Establishment of a noninvasive predictive model for antiviral therapy in patients with chronic hepatitis B virus infection and an age of ≤30 years / 临床肝胆病杂志

ObjectiveTo predict whether antiviral therapy is required in patients with chronic hepatitis B virus （HBV） infection and an age of ≤30 years by establishing a noninvasive model， and to investigate the diagnostic value of this model. MethodsA retrospective analysis was performed for the clinical data of 175 patients with chronic HBV infection who were admitted to Shenzhen Third People’s Hospital from January 2017 to January 2023 and met the inclusion criteria， and according to the results of liver biopsy， they were divided into treatment group with 41 patients （with indications for antiviral therapy） and observation group with 134 patients （without indications for antiviral therapy）. The two groups were analyzed in terms of the indicators including clinical data， imaging examinations， and serum biochemical parameters. The univariate and multivariate Logistic regression analyses were used to investigate the parameters affecting the indication for antiviral therapy， and different models for predicting the need for antiviral therapy were constructed based on related parameters. The receiver operating characteristic （ROC） curve was used to compare the diagnostic value of different models. The independent-samples t test was used for comparison of normally distributed continuous variables between groups， and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous variables between groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. ResultsThere were significant differences between the treatment group and the observation group in alanine aminotransferase， ferritin， total cholesterol （CHOL）， triglyceride， platelet count， liver stiffness measured by sound touch elastography （STE）， and procollagen III N-terminal propeptide （PIIIP） （all P<0.05）. The multivariate Logistic regression analysis showed that CHOL （odds ratio ［OR］=0.4， 95% confidence interval ［CI］： 0.2‍ ‍—‍ ‍1.0）， STE （OR=1.5， 95%CI： 1.0‍ ‍—‍ ‍2.1）， and PIIIP （OR=1.1， 95%CI： 1.0‍ ‍—‍ ‍1.1） were independent predictive factors for the indications for antiviral therapy. Model 1 （STE+PIIIP+CHOL）， model 2 （STE+PIIIP）， model 3 （STE+CHOL）， model 4 （PIIIP+CHOL） had an area under the ROC curve of 0.908， 0.848， 0.725， and 0.725， respectively， while STE， PIIIP， and CHOL used alone had an AUC of 0.836， 0.725， and 0.634， respectively， suggesting that model 1 had the largest AUC， with a specificity of 77.34% and a sensitivity of 96.36%， and had a significant difference compared with STE， PIIIP， CHOL， and the models 2， 3， and 4 （Z=0.21， 3.08， 3.06， 3.23， 0.89， and 0.88， all P<0.05）. ConclusionThe noninvasive model established based on CHOL， STE， and PIIIP has a good value in predicting the need for antiviral therapy in patients with chronic HBV infection and an age of ≤30 years.

The perception and experience of frail older adults on exercise:a Meta-synthesis of qualitative research / 中国实用护理杂志

Objective:To systematically review the qualitative researches on the perception and experience of frail older adults on exercise, so as to provide a theoretical basis for the formulation of exercise intervention strategies of frailty.Methods:Qualitative researches on the perception and experience of frail older adults on exercise was retrieved by computer in Chinese and English databases such as PubMed, Web of Science, CINAHL, Cochrane Library, EBSCO, Ovid, Clinical Trial, China National Knowledge Infrastructure, WanFang Data, VIP and SinoMed. The retrieval time limit was from the establishment of the database to December 2022. The quality of the article was evaluated using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center (2016) in Australia. The results were analyzed by pooled synthesis method.Results:A total of 9 articles were included, and 26 research results were extracted. The results were grouped into 7 new categories, which were further integrated into 4 integrated results, namely, cognition of physical exercise, adjusting exercise mode to fit the physical condition, factors influencing exercise participation, the dilemmas and demands of exercise.Conclusions:The frail older adults lack of knowledge about exercise and their athletic ability is decreased. Their exercise behavior is affected by various factors, and there are difficulties and needs for exercise. They need multi-directional psychological, information and medical exercise support from family, society, hospital and other aspects.

Research advances in non-invasive diagnosis models for liver fibrosis in chronic hepatitis B / 临床肝胆病杂志

It is vital for reducing the occurrence of complications, such as liver cirrhosis and hepatic carcinoma, to early diagnose liver fibrosis in chronic hepatitis B and intervene in time with antiviral therapy. Although liver biopsy is the "golden standard" for the diagnosis of fibrosis, it has certain disadvantages, such as complicated operation, invasion, and occurrence of complications. Therefore, non-invasive diagnosis models have gained more and more attention clinically. In this review, we summarizes the non-invasive diagnosis models for chronic hepatitis B that have been established throughout the world. It is noticed that there are a number of models being studied and each model has a diagnostic value, to some degree, but a lack of consensus exists. The development of more efficient models that can replace liver biopsy still needs further research to assess liver fibrosis in chronic hepatitis B and guide antiviral therapy.