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Objective:To explore clinical value of nucleic acid detection for hepatitis B virus (HBV) screening in hospitalized patients.Methods:This cross-sectional study collected and analyzed plasma samples from patients admitted to 10 domestic medical institutions from July 2021 to December 2021. Serological immunoassay and nucleic acid screening were used to simultaneously detect hepatitis B markers such as hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B e Antigen (HBeAg), hepatitis B e antibody (HBeAb), hepatitis B core antibody (HBcAb),and HBV DNA. Statistical analysis was performed on the serology, nucleic acid test results and clinical information of the patients.Results:Of the 8 655 collected samples, HBsAg was positive in 216 (2.50%) samples,HBV DNA was positive in 238 (2.75%) samples ( P>0.05); 210 (2.43%) samples were positive for both HBsAg and HBV DNA, 28 (0.32%) were HBsAg negative and HBV DNA positive, 6 cases (0.07%) were HBsAg positive and HBV DNA negative. Conclusion:These results indicate that the HBV DNA testing is equally effective as hepatitis B virus serological detection for hepatitis B virus screening in hospitalized patients.
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Objective:This multi-centre study was conducted to assess the efficacy of various preoperative/pre-transfusion screening methods for blood transmitted disease.Methods:From July 2021 to December 2021, plasma samples of patients admitted to 10 hospitals were collected for screening preoperative/pre-transfusion blood transmitted disease. Nucleic acid detection technology was used to detect hepatitis B virus (HBV) DNA, hepatitis C virus (HCV) RNA and human immunodeficiency virus (HIV)(1+2) RNA, and the results were compared with the immuno-serological methods. χ 2 test and Kappa test were used to analyze the efficacy of these two methods. Results:A total of 8 655 valid specimens were collected from 10 hospitals. There was a statistically significant difference in the positive detection rate of HCV between the two methods ( P<0.001). There was no significant difference in the positive detection rate of HBV and HIV assessed by the two methods ( P>0.05), but the number of positive cases detected by HBV DNA and HIV RNA (218 and 4 cases) was significantly higher than the corresponding serological results (216 and 2 cases). At the same time, there were HBV, HCV and HIV immuno-serological omissions by the immuno-serological methods, among which 28 cases were HBsAg negative and HBV DNA positive, 2 cases were HCV antibody negative and HCV RNA positive, and 2 cases were HIV antigen/antibody negative and HIV RNA positive. In addition, in the 66 samples with inconsistent results from the two detection methods, 83.3% (55/66), 68.2% (45/66), 63.6% (42/66) and 62.1% (41/66) of patients aged was>45 years, tumor, surgery and male, respectively. Conclusions:Compared with immuno-serological tests, nucleic acid tests have the advantage in terms of sensitivity on detecting HBV, HCV and HIV infection and could reduce missed detection. The risk of transmission can be reduced by adding HBV, HCV, and HIV nucleic acid tests to preoperative/pre-transfusion immuno-serological tests screening for patients over 45 years of age and tumor patients.
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Objective:To compare the cost-effectiveness of hospitalized Chinese patients undergoing nucleic acid screening strategies for hepatitis B and hepatitis C, immunological screening strategy, and no screening strategy under different willingness to pay (WTP). The results might aid to decision-making for the optimal strategy.Methods:In this study, nucleic acid screening, immunological screening and no screening were used as screening strategies, and China′s GDP in 2021 (80 976 yuan) was used as the threshold of WTP to construct a Markov model. After introducing parameters related to the diagnosis and treatment of hepatitis B and C in inpatients, a cohort population of 100 000 inpatients was simulated by TreeAge Pro 2021 software, the total cost, total health effects, incremental cost-effectiveness ratio and average cost-effectiveness ratio of different screening strategies were calculated, and cost-effectiveness analysis was conducted. Univariate and probabilistic sensitivity analysis were used to assess the impact of parameter uncertainty on the final results.Results:Compared with the non-screening strategy, the incremental total cost of the hepatitis B immunological screening strategy for cohort patients was 11 049 536 yuan, and the incremental cost-effectiveness ratio was 24 762 yuan/quality-adjusted life years (QALY), while the total incremental cost of nucleic acid screening was 19 208 059 yuan, and the incremental cost-effectiveness ratio was 29 873 yuan/QALY; the incremental cost-effectiveness ratio of nucleic acid screening and immunological screening was 45 834 yuan/QALY. Compared with the non-screening strategy, the incremental cost-effectiveness ratio of hepatitis C immunological screening strategy was 5 731 yuan/QALY, the incremental cost-effectiveness ratio of nucleic acid screening strategy was 8 722 yuan/QALY, the incremental cost-effectiveness ratio of nucleic acid screening and immunological screening was 45 591 yuan/QALY. The results of probabilistic sensitivity analysis showed that when the cost of nucleic acid testing exceeded 214.53 yuan, it was not cost-effective to perform hepatitis B nucleic acid screening under the WTP as 1 fold GDP. When the cost of nucleic acid testing exceeded 132.18 yuan, it was not cost-effective to conduct hepatitis C screening under the WTP as 1 fold GDP.Conclusions:Nucleic acid screening strategy can achieve more cost-effectiveness and is worthy of vigorous promotion. Compared with no screening, both the nucleic acid and immunological screening strategies are cost-effective, and hepatitis nucleic acid screening is the optimal strategy for hospitalized patients.
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Autologous ozonized blood transfusion(AOBT) is a therapy of re-transfusion of 100-200 mL of autologous blood after shaking and agitation with appropriate amount of oxygen-ozone in vitro. The oxidation of blood through the strong oxidation of ozone can enhance the non-specific immune response of the body, regulate the internal environment and promote health. This therapy has been increasingly applied in clinical practice, while no unified standard for the operation process in terms of ozone concentration, treatment frequency and treatment course had been established. This operation process of AOBT is primarily explored in order to standardize the operation process and ensure its safety and efficacy.
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Objective:To explore the selection strategy of blastocyst transfer number in freeze-thaw cycle for women over 40 years old, so as to provide reference for reducing twin rate and improving perinatal clinical outcome.Methods:A retrospective analysis was made of 377 patients who underwent freeze-thaw blastocyst transplantation in the reproductive center of Guangdong Maternal and Child Health Hospital from January 2017 to December 2019. They were divided into single blastocyst and double blastocyst transplantatio groups according to the number of blastocyst transplantation. The clinical pregnancy rate, implantation rate, abortion rate, live birth rate, premature delivery rate, twin rate and singleton delivery rate were compared between the two groups.Results:⑴There was no significant difference between two groups regarding the majority of baseline characteristics, including age at retrieval, age at transfer, body mass index (BMI), antral follicle count (AFC), basal follicle stimulating hormone (FSH), anti Mullerian hormone (AMH), endometrial thickness at transfer day, number of oocytes retrieved, Gn starting dose, Gn days, Gn dosage, embryos at cleavage stage and top-quality embryos ( P>0.05). ⑵ There was no significant difference in the rate of implantation, early pregnancy loss, late pregnancy loss and live birth between two groups ( P>0.05). ⑶ The preterm birth rate was higher in the double blastocyst transplantation group compared with the single blastocyst transplantation group, albeit not reaching significant difference (31.7% vs 12.5%, P=0.083). ⑷ The clinical pregnancy rate and the twin pregnancy rate was significantly higher in the double blastocyst transplantation group compared with the single blastocyst transplantation group ( P<0.05). ⑸ The singleton birth rate was significantly lower in the double blastocyst transplantation group compared with the single blastocyst transplantation group (75.61% vs 95.83%, P<0.05). Conclusions:In women ≥40 years old, transferring a single blastocyst can result in live birth rate that is similar as transferring two blastocysts while dramatically reducing the risk of twin pregnancy rate and increasing singleton birth rate.
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Objective@#To compare the clinical efficacy of stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) in the treatment of brain metastases from January 2006 to December 2016, lung adenocarcinoma and analyze the related factors.@*Methods@#In this multi-center retrospective analysis, clinical data of 208 patients with brain metastases from lung adenocarcinoma were retrospectively analyzed and assigned into the SRT (n=86) and SRS groups (n=122). The clinical characteristics of patients in two groups were analyzed. The local tumor control rate, median survival time and radiation brain injury were statistically compared between two groups.@*Results@#At the end of follow-up, the objective response rates (ORR) were 70.9% and 71.3% in the SRT and SRS groups (P=0.772). The local tumor control rates at 12 months were 89% and 86% in the SRT and SRS groups (P=0.383). The median overall survival time of all patients was 14.3 months, 15.6 months in the SRT group and 13.7 months in the SRS group (P=0.349). Multivariate analysis showed that large target volume (P<0.001), low GPA score (P=0.012) and no insensitive gene mutation (P<0.001) were the main factors of poor prognosis. The incidence of late radiation brain injury was 5.8% and 14.8% in two groups (P=0.043).@*Conclusions@#SRT and SRS yield similar clinical efficacy in the treatment of brain metastases from lung adenocarcinoma. SRT may have a lower incidence of late radiation brain injury than SRS.
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Objective:To investigate the application value of high-frequency linear array probe in prenatal ultrasound diagnosis of fetal kidney fusion anomalies.Methods:A senior sonographer for prenatal diagnosis used a convex array probe and a high-frequency linear array probe to obtain and store renal images of the transverse section, sagittal and coronal plane and ectopic kidney of 27 fetuses with suspected or diagnosed fetal renal fossa emptiness, abnormal renal position and abnormal renal contour in Guangdong Women and Children Hospital from December 2018 to October 2019. The images were analyzed to judge the possibility of kidney fusions by another senior sonographer (subject 1) and a junior sonographer (subject 2) separately. Then, ROC curves were plotted and statistically analyzed based on postnatal follow-up results. The Kappa coefficient between the two subjects was calculated.Results:Areas under the two ROC curves were 0.969 and 0.756 when using a convex array probe, but 1.000 and 1.000 with a high-frequency linear array probe by two subjects separately. Subject 1 had no significant difference using two kinds of probes ( P>0.05), however, subject 2 had higher diagnostic accuracy when using high frequency linear array probes ( P<0.05). The diagnostic consistence of high-frequency linear array probe between subjects was higher than convex array probe, the Kappa coefficients were 1.000 and 0.516, respectively. Conclusions:The application of high-frequency linear array probe in prenatal diagnosis of fetal kidney fusion anomalies is feasible, and can improve the confidence and diagnostic accuracy for fetal kidney fusion anomalies.
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Objective To compare the clinical efficacy of stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) in the treatment of brain metastases from January 2006 to December 2016,lung adenocarcinoma and analyze the related factors.Methods In this multi-center retrospective analysis,clinical data of 208 patients with brain metastases from lung adenocarcinoma were retrospectively analyzed and assigned into the SRT (n=86) and SRS groups (n=122).The clinical characteristics of patients in two groups were analyzed.The local tumor control rate,median survival time and radiation brain injury were statistically compared between two groups.Results At the end of follow-up,the objective response rates (ORR) were 70.9% and 71.3% in the SRT and SRS groups (P=0.772).The local tumor control rates at 12 months were 89% and 86% in the SRT and SRS groups (P=0.383).The median overall survival time of all patients was 14.3 months,15.6 months in the SRT group and 13.7 months in the SRS group (P=0.349).Multivariate analysis showed that large target volume (P<0.001),low GPA score (P=0.012) and no insensitive gene mutation (P< 0.001) were the main factors of poor prognosis.The incidence of late radiation brain injury was 5.8% and 14.8% in two groups (P=0.043).Conclusions SRT and SRS yield similar clinical efficacy in the treatment of brain metastases from lung adenocarcinoma.SRT may have a lower incidence of late radiation brain injury than SRS.
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Objective To compare the perinatal outcomes between singleton and twin pregnancies and the influencing factors in young cases(age < 35)after in vitro fertilization/egg cell sperm injection-embryo transfer (IVF/ICSI-ET). Methods A retrospective study was performed to analysis the perinatal outcomes of the young cases after IVF/ICSI-ET from January 2015 to July 2016.Results The total abortion rate,early abortion rate and the average body weight of the twin group were significantly lower than the singleton group(P < 0.05),the mid-term abortion rate,the preterm delivery rate,cesarean section rate and the low birth weight rate were opposite (P<0.05),while the total pregnancy loss rate and the rate of birth defects were not significantly different between the groups(P>0.05).The frozen-thawed embryo transfer,blastocyst transfer and double-embryo transfer were the risk factors of twin pregnancy. Conclusions Twin pregnancy may increase the risk of adverse perinatal outcomes. Selective single blastocyst transfer during frozen-thawed cycle is an effective measure for young cases,in which it can keep a balance between high clinical pregnancy rate and reducing twin pregnancy rate.
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Objective To compare the parameters of bilateral tubal ligation by LESS and multi-incision laparoscopy and their prognosis of IVF-ET. Methods From Jun. 2016 to Dec. 2017,32 patients underwent LESS bilateral tubal ligation and 60 patients under-went multi-incision laparoscopic bilateral tubal ligation were enrolled. The demographic data ,operative parameters ,and postoperative prognosis of IVF- ET in the two groups were summarized and compared. Results The mean operating time in LESS group was prolonged and its operative hospital stay was significantly decreased compared to multi-incision laparoscopic group. No significant difference was observed in the intraoperative blood loss in two groups. Moreover,no significant differences were found in the AFC,AMH,Gn stimulation days,total Gn dosage,Ovum number,good quality embryo rate,embryo implantion rate,clinical pregnancy rate and early spontaneous abortion rate in two groups. Conclusions For experienced laparoscopic surgeons,LESS is a safe and feasible procedure with similar perioperative outcomes to multi-incision laparoscopic surgery.
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Objective To investigate the effect of sperm preparation in male infertility on sperm morphology and DNA fragmentation index(DFI). Methods Four hundred men were divided into the groups of fertile , teratozoospermics and unexplained subfertility. Sperm morphology and DFI were analyzed before and after the sperm preparation. Results Sperm abnormal morphology and DFI in the infertility group were higher than those in the fertile group ,but significantly decreased after sperm preparation. The method of density gradient separation results in obtaining better sperm(P<0.01). Conclusions Compared to the method of swimming up ,the method of density gradient separation could result in obtaining sperm with improved normal morphology and DNA integrity.
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Objective To discuss the perioperative nursing measures for patients with acute deep vein thrombosis who are receiving mechanical thrombectomy.Methods The clinical data of 9 patients with acute deep vein thrombosis of lower limbs,who were admitted to the Department of Vascular Surgery,Xuanwu Hospital of Capital Medical University,Beijing,China,during the period from January 2015 to February 2016 to receive mechanical thrombectomy,were retrospectively analyzed.The nursing methods were summarized and the key points of nursing care were discussed.Results All patients were successfully treated with mechanical thrombectomy,and in all 9 patients the venous blood flow recovered after treatment.Careful and comprehensive nursing measures were strictly carried out after treatment,and the lower limb swelling symptoms were significantly improved in all patients (P<0.05).No perioperative complications occurred.Conclusion In treating acute deep vein thrombosis of lower limbs with mechanical thrombectomy method,strict perioperative care is particularly important.Understanding the key points of nursing care and strict implementation of the corresponding nursing measures can help patients to recover promptly.
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During the development of pancreatic cancer,the local and whole immune state of the patients is constantly changing,and through which the cancer cells escape from the immune attack.The main immunologic mechanism includes the induction of tumor immune suppression cells and producing the related cytokines.The changes of the whole immune status include the increase of immunosuppressive cells,the change of the immune function of T cell subsets and the inhibition of natural killers and lymphokine activated killer cells.In the local tumor,the infiltrating lymphocytes loss the function,and the ratio of Thl/Th2 cytokines is imbalance.
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Objective To confirm the correlation between pre or post processing semen parameters and clinical pregnancy rate in infertile couples with male factors undergoing intrauterine insemination (IUI) .Methods The pregnancy rate based on ovulation in‐ducing agent in infertile couples with male factors infertility per the 2010 world health organization criteria treated with IUI was e‐valuated .One hundred and twenty eight cycles were divided into pregnant group (16 cycles) and non‐pregnant group(112 cycles) . The pre or post processing semen parameters were retrospectively evaluated .Results The overall pregnancy rate was 12 .5% .All parameters in this study has no statistically significant difference between the two groups (P>0 .05) .Logistic multivariate analysis showed that there was no significant correlation between semen parameters and clinical pregnancy rate (P> 0 .05) .Conclusion There are no significant correlations between semen parameters and clinical pregnancy rate when the normal forms of patients with male infertility was 4% or higher .No semen parameters could predict results of clinical pregnancy .
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Objective To compare the efficacy of gradient and swim-up semen preparation techniques on pregnancy rates in couples undergoing intrauterine insemination (IUI) cycles with human menopausal gonadotropin (HMG) stimulation. Methods Five hundred and seventy one cycles were devided into the swim up or the gradient technique groups for sperm preperation. The clinical pregnancy rates per cycle were evaluated. Results The clinical pregnancy rates per cycle were significantly higher in the gradient group (17.8%) than that in the swim up group (11.4%)(P < 0.05). In the subgroup of unexplained subfertile couples, the gradient group also revealed significantly higher clinical pregnancy rates per cycle (33.7%) than that in the swim up group (20.3%)(P<0.05). In couples with mild male factor subfertility, the gradient group also revealed significantly higher clinical pregnancy rates per cycle (11.6%) than that in the swim up group (7.6%)(P < 0.05). Conclusion The gradient technique significantly improves clinical outcome in IUI cycles of unexplained subfertile and male subfertile couples.
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OBJECTIVE: The aim of this study was to investigate the clinical effects of sartorius tendon transposition versus sartorius transposition during bilateral inguinal lymphadenectomy of radical vulvectomy. METHODS: A total of 58 vulvar cancer patients who had surgery from May 2007 to October 2013, in which 30 patients received sartorius transposition and 28 patients received sartorius tendon transposition. All patients were matched by age, body mass index, stage, histology, and grade. Intraoperative variables and postoperative complications, recurrence, progression-free survival (PFS), and overall survival (OS) and postoperative life quality were compared and analyzed. RESULTS: No significant differences were found at median surgical times and amounts of bleeding (p=0.316 and p=0.249, respectively), neither at the incidences of groin cellulitis and lymphocele (p=0.673 and p=0.473, respectively), but the recovery times of the inguinal wounds were shorter (p=0.026) and the incidences of wound break and chronic lymphedema were significantly decreased in the tendon transposition group (p=0.012 and p=0.022, respectively). Postoperative quality of life in tendon transposition group was significantly improved as indicated by the EORTC QLQ-C30 questionnaire. Recurrences were similar (p=0.346) and no significant differences were found at PFS and OS (p=0.990 and p=0.683, respectively). CONCLUSION: Compared to sartorius transposition, sartorius tendon transposition during inguinal lymphadenectomy led to improved patient recovery, reduced postoperative complications, and improved life quality without compromising the outcomes.
Sujets)
Femelle , Humains , Études cas-témoins , Études de suivi , Lymphadénectomie/méthodes , Métastase lymphatique , Traitements préservant les organes/méthodes , Lambeaux chirurgicaux , Infection de plaie opératoire/étiologie , Tendons/transplantation , Vulve/chirurgie , Tumeurs de la vulve/chirurgieRésumé
Objective To study the clinical curative effect of adefovir and lamivudine in the treatment of chronic hepatitis B .Methods 68 patients with chronic hepatitis B were randomly divided into the treatment group and control group,34 cases in each group.The treatment group was treated with adefovir and lamivudine for 48 weeks,the control group was treated by lamivudine for 48 weeks.12,24,36,48 weeks after treatment ,the changes of liver func-tion,ALT index in HBV DNA,HBV DNA and the changes of serum HBeAg negative rate ,HBeAg/HBeAb seroconver-sion rate and adverse reaction were observed and compared .Results With the extension of treatment time ,ALT,HBV DNA in the two groups were gradually decreased , there were significant differences before and after treatment ( t=4.63,4.65,P<0.05).24,36,48 weeks after treatment,ALT,HBV DNA in the treatment group were significantly lower than those in the control group[ALT (89.9 ±16.7) U/L,(60.1 ±13.8) U/L,(44.6 ±8.9) U/L vs (90.7 ± 17.6) U/L,(72.0 ±14.1) U/L,(61.3 ±24.5) U/L;HBV DNA (4.92 ±1.44) U/L,(3.35 ±1.37) U/L,(2.53 ± 1.31) U/L vs (5.02 ±1.41) U/L,(3.69 ±1.40) U/L,(3.02 ±1.35) U/L],there were significant differences between two groups(F=4.32,4.56.4.76,all P<0.05).After treatment,the HBV DNA and HBeAg negative con-version rate,HBeAg/HBeAb seroconversion rate in two groups were increased significantly ,the differences were statis-tically significant(χ2 =4.63,4.36,4.21,4.27,4,35,4.23,all P<0.05).At the 24th week of treatment,the serolog-ical markers of HBV had no significant difference , but after 24 weeks, serum markers in the treatment group (67.65%,32.35%,26.47%,85.29%,38.23%,35.29%) were obviously higher than those in the control group , the differences between the two groups were significant (χ2 =4.43,4.73,4.23,4.32,4.34,4.46,4.76,4.34,4.22, 4.29,4.34,4.45,all P<0.05).Conclusion Adefovir and lamivudine combination therapy in the treatment of chro-nic hepatitis B has obvious clinical effect ,has no serious adverse reactions ,which is suitable for clinical application .
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Objective To systematically evaluate the risk factors for upper extremity lymphedema after breast cancer treatment and the strength of their associations.Methods PubMed,Ovid,EMbase,and the Cochrane Library were searched to identify clinical trials published up to December 2012.The quality of included studies was assessed by the Newcastle-Ottawa Scale;data analysis was performed by Stata 10.0 and RevMan 5.2;the strength of associations between risk factors and breast cancer-related upper extremity lymphedema was described as odds ratio (OR) and 95% confidence intervals (CI).Results Twenty-two studies involving 10106 patients were included in the meta-analysis.The risk factors for upper extremity lymphedema after breast cancer treatment mainly included axillary lymph node dissection (OR =2.72,95% CI=1.06-6.99,P=0.038),hypertension (OR=1.84,95% CI=1.38-2.44,P=0.000),body mass index (OR =1.68,95% CI=1.22-2.32,P =0.001),and radiotherapy (OR =1.65,95% CI =1.20-2.25,P =0.002),while no significant associations were found for such factors as chemotherapy,age,number of positive lymph nodes,and number of dissected lymph nodes.Conclusions The incidence of upper extremity lymphedema is high among patients with breast cancer after treatment,and axillary lymph node dissection,hypertension,body mass index,and radiotherapy are the main risk factors for lymphedema after breast cancer treatment.
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Objective To explore the clinical value of high frequency ultrasound combined with serum tumor specific growth factor in diagnosis of thyroid cancer.Methods 155 patients with thyroid tumor received preoperative high frequency ultrasound and the detection of TSGF content,the histopathologic examination was given after operation.The clinical value of high frequency ultrasound and TSGF detection in diagnosis of thyroid cancer was analyzed.Results The sensitivity of high frequency ultrasound in diagnosis of thyroid carcinoma was 82.54%,the specificity was 81.52%.The sensitivity of TSGF in diagnosis of thyroid cancer was 79.37%,the specificity was 78.26%.The sensitivity of high frequency ultrasound combined with TSGF in diagnosis of thyroid cancer was 92.06%,the specificity was 93.48%.And the coincidence rate of combined detection was significantly higher than the two methods used alone,the difference was statistically significant (P < 0.05).Conclusion High frequency ultrasound combined with TSGF detection can make up the shortage of the two methods,which has important value in improving the diagnosis of thyroid carcinoma.
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Objective To investigate the expression and distribution of aquaporin 3 (AQP3) in mouse early embryos at different stages.Methods Controlled ovarian hyperstimulation model of Kunming mouse was used to collect four-cell embryos,eight-cell embryos,morula stage,and early blastocysts.Immunofluorescence microscopy and laser confocal microscopy were used to detect expression and distribution of AQP3 channels in these stages.Results Fluorescence signal of AQP3 was found in four embryonic stages of mice.Distribution within embryo was different at different embryonic stages.AQP3 was mainly expressed on the karyotheca of blastomeres at four-cell and eight-cell stage.In morula stage,AQP3 was mainly expressed on cell membrane of each blastomere.In early blastocysts,AQP3 was predominantly expressed on the cell membrane and cytoplasm of trophoblastic cell.Conclusions AQP3 trans-membrane channel might have potential regulation function on mouse embryonic development.