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Objective:To investigate imaging characteristics of papulopustular rosacea (PPR) by high-frequency ultrasound combined with color Doppler flow imaging.Methods:From August 2021 to August 2022, 30 patients with PPR were enrolled from the Department of Dermatology, the First Affiliated Hospital of Baotou Medical College in the Inner Mongolia Autonomous Region, and 30 healthy volunteers served as controls. The 22-MHz high-frequency ultrasound combined with color Doppler blood flow imaging was performed to measure the skin thickness, echo and blood flow parameters at the cheek, and the ultrasound results were compared between the two groups. Comparisons between groups were conducted by using t test or chi-square test. The diagnostic value was analyzed using the area under the curve (AUC) in the receiver operating characteristic (ROC) curve. Results:In the case group, there were 12 males and 18 females, and their ages ranged from 22 to 65 years (42.3 ± 12.8 years) ; in the control group, there were 10 males and 20 females, and their ages ranged from 24 to 62 years (41.0 ± 8.4 years) . The epidermal and dermal thicknesses at the cheek were significantly higher in the case group (132.64 ± 12.29 μm, 1 812.29 ± 85.52 μm, respectively) than in the control group (104.34 ± 14.45 μm, 1 671.77 ± 146.55 μm, respectively, both P < 0.05) . High-frequency ultrasound images showed that the case group was mainly characterized by irregular hypoechoic areas in the cheek dermis (80%) , while banded moderately echoic areas were common in the cheek dermis in the control group (90%) ; subepidermal low-echogenic bands and dermal irregular hypoechoic areas were more likely to appear in the case group than in the control group (93.33% vs. 43.33%, 80% vs. 10%, respectively, both P < 0.001) . Compared with the control group, the case group showed a significantly increased proportion of patients with abundant blood flow signals (93.3% vs. 10%, P < 0.05) , and significantly increased blood vessel diameters (1.60 ± 0.42 mm vs. 0.95 ± 0.32 mm, P < 0.05) ; there was no significant difference in peak systolic blood flow velocity and vascular resistance index between the two groups (both P > 0.05) . The AUC of high-frequency ultrasound combined with color Doppler flow imaging quantitative parameters (including epidermal thicknesses, dermal thicknesses, and blood vessel diameters) was 0.989 (95% CI: 0.970 - 1.000) for the diagnosis of PPR, and the sensitivity and specificity were both 96.7%, which were higher than those of single parameter-based diagnostic model. Conclusion:High-frequency ultrasound combined with color Doppler flow imaging can help improve the accuracy of the diagnosis of PPR, by accurately and non-invasively measuring skin thickness and blood flow parameters.
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Objective:To investigate the relationship and diagnostic value of serum hepatitis B virus(HBV) RNA on liver significant inflammation in chronic hepatitis B (CHB)patients with normal or mildly elevated alanine transaminase (ALT) levels.Methods:A total of 211 treatment-naive CHB patients with ALT<two times of the upper limit of normal in Shanghai Public Health Clinical Center, Fudan University between January 2016 and June 2019 were retrospectively studied.All of them received liver biopsy. Serum HBV RNA levels were quantified by quantitative reverse transcription polymerase chain reaction. Statistical analyses were performed with t test, Mann-Whitney U test, chi-square test and logistic regression analysis. Results:In 83 hepatitis B e antigen (HBeAg)-positive patients, the serum HBV RNA levels decreased with the increasing severity of liver inflammation ((6.208±1.363) lg copies/mL vs (4.654±0.962) lg copies/mL, t=6.035, P<0.01). In 138 HBeAg-negative patients, the serum HBV RNA levels increased with the increasing severity of liver inflammation ((3.101±0.720) lg copies/mL vs (3.965±0.782) lg copies/mL, t=-5.892, P<0.01). Logistic regression analysis showed that serum HBV RNA level was an independent predictor for significant liver inflammation (odds ratio ( OR)=0.168, P=0.003) in HBeAg-positive patients. Area under receiver operator characteristic curve (AUROC) was 0.82 (95% confidence interval ( CI) 0.73-0.91) of HBV RNA and 0.56(95% CI 0.44-0.69) of ALT for the diagnosis of significant liver inflammation. The difference was statistically significant ( z=2.975, P=0.003). Serum HBV RNA ( OR=4.960, P<0.01), γ-glutamyl transpeptidase ( OR=1.021, P=0.019) and blood platelet (PLT) ( OR=0.987, P=0.008) were independent predictors for significant liver inflammation in HBeAg-negative patients. The AUROC of HBV RNA and ALT was 0.78(95% CI 0.69-0.87) and 0.65(95% CI 0.55-0.75), respectively. The AUROC of combination diagnostic model consisting of HBV RNA, γ-glutamyl transpeptidase and blood platelet was 0.86(95% CI 0.79-0.93) for the diagnosis of significant liver inflammation. Conclusions:The serum HBV RNA levels are significantly different among the different phases of liver inflammation in treatment-naive CHB patients with normal or mildly elevated ALT levels. Inflammation-related serum HBV RNA and combination diagnostic model are expected to be the novel non-invasive diagnostic biomarkers for significant liver inflammation and of great benefit for determining the time for clinical medication of treatment-naive CHB patients.
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Objective@#To explore and analyze the intervention effect of two different case teaching methods on critical thinking of nursing interns.@*Methods@#from July 2016 to July 2018, a total of 62 nursing students in a three grade hospital in Chongqing were selected. They were divided into control group (29) and intervention group (33) according to their internship years. The control group received routine case teaching method, while the intervention group adopted the "Internet+" case teaching method to carry out clinical teaching.@*Results@#Nursing students in the intervention group were significantly better than those in the control group in seeking truth, open thinking, systematization ability, analytical ability, self-confidence, thirst for knowledge and maturity (t=3.978-6.875, P<0.05). Nursing students in the critical thinking grade distribution intervention group were higher than those in the control group (t=-6.522--2.202, P<0.05). In clinical decision-making ability, problem-finding ability, goal-setting ability, decision-making ability, implementation decision-making ability and evaluation feedback were also higher than those in the control group (P<0.05). The ability was higher than that of the control group (χ2=7.922, P<0.05).@*Conclusion@#case teaching based on "Internet+" can better improve the clinical thinking method of nursing students, enhance the critical thinking level and clinical decision-making ability of nursing students, and improve the quality of clinical teaching. It is worthy of popularization and application in clinical practice.
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Objective To investigate the clinical application effect of the optimized hierarchical management model based on the advanced system of nursing professional competence.Methods A total of 500 nurses from 5 secondary or tertiary hospitals in Dazu district of Chongqing were selected and randomly divided into intervention group and control group,with 250 nurses in each group.The traditional management model was adopted for the control group,and the optimized hierarchical management model based on the advanced professional competence system was adopted for the intervention group.The two groups were compared in terms of nursing ability,clinical work quality,and incidence rate of adverse events.All the data were analyzed by SPSS 23.0,Chi-square test and t test were used for statistical analysis.Results There were no significant differences in age,sex,marital status,professional title,and working years between the two groups (P＞0.05).The baseline data were consistent and comparable.Compared with the control group,the intervention group had significantly higher scores of nursing ability [(82.30 ± 3.83) vs.(72.78 ± 5.33)] and nursing quality [(97.53 ± 9.71) vs.(90.17 ± 8.18)].The intervention group had a significantly lower incidence rate of adverse events than the control group [(0.9％ vs.3.9％),P＜0.05].Conclusion The optimized hierarchical management model for nursing staff based on the advanced professional competence system can improve the professional competence and clinical nursing quality of nursing staff,reduce the incidence rate of adverse events,and provide a reference for improving the level of nursing management.
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Objective To explore and analyze the intervention effect of two different case teaching methods on critical thinking of nursing interns. Methods from July 2016 to July 2018, a total of 62 nursing students in a three grade hospital in Chongqing were selected. They were divided into control group (29) and intervention group (33) according to their internship years. The control group received routine case teaching method, while the intervention group adopted the "Internet+" case teaching method to carry out clinical teaching. Results Nursing students in the intervention group were significantly better than those in the control group in seeking truth, open thinking, systematization ability, analytical ability, self-confidence, thirst for knowledge and maturity (t=3.978-6.875, P<0.05). Nursing students in the critical thinking grade distribution intervention group were higher than those in the control group (t=-6.522--2.202, P< 0.05). In clinical decision-making ability, problem-finding ability, goal-setting ability, decision-making ability, implementation decision-making ability and evaluation feedback were also higher than those in the control group (P<0.05). The ability was higher than that of the control group (χ2=7.922, P<0.05). Conclusion case teaching based on "Internet+" can better improve the clinical thinking method of nursing students, enhance the critical thinking level and clinical decision-making ability of nursing students, and improve the quality of clinical teaching. It is worthy of popularization and application in clinical practice.
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Objective To explore the expression profiles and their clinical significance of serum exosomal microRNA (miRNA ) in the different phases of natural history in chronic hepatitis B (CHB ) patients .Methods A total of 92 treatment-naive CHB patients in Shanghai Public Health Clinical Center between January 2014 and January 2017 were retrospectively studied .The cases in immune tolerant (IT) phase ,immune reactive (IR) phase ,inactive carrier (IC) phase and HBeAg-negative CHB (ENH) phase were 24 ,24 ,24 ,and 20 ,respectively .Exosomes were isolated by ExoQuick solution from 250μL serum . The expressions of the surface protein markers LAMP2 and TSG101 in serum exosomes were determined by Western blotting . The expressions of miRNA-122 , miRNA-125a , miRNA-29c , miRNA-200c in exosomes were detected by real-time fluorescent quantitative PCR .The Kruskal-Wallis H test and Mann-Whitney U test were used to determine intergroup differences . The correlation coeffcients ( r) were calculated using Spearman′s correlation .Receiver operating characteristic (ROC) and the area under the curve (AUC ) were used to calculate the diagnostic values . Results Western blotting showed that exosome-specific markers LAMP2 and TSG101 were positive .The levels of serum exosomal miRNA-122 , miRNA-125a ,miRNA-29c and miRNA-220c were significantly different in CHB patients in different phases (H=41 .06 ,29 .31 ,49 .14 and 31 .73 ,respectively ,all P<0 .05) .Based on the results of liver function test and liver biopsy , serum exosomal miRNA-122 , miRNA-29c and miRNA-200c in inflammation group were down-regulated (U = 804 ,317 and 574 ,respectively ,all P< 0 .05) ,while miRNA-125a was up-regulated (U=279 ,P<0 .01) compared with non-inflammation group .The level of exosomal miRNA-200c was negatively correlated with ALT (r= -0 .3932 ,P<0 .01) ,while the level of miRNA-125a was positively correlated with ALT (r=0 .5981 , P<0 .01) .AUC of the above exosomal miRNA were 0 .6193 ,0 .8396 ,0 .8243 and 0 .6883 ,respectively .The highest AUC was miRNA-125a with the sensitivity of 84 .62％ and the specificity of 74 .47％ .AUC of ALT discrimination for liver inflammation was 0 .7953 ,with the sensitivity of 81 .08％ and the specificity of 70 .97％ .Conclusions The serum exosomal miRNA levels are significantly different among the different phases of natural history in CHB patients .Inflammation-associated exosomal miRNA is expected to be the non-invasive diagnostic biomarkers of liver inflammation and is of great benefit for determining the best time for clinical medication of CHB patients .
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Objective To explore the effect of reflecting diary training on the ability of critical thinking of nursing students.Methods By cluster sampling,248 nursing students were selected and randomly divided into intervention group and control group with 124 students in each group.The intervention group received reflective journal training apart from the general clinical internship,while control group received general clinical internship.The critical thinking ability between groups were evaluated and compared before training,6 months after training (T2) and 1 year after training (T3) by using the Chinese version of Critical Thinking Disposition Inventory (CTDI-CV).The performed satisfaction of intervention group evaluated in T2 and T3.Results There were no significant difference of the CTDI-CV scores between groups before training (P＞0.05).It was found that the intervention group performed better and had higher scores than the control group in CTDI-CV and dimensions including searching for truth,open-mindedness,analytical ability,systematic ability,critical thinking,self-confidence,curiosity and cognitive maturity at T2 and T3.The intervention group had a high-level of satisfaction of this training program.The satisfaction of each item at T2 was over 90.2％,and at T3 was over 88.6％.Conclusion Reflecting journal training can improve the critical thinking ability of nursing students.The training program was well-received by nurses.
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ObjectiveTo investigate the clinical features of acute hepatitis B (AHB) and acute exacerbation of chronic hepatitis B (CHB) for differential diagnosis. MethodsA retrospective analysis was performed on the clinical data of 96 AHB patients and 124 patients with acute exacerbation of CHB, who were admitted to the Public Health Clinical Center Affiliated to Fudan University from June to December, 2014. Comparison of continuous data between the two groups was made by Mann Whitney U test, while comparison of categorical data was made by chi-square test. ResultsThere were no significant differences in the age of onset and sex between the AHB group and the acute exacerbation of CHB group; the incidence was higher in males than in females. Sexual transmission and iatrogenic transmission were the main routes of transmission for AHB, while mother-to-child transmission was the main route of transmission for acute exacerbation of CHB. The sensitivity and specificity of alanine aminotransferase (ALT) level ≥1072 U/L for diagnosing AHB were 78.6% and 79.2%, respectively. The sensitivity and specificity of S/CO ≥13.6 in the anti-HBc-IgM test for diagnosing AHB were 94.5% and 89.3%, respectively. At week 2 after admission, the AHB group showed significantly greater decreases in levels of HBsAg, HBeAg, and hepatitis B virus (HBV) DNA than the acute exacerbation of CHB group (P＜0.05). At week 8 after admission, the AHB group had significantly higher HBsAg clearance rate, anti-HBs seroconversion rate, HBeAg clearance rate, anti-HBe seroconversion rate, and HBV DNA clearance rate than the acute exacerbation of CHB group (P＜0.05). ConclusionIt is helpful for making the differential diagnosis between AHB and acute exacerbation of CHB to know the route of transmission, ALT level, anti-HBc-IgM test result (S/CO value), HBV DNA clearance rate, and the seroconversion rates of HBV markers.
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Chronic hepatitis B (CHB) is one of the major causes of liver cirrhosis and hepatocellular carcinoma. Interferon and nucleos(t)ide analogues can control disease progression. However, they cause very low HBsAg clearance or seroconversion rates and relapse in most patients after treatment withdrawal. In recent years, the further understanding of the interaction between hepatitis B virus (HBV) and host gives birth to a large number of novel drugs that hold promise for successful cure of CHB. This paper reviews several novel drugs against HBV in phase Ⅰ, Ⅱ, or Ⅲ clinical trials, and points out that these novel drugs against HBV have preliminarily indicated a bright future.
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ObjectiveTo investigate the independent predictive factors for significant liver histological changes (SLHCs) in patients with HBeAg-positive high-viral-load chronic hepatitis B virus (HBV) infection and a normal alanine aminotransferase (ALT) level. MethodsA retrospective analysis was performed on the clinical data of 116 previously untreated patients with HBeAg-positive high-viral-load (HBV DNA≥105 copies/ml) chronic HBV infection and a normal ALT level (＜50 U/L) who were hospitalized in Shanghai Public Health Clinical Center Affiliated to Fudan University from June 2013 to August 2015. The definition of SLHCs was inflammation ≥G2 and/or fibrosis≥S2. The t-test or Mann-Whitney U rank sum test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Univariate and multivariate regression analyses were used to determine independent predictive factors for SLHCs. ResultsOf all the 116 patients, 47(40.5%) had SLHCs. The multivariate analysis showed that age (OR=2.828, P＜0.05), ALT (OR=1.011, P＜0.05), and gamma-glutamyl transpeptidase (GGT) (OR=1.089, P＜0.05) were independent predictors for SLHCs in patients with HBeAg-positive high-viral-load chronic HBV infection and a normal ALT level. The patients aged ≤30 years had a significantly lower incidence rate of SLHCs than those aged＞30 years (21.6% vs 49.4%, χ2=6.42, P=0.015), the patients with ALT ≤30 U/L had a significantly lower incidence rate of SLHCs than those with 30 U/L＜ALT≤50 U/L (17.6% vs 50.0%, χ2=19.86, P＜0.001), and the patients with GGT≤40 U/L had a significantly lower incidence rate of SLHCs than those with GGT＞40 U/L (28.8% vs 66.7%, χ2=28.63, P＜0.001). ConclusionIn patients with HBeAg-positive high-viral-load chronic HBV infection and a normal ALT level, those with an age of＞30 years, ALT＞30 U/L, and GGT＞40 U/L tend to develop SLHCs and need liver biopsy.
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There are about 150 million people around the world with chronic hepatitis C virus (HCV)infection currently,of whom 20%will ultimately progress to cirrhosis and eventually die of end-stage liver disease and hepatocellular carcinoma.Interferon (IFN)has long been recognized as the cornerstone of the treatment of chronic hepatitis C because of its role in sustained virologic response and prevention of disease progression.However,it has limited efficacy and multiple adverse effects.In recent years,direct-acting antiviral agents (DAAs) have shown good efficacy.This review summarizes the recent advances in IFN-free anti-HCV therapeutic regimens based on DAAs.We believe that,with the emergence of DAAs,IFN-free therapies will develop rapidly and display better prospects.
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Interferon and nucleotide/nucleoside analogues are currently widely used in the management of chronic hepatitis B virus ( HBV) infections, but are facing problems such as poor sustained virologic response, low HBsAg clearance rate and a high risk of recurrence after drug withdraw.Exploring new target of anti-HBV agent has become a hot topic in recent years.This paper reviews the research progress on new anti-HBV targets and related drugs.
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Patients with hepatitis C virus (HCV)-related cirrhosis are at a higher risk for the development of hepatic failure and hepatocellular carcinoma (HCC) compared with non-cirrhotic patients. Antiviral therapies for HCV-related cirrhosis may reduce the incidence of HCC and hepatic failure. This article introduces current antiviral therapies for HCV-related cirrhosis: P/R, DAA+P/R, and IFN-free regimens, and summarizes the present situation of antiviral therapies for HCV-related cirrhosis. It is thought that the advent of direct-acting antivirals has improved the rate of sustained virologic response and reduced the incidence of adverse events during the treatment of HCV-related cirrhosis. Interferon-free regimens have great advantage and potential in antiviral therapies for HCV-related cirrhosis.
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Chronic infection with hepatitis B virus (HBV) often leads to the development of liver cirrhosis and liver cancer, creating immense sociological, clinical, and economic burdens worldwide. Although current anti-HBV drugs can control the disease progression, they often fail to eliminate the virus because of the presence of covalently closed circular DNA (cccDNA) in the hepatocyte nucleus. We review the research advances in therapeutic strategies against cccDNA from the aspects of interfering with cccDNA synthesis, promoting cccDNA degradation, and silencing cccDNA. Targeting cccDNA is a promising approach that may lead to a cure of chronic HBV infection.
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The hepatocellular carcinoma (HCC) diagnosed by serum biomarkers is usually at late stages, and the five-year survival rate of HCC is extremely low. Therefore, it is necessary to develop an efficient and noninvasive biomarker that can detect HCC at an early stage and to explore a new strategy for the treatment of HCC. Abundant evidence has shown that microRNAs(miRNA)s is involved in the development and progression of HCC, and it can be a sensitive biomarker for the detection of HCC and a new target for the treatment of HCC. The article introduces the application of miRNAs in the diagnosis and treatment of HCC, and believes that the diagnosis and treatment strategy for HCC based on miRNAs has great potential in clinical application, yet remains to be studied.
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Recent studies have shown that the pathophysiology of hepatocellular carcinoma (HCC) involves epigenetic alterations in DNA methylation, histone modifications, and microRNAs. In this review, we describe the general characteristics of epigenetic machinery in HCC as well as the current advances in epigenetic therapy for HCC. It is pointed out that epigenetic therapy has good prospects in the treatment of HCC, but there is still a long way before clinical application.
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Objective To investigate the association of restriction fragment length polymorphisms (RFLP) in p.S267F of SLC10A1 gene with clinical outcomes of hepatitis B virus (HBV) infection. Methods Clinical data of 1 268 patients with HBV infections admitted in Public Health Clinical Center Affiliated to Fudan University during July 2014 and February 2015 were collected.Polymerase chain reaction-restriction fragment length polymorphism ( PCR-RFLP) method was used to genotype the p .S267F of SLC10A1 gene in all patients, and the potential association between variants in p .S267F of SLC10A1 gene and the clinical outcomes of HBV infection was analyzed .Results Among 1 268 patients with HBV infections, 1 226 were of genotype CC, and 42 were of genotype CT, so the variation rate in p.S267F was 3.31%(42/1 268).Compared with patients with genotype CC , patients with genotype CT had a higher incidence of acute HBV infections (13.6%vs.28.6%,χ2 =19.819, P<0.05) and a lower incidence of HBV-related liver cirrhosis or hepatocellular carcinoma (13.9% vs.4.8%, χ2 =18.945, P <0.05). Conclusion RFLP in p.S267F of SLC10A1 gene may be associated with chronicity and aggravation of HBV infection, and genotype CT is possibly a protective factor .
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Objective To analyze the clinical manifestations of refractory mycoplasma pneumoniae pneumonia (RMPP)which unresponded to methylprednisolone in the dosage of 2 mg·kg-1 ·d-1 for 3 day.Methods Retrospective analysis was performed on the clinical data of 120 children with RMPP.The patients were divided into effective group and ineffective group according to ini-tial effeet of 2 mg· kg-1 · d-1 methylprednisolone.The elinical manifestations,laboratory examination,radiological features and bronchofibroscopic findings of the children were compared.Results Twenty-eight patients in 120 were poor curative effect after regular 2 mg·kg-1 ·d-1 methyl prednisolone therapy,accounted for 23.3%.There were 10 patients in 28 with mixed infection,ac-counted for 35.7%;13 patients with appeared necrotizing pneumonia,accounted for 46.4%;13 patients with secretion obstruction, accounted for 46.4%;10 patients with endometrium necrosis,accounted for 35.7%.92 patients in 120 were good curative effect af-ter regular 2 mg·kg-1 ·d-1 methyl prednisolone therapy,accounted for 76.7%.There were 5 patients in 92 with mixed infection, accounted for 5.4%;10 patients with secretion obstruction,accounted for 10.9;5 patients with secretion obstruction,accounted for 5.4%.The difference was statistically significant (P <0.05).There were correlation between effect of hormone therapy and the levels of WBC,N,hs-CRP,LDH,PCT,IL-6,IL-8,LP,SF,D-dimmer.Multiple factors analysis showed that N,hs-CRP,LDH,IL-8, IL-6 were independent risk factors influence the effect of regular hormone therapy (P <0.05).The effective were improved after in-creasing hormone doses or share ivig.Antibiotic use days in effective group was obviously lower than that in ineffective group,.The difference was statistically significant (P <0.05).Duplex control antibiotics use ratio in ineffective group was significantly higher than that in effective group.The difference was statistically significant (P <0.05).Conclusion Treatment with 2 mg·kg-1 ·d-1 methvlprednisolone could improve clinical symptoms and radiological manifestations of most children with RMPP quickly.But it may be ineffective in some situations such as N,hs-CRP,LDH,IL-8 and IL-6.
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In recent years, with the advances in life cycle of hepatitis C virus (HCV) and the approval of direct-acting antiviral agents (DAAs), great progress has been made in treatment of chronic hepatitis C (CHC).This article reviews the research progress of DAAs in CHC management, showing the possibility of the elimination of HCV infection by DAAs.DAAs have not been widely clinically used due to high medication costs, but can be used as a supplement for the combination therapy of pegylated interferon and ribavirin.