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Due to significant innovations in the diagnosis and treatment of hepatitis D virus （HDV）， the European Society of Hepatology （EASL） published its first international clinical practice guidelines on the management of individuals with HDV infection in July 2023. The guidelines mainly focus on the six aspects of HDV screening， diagnosis， clinical features and influencing factors， patient monitoring and selection for treatment， therapeutic methods and treatment endpoints. The guidelines give recommendations by answering and elaborating on 13 questions covering these six aspects. In addition， the guidelines also provide the prospect of the future treatment of HDV. The author’s team makes an excerpt of the guidelines and systematically introduces various evaluation points in recommendations and clinical management suggestions， in order to promote the development of clinical management and decision-making for individuals with HDV infection in China.
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@#Conventional treatment of glioma has not significantly improved the prognosis of patients, so people pay more attention to the potential of immuno-checkpoint inhibitors in the treatment of glioma. This article reviews the expression and mechanism of some negative immune checkpoints in gliomas, such as programmed death-1 (PD-1), programmed death ligand-1 (PD-L1), cytotoxic T lymphocyte antigen-4 (CTLA-4), T-cell immunoglobulin and mucin-domain containing-3 (TIM-3), lymphocyte-activation gene-3 (LAG-3), T cellimmunoreceptor with Ig and ITIM domains (TIGIT), B7-H4 and V-domain immunoglobulin suppressor of T-cell activation (VISTA), as well as progress of immune checkpoint inhibitors in clinical research, with a prospect of their future in immunotherapy.
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Objective:To investigate the clinical efficacy and adverse reactions of anlotinib combined with irinotecan in the third line treatment of metastatic esophageal cancer.Methods:From October 2018 to October 2019, 52 patients with metastatic esophageal cancer who had developed distant metastasis after receiving standard concurrent chemoradiotherapy and failed second-line chemotherapy were selected from Lu′an Hospital of Traditional Chinese Medicine of Anhui Province. The patients were divided into experimental group and control group by random number table method, with 26 cases in each group. The control group was given intravenous chemotherapy with irinotecan. The experimental group was treated with oral erlotinib combined with intravenous chemotherapy of irinotecan. The clinical efficacy and adverse reactions of the two groups were evaluated after 2 cycles of treatment.Results:Before treatment, there was no significant difference in Karnofsky performance status (KPS) score between the experimental group and the control group (76.15±7.52 vs. 74.62±8.59, t=-0.137, P=0.892). After treatment, there was no significant difference between the two groups (70.77±6.28 vs. 72.69±8.74, t=-1.761, P=0.084). However, after treatment, the KPS score in the experimental group was lower than that before treatment ( t=3.035, P=0.006). There was no statistical significance in the KPS scores of the control group before and after treatment ( t=1.000, P=0.327). Adverse reactions in the two groups were mainly grade 1-2. The incidences of grade 1-2 myelosuppression and diarrhea in the experimental group were 61.5% (16/26) and 46.2% (12/26), which were significantly higher than those in the control group (19.2%, 5/26 and 19.2%, 5/26), with statistically significant differences ( χ2=9.665, P=0.002; χ2=4.282, P=0.039). The disease control rate of the experimental group was 73.1% (19/26), which was significantly higher than that of the control group (46.2%, 12/26), and there was a statistically significant difference between the two groups ( χ2=3.914, P=0.048). The median progression-free survival of the experimental group and the control group was 52 days and 45 days, respectively, and there was a statistically significant difference ( χ2=4.692, P=0.032). Conclusion:Anlotinib combined with irinotecan in the third-line treatment of metastatic esophageal cancer has obvious efficacy, but to a certain extent, it increases the incidence of grade 1-2 myelosuppression and diarrhea, and the KPS score is lower compared with before treatment.
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Objective To analyze the influence of early treatment of pregnancy combined with subclinical hypothyroidism (SCH) during pregnancy on pregnancy outcome.Methods From January 2013 to June 2015,128 pregnant women who were diagnosed as SCH in the Maternal and Child Health Hospital of Beilun District were randomly divided into the observation group and control group according to the digital table,with 64 cases in each group.The observation group was given levothyroxine early treatment,while the control group adopted conventional hospitalization,unexposed.Pregnancy outcomes of the two groups were analyzed.Results After treatment,the incidence rates of complications in the observation group:preeclampsia (4.69％),poor fetal growth (1.56％),premature rupture of membranes (7.81％),less amniotic fluid volume (4.69％),placental abruption (0％),postpartum hemorrhage (3.12％);the incidence rates of complications in the control group:preeclampsia (17.19％),poor fetal growth (10.94％),premature rupture of membranes (21.88％),less amniotic fluid volume (15.63％),placental abruption (6.25％),postpartum hemorrhage (12.50％),and there were statistically significant differences between two groups (x2 =5.133,4.800,5.006,4.195,4.129,3.905,P =0.023,0.028,0.025,0.041,0.042.0.048).After treatment,the incidence rates of adverse pregnancy outcomes:preterm birth (3.12％),cesarean section (60.94％),abortion (0.00％),fetal distress (4.69％),perinatal death (0.00％);the incidence rates of adverse pregnancy outcomes in the control group:preterm birth (12.50％),cesarean section (79.69％),abortion (7.81％),fetal distress (15.63％),perinatal death (6.25％),and the differences between the two groups were statistically significant (x2 =3.905,5.389,5.203,4.195,4.129,P =0.048,0.020,0.023,0.041,0.042).Conclusion Pregnancy complicated with SCH has different degree influence on patients with obstetric complications and outcome of pregnancy,early effective drug treatment can significantly reduce the incidence of obstetric complications and adverse pregnancy outcomes.
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Objective To make a meta-analysis of the effectiveness of hyperthermic perfusion chemotherapy (HPC) combined with bevacizumab for malignant ascites or malignant pleural effusion,and to provide the references for further practice and studies.Methods VIP,Wanfang data,PubMed and CNKI were searched from inception to January 2018.HPC combined with bevacizumab or HPC alone for malignant ascites or pleural effusion were collected for controlled clinical trial (CCT).According to inclusion and exclusion criteria,two reviewers checked studies,extracted data and assessed quality of the included studies.RevMan 5.3 software was used to make a meta-analysis.Results A total of 4 CCT involved 226 patients.Meta-analysis showed that compared with the HPC alone,HPC combined with bevacizumab had a higher rate in clinical efficiency (OR =4.82,95 ％ CI 2.45-9.49,P ＜ 0.000 01),malignant ascites or pleural effusion control rate (OR =4.06,95 ％ CI 1.09-15.11,P ＜ 0.05),quality of life improvement rate (OR =6.79,95 ％ CI 3.53-13.08,P ＜ 0.000 01),and the difference was statistically significant.Conclusion HPC combined with bevacizumab can improve the clinical effective rate,effusion control rate and quality of life improvement rate of the patients with malignant ascites or pleural effusion.
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Objective@#Toexplore work process-oriented theory nursing ward round, research work process-oriented theory nursing ward round on critical thinking capacity of nursing undergraduates.@*Methods@#Totally 80 Elective nursing ward round courses of nursing undergraduates were divided into the experimental A group and the experimental b group with 40 cases in each group. The experimental A group select the beginning of 9 weeks on Until, the experimental B group select the after of 9 weeks on Until. The nursing undergraduates were assessed by CTDI-CV on first, ninth, eighteenth weeks to evaluate the effect of the two groups.@*Results@#Main effect of group factor and time factor of CTDI-CV had statistical significance (P<0.05) . There were significant interaction in the scores of CTDI-CV. Simple effect analysis demonstrated the scores of CTDI-CV in the experimental A group were higher than those of the experimental b group after the intervention (P<0.05) . Two groups of on first, ninth, eighteenth weeks measured values compared the effect of amount of FB<FA, the experimental group A intervention effect was better than in the experimental group B intervention.@*Conclusions@#For nursing undergraduates guided based on the working process of the curriculum of nursing ward round the critical thinking ability had good practice guidance, and on the start time to choose university grade three semester two on 9 weeks before commencement of nursing undergraduates promotes higher critical thinking ability.
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Objective To investigate the development of thyroid function before 20 weeks of pregnancy refer-ence range and prevalence of thyroid dysfunction.Methods 1 706 healthy routine check early single births over the same period of non-pregnant women and maternal health check were chosen for the study.Thyroid function were meas-ured,characteristics of thyroid function changes were analyzed.Results TSH median values minimum and maximum eight weeks of pregnancy,respectively,19 +6 weeks of gestation,respectively 0.90mU/L,2.74mU/L,FT4 median value minimum and maximum respectively nine weeks pregnant, pregnant 19 +6 week, respectively 11.34mpmol/L, 8.75pmol/L,TSH with the extension of time to pregnancy gradually increase, while FT4 decreased.Compared with non-pregnant women,pregnant 8 to 12 +6 weeks pregnant median TSH decreased 28.48%,FSH level in 34 cases of pregnant women during pregnancy was lower than the reference range,accounting for 5.54%.FT4 than non-pregnant women the median increased 7.98%,39 cases of pregnant women during pregnancy than non-FT4 reference range,ac-counting for 6.35%.In section 2.5% and 97.5% of euthyroid reference range, non-pregnant females, 8 to 12 +6 weeks of pregnancy,13 to 16+6 weeks of pregnancy,17 to 19 +6 weeks of gestation TSH reference range was 0.16-5.90mU/L, 0.03-3.66mU/L, 0.06-3.75mU/L, 0.32-4.32mU/L, FT4 respectively 6.70-14.04pmol/L, 7.99-18.67pmol/L,6.19-16.23pmol/L,6.43-13.50pmol/L.In 1 706 cases of pregnant women before 20 weeks of pregnancy,41 cases of thyroid dysfunction exists,the total prevalence of 2.40%,including one case of hyperthyroid-ism,1 case of hypothyroidism,subclinical hypothyroidism in 33 cases,6 cases of low FT4 hyperlipidemia,most common subclinical hypothyroidism.Thyroid peroxidase autoantibodies ( TPOAb ) positive rate was 18.70%.Conclusion Pregnancy 20 weeks pregnant TSH and FT4 before presenting specific changes,TSH at 8 to 12 +6 weeks of pregnancy decreased gradually,gradually increased,while the FT4 in 8 to 12 +6 weeks of pregnancy increased gradually,gradually reduce;thyroid dysfunction prevalence is higher,to subclinical hypothyroidism is most common in early pregnancy,so we recommend routine thyroid function tests.
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Objective To investigate the advantages and disadvantages of two different approaches (i.e.internal jugular vein and subclavian vein) when used for the implantation of central venus access ports (CVAP).Methods We retrospectively analyzed 620 patients who underwent the implantation of CVAP via the approach of internal jugular vein (n =222) or subclavian vein (n =398) and compared the success rate on first attempt as well as the incidences of peroperative and long-term complications.Results The implantation of CVAP was successfully performed in all the 620 patients,with the success rate on first attempt being 97.24％ (387/398) in the subclavian vein group and 89.19％ (198/222) in the internal jugular vein group (U =0.171,P ＜ 0.01).The incidences of perioperative/long-term complications were 0.90％ (2/222) /1.80％ (4/222) in the internal jugular vein group and 1.26％ (5/398) /2.01％ (8/398) in the subclavian vein group,showing no significant differences (all P ＞ 0.05).Conclusions The implantation of CVAP via either the internal jugular vein approach or subclavian vein approach is safe and reliable.Few complications will occur if performed properly.
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Student leaders are the important work force which the college student management and education in the process to rely on.They are not only the bridge and link between schools,teachers and ordinary students,but also the reserve of schools and social management cadres.Grasping and analyzing their basic conditions,the growing demand and group identity is significant.In this paper,the group identity of the student leaders has been sorted out,and their needs and deficiencies are understood through research and discussion about their positioning in the self-awareness,growth and success.And by drawing on the experience of student affairs management in the United States such as ＂student services＂,＂student development ＂,＂student learning＂,we put forward some suggestions in team-building and personnel training of the current student leaders etc..