended RVR (34.1 % vs 29.4%;χ2 =0.122,P =0.809)and early virological response (79.5 % vs 82.3%;χ2 =0.612,P =0.964).Conclusions Retreatment with antiviral therapy is necessary in CHC patients with genotype 1b. IL-28B rs12978960 genetic polymorphism is predictive to the SVR of retreatment,especially for patients without RVR,which will provide individualized treatment and optimize the treatment strategy.
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<p><b>OBJECTIVE</b>To determine the role of hepatitis C virus (HCV) genotype 1 b genetic variation in the open reading frame for treatment outcomes of the pegylated-interferon/ribavirin (peg-IFN/RBV) combination therapy by examining patients from Henan Province with chronic hepatitis C (CHC).</p><p><b>METHODS</b>Thirty-seven treatment naive patients infected with HCV genotype 1b were included in the study. Prior to initiation of a 48-week course of peg-IFN/RBV therapy, peripheral blood was drawn for sequencing of the viral ORF 5'-half. Patients were assessed at the end of the 48 weeks of treatment and at a 6-month follow-up appointment. The patient data was stratified according to the status of sustained viral response (SVR) group and non-response (NR) and statistical analysis was performed to determine the correlation between detected genetic variations and treatment response status.</p><p><b>RESULTS</b>Genetic variability in the ORF 5'-half was significantly higher among the individuals in the SVR group than among those of the NR group. Significant differences were found in the gene regions encoding p7, NS2 and NS3. For p7, the NR group had actual and expected frequencies of special mutation of 9.0 and 17.4 and total mutation of 77.0 and 68.6, while the SVR group had actual and expected frequencies of special mutation of 42.0 and 33.6 and total mutation of 124.0 and 132.4 (x2 =7.725, P =0.05). For NS2, the NR group had actual and expected frequencies of special mutation of 36.0 and 54.3 and total mutation of 270.0 and 251.7, while the SVR group had actual and expected frequencies of special mutation of 106.0 and 87.7 and total mutation of 388.0 and 406.3 (x2 = 12.16, P less than 0.01). For NS3, the NR group had actual and expected frequencies of special mutation of 49.0 and 53.4 and total mutation of 241.0 and 236.6, while the SVR group had actual and expected frequencies of special mutation of 81.0 and 76.6 and total mutation of 335.0 and 339.4 (x2 =6.745, P =0.043). The inter-patient genetic variations in the NS3 gene were concentrated in the protease domain. Furthermore, there was a strong correlation between HCV diversity in p7 and treatment outcome.</p><p><b>CONCLUSION</b>The genetic data reported here provides strong support for the role of NS2, NS3 and p7 in antagonizing the peg-IFN/RBV response during the treatment of HCV infections. We conclude that higher inter-patient viral genetic diversity correlates with successful treatment and may modulate the efficacy of antiviral therapy in CHC patients of Henan.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Drug Therapy, Combination , Genotype , Hepacivirus , Genetics , Hepatitis C, Chronic , Drug Therapy , Virology , Interferons , Therapeutic Uses , Open Reading Frames , Ribavirin , Therapeutic Uses , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To construct the recombinant HCV-1b replicon by replacing NS5A region using serum samples from patients with chronic hepatitis C (CHC) in South China and explore the biological characteristics of NS5A protein in response to antiviral therapy.</p><p><b>METHODS</b>The on-off plasmid containing the cutting sites of the restriction endonucleases MIu I and Bcl I was designed based on the backbone of robust HCV 1b replicon. The full-length fragments of HCV NS5A were amplified from different CHC patients by RT-PCR and cloned into pMD-18 vector, followed by sequence analysis of amino acid mutation of ISDR, PKRBD, V3 and IRRDR within the NS5A region. If the amplicon obtained contained no MIu I or Bcl I cutting sites, the NS5A fragment was re-amplified using primers containing the cutting sites and inserted into the replicon for replacement.</p><p><b>RESULTS</b>The full-length fragments of NS5A were obtained successfully from CHC patients. The core region of ISDR-V3 of NS5A was replaced in the HCV replicon plasmid and showed correct sequences. The amino acid mutations of ISDR and PKRBD within NS5A were more frequent in patients with sustained viral response (SVR) than those without SVR. A high variability in the amino acid sequence was observed in both IRRDR and V3 regions.</p><p><b>CONCLUSION</b>The plug-in type recombinant HCV replicon for replacement of NS5A region in the virus from CHC patients has been successfully constructed, which provides a basis for further investigation of the biological characteristics of NS5A protein, the mechanisms of interferon-resistance, and antiviral therapy of difficult-to-treat CHC.</p>
Subject(s)
Humans , Amino Acid Sequence , Antiviral Agents , Pharmacology , Drug Resistance , Genetics , Genetic Variation , Genotype , Hepacivirus , Genetics , Hepatitis C, Chronic , Drug Therapy , Virology , Interferons , Pharmacology , Molecular Sequence Data , Recombination, Genetic , Replicon , Genetics , Sequence Analysis , Viral Nonstructural Proteins , GeneticsABSTRACT
Aptazymes are a new artificial synzyme, selected from the random oligonucleotide sequence libraries against various of effector molecules. They own the advantages of an aptamer(the receptor site) and the ribozyme (the catalytic active site). Moreover, aptazymes as catalytic molecular beacon provide a new orientation for the quantitative analysis of effector molecules. Aptazymes not only have the application in genomics and proteomics, but also have potential applications in biosensor and DNA AND gate.