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； ObjectiveTo explore the effect of direct-acting antiviral treatment on renal function in patients with chronic hepatitis C. MethodsA total of 123 HCV-infected patients receiving DAAs treatment at the Third Affiliated Hospital of Sun Yat-sen University from January 2017 to December 2021 were included in this study. To explore the renal function in patients with chronic hepatitis C treated with direct-acting antivirals， serum creatinine values were collected before， during and after the treatment， which were used to estimate the eGFR by the MDRD equation to assess the changes in renal function. ResultsOf the 123 patients enrolled， 67.5%（n=83）were male， and the mean age of participants was （50±11） years old. The mean follow-up period was 24 weeks . Comorbidities included cirrhosis in 26.8%， and diabetes in 10.6%. Meanwhile， 11.4% of the cohort had eGFR < 60 mL/（min ·1.73 m2）， 33.3% of the cohort had eGFR 60 to 90 mL/（min ·1.73 m2）， and 55.3% had eGFR≥90 mL/（min ·1.73 m2）. No decrease in renal function was seen among all the HCV-infected patients at the end of treatment or the follow-up period after treatment. However， compared with the eGFR at the baseline， eGFR in CKD2 patients in the follow-up period was improved 【（88.65±15.52） mL/（min ·1.73 m2）vs （78.12 ±7.60） mL/（min ·1.73 m2）， P< 0.001】. And 14.6% （n=18） of patients experienced progressive deterioration of renal function. Logistic regression analysis showed that diabetes could predict the deterioration of renal function （OR=4.663， P=0.016）. ConclusionsOur study shows renal function is not impair among HCV-infected patients following DAAs treatment， and renal function in CKD2 patients have improvements. However， HCV-infected patients with diabetes mellitus are at a high risk of renal impairment and closely monitoring of renal function is still needed.
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BACKGROUND:Hydrogen,as an antioxidant,can reduce oxidative stress induced by strenuous exercise and achieve the effect of improving fatigue.Several studies have been reported on the potential effects of hydrogen-rich water or hydrogen-rich gas on improving exercise fatigue and athletic performance. OBJECTIVE:To investigate the effects of hydrogen-rich gas inhalation prior to high-intensity exercise on proprioception and muscular endurance performance after exercise fatigue. METHODS:Through a randomized,double-blind,crossover,and repeated measurement experimental design,24 healthy men were randomly divided into group A and group B,with 12 in each group.In the first phase of the crossover experiment,group A inhaled hydrogen-rich gas(hydrogen group)for 20 minutes and group B inhaled placebo gas(air;placebo group)for 20 minutes.Then,cycle ergometers were used to establish the fatigue model.Visual analog fatigue scale,heart rate variability,knee joint proprioception(passive position perception,joint motion perception,and muscle force perception)and isometric knee extension muscle endurance were tested before and after intervention.After a 7-day washout period,two groups exchanged intervention methods and the above tests were performed again in the second phase of the experiment.Differences between the results of groups A and B in the two phases were compared,and finally the results of the two phases were integrated to compare the overall differences between hydrogen intervention and placebo intervention. RESULTS AND CONCLUSION:In the first phase of the crossover experiment,the visual analog fatigue scale score of the hydrogen group after intervention was significantly lower than that of the placebo group(P<0.01).The root mean square of the difference between the adjacent R-R,mean low-frequency output power,mean high-frequency output power,and isometric muscle endurance after intervention in the hydrogen group were significantly higher than those in the placebo group(P<0.05).Passive position perception and joint motion perception after intervention in the hydrogen group were significantly better than those in the placebo group(P<0.05).There was no significant difference in muscle force perception between the two groups(P>0.05),but muscle force perception in the placebo group after intervention was significantly worse than that before intervention(P<0.01).The difference trend of all test results after intervention in the two groups in the first phase of the experiment showed the same results in the second phase of the experiment.The integrated results also showed that the hydrogen group had better test values for the above indicators than the placebo group(P<0.05).Linear regression analysis showed a positive correlation between post-intervention visual analog fatigue scale scores and passive position perception results(r=0.327,P=0.023),i.e.,the higher subjective fatigue level after high-intensity exercise indicated the worse passive position perception results.To conclude,inhaling hydrogen-rich gas before high-intensity exercise can reduce the degree of fatigue after exercise,thereby improving proprioception and muscle endurance performance,which may be a new strategy to reduce the occurrence of injury.And its effectiveness can be achieved repeatedly.
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Objective To investigate the effects of direct-acting antiviral agents (DAA) therapy on the frequency of myeloid-derived suppressor cells (MDSC) and their subset of monocytic myeloid-derived suppressor cells (M-MDSC) in chronic hepatitis C (CHC) patients.Methods A total of 32 treatment-naive CHC patients and 16 healthy controls were recruited at Third Affiliated Hospital of Sun Yat-Sen University from June 2016 to June 2017.The peripheral blood mononuclear cells ( PBMC) were separated from the peripheral blood of patients with CHC before DAA therapy , at four weeks after DAA therapy , at 12 weeks after DAA therapy and 12 weeks after the end of DAA therapy.The frequencies of MDSC and M-MDSC were detected by the flow cytometer.The t test, U test and chi-square test was employed to analyze the data.Results All the 32 treatment-naive patients achieved the rapid virological response and no virological breakthrough was observed . Before DAA therapy, the frequency of MDSC in CHC patients was 2.18%, which was higher than healthy individuals (0.60%; Z＝-4.593, P＜0.01), and positively correlated with the plasma levels of hepatitis C virus (HCV) RNA (r＝0.688, P＜0.01) and aspartate aminotransferase (r＝0.735, P＜0.01).After four weeks of DAA therapy, the frequency of MDSC decreased significantly to 1.07%, with no statistical significance compared to the controls ( Z＝-1.221, P＞0.05).However, at 12 weeks after DAA therapy , the MDSC frequency increased , with statically significance compared to the controls (1.64%vs 0.60%, Z＝-3.117, P＝0.002).At 12 weeks after the end of DAA therapy , the MDSC frequency had decreased to 1.29%again, with no statistical significance compared to the controls ( Z ＝-1.387, P ＝0.664).The changes of M-MDSC frequency were slightly different.Before DAA therapy, the frequency of M-MDSC in CHC patients was higher compared to healthy controls (1.66%vs 0.81%, Z＝-2.745, P＜0.01).The frequencies of M-MDSC were 0.91%, 1.09% and 1.10% at four, 12 weeks after DAA and 12 weeks after the end of DAA therapy , respectively.The differences were not statistically significant compared to the controls (Z＝-0.589,-1.028 and -0.486, respectively, all P＞0.05).Conclusion Immune status of the peripheral MDSC and M-MDSC can return to normal after DAA therapy in CHC patients.
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Objective@#To investigate the effects of direct-acting antiviral agents (DAA) therapy on the frequency of myeloid-derived suppressor cells (MDSC) and their subset of monocytic myeloid-derived suppressor cells (M-MDSC) in chronic hepatitis C (CHC) patients.@*Methods@#A total of 32 treatment-naive CHC patients and 16 healthy controls were recruited at Third Affiliated Hospital of Sun Yat-Sen University from June 2016 to June 2017. The peripheral blood mononuclear cells (PBMC) were separated from the peripheral blood of patients with CHC before DAA therapy, at four weeks after DAA therapy, at 12 weeks after DAA therapy and 12 weeks after the end of DAA therapy. The frequencies of MDSC and M-MDSC were detected by the flow cytometer. The t test, U test and chi-square test was employed to analyze the data.@*Results@#All the 32 treatment-naive patients achieved the rapid virological response and no virological breakthrough was observed. Before DAA therapy, the frequency of MDSC in CHC patients was 2.18%, which was higher than healthy individuals (0.60%; Z=-4.593, P<0.01), and positively correlated with the plasma levels of hepatitis C virus (HCV) RNA (r=0.688, P<0.01) and aspartate aminotransferase (r=0.735, P<0.01). After four weeks of DAA therapy, the frequency of MDSC decreased significantly to 1.07%, with no statistical significance compared to the controls (Z=-1.221, P>0.05). However, at 12 weeks after DAA therapy, the MDSC frequency increased, with statically significance compared to the controls (1.64% vs 0.60%, Z=-3.117, P=0.002). At 12 weeks after the end of DAA therapy, the MDSC frequency had decreased to 1.29% again, with no statistical significance compared to the controls (Z=-1.387, P=0.664). The changes of M-MDSC frequency were slightly different. Before DAA therapy, the frequency of M-MDSC in CHC patients was higher compared to healthy controls (1.66% vs 0.81%, Z=-2.745, P<0.01). The frequencies of M-MDSC were 0.91%, 1.09% and 1.10% at four, 12 weeks after DAA and 12 weeks after the end of DAA therapy, respectively. The differences were not statistically significant compared to the controls (Z=-0.589, -1.028 and -0.486, respectively, all P>0.05).@*Conclusion@#Immune status of the peripheral MDSC and M-MDSC can return to normal after DAA therapy in CHC patients.
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Through the questionnaire survey on the current situation of human research ethical management in Beijing medical and health institutions, this paper analyzed the problems existing in ethical management of Beijing medical and health institutions and put forward corresponding countermeasures and suggestions. The results showed that overall status of human research ethical management in Beijing medical and health institutions was satisfying. But the ethical management levels of different types of medical and health institutions were quite different, and medical and health institutions, health family planning administration departments and academic teams should all make corresponding contributions.
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Objective:Explore a service model on hospice care in China. Method:Investigate on hospice care needs and demands in the city of Beijing, Shanghai and Baotou From June to September 2016. Result:More than 80 percent of the respondents willing to receive hospice care service, and people tend to have different hospice service model in different demographic groups, and the number of people choosing"general hospital" was the highest, nearly one- third. Conclusion:The society has a high demand for hospice care service, and to explore a service model which is government-led and the whole society involved and family as the core and community united and connected by hospice care institution and guided by the general hospital can promote the development of hospice care in China.
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Porcine deltacoronavirus (PDCoV) has been recently recognized as an emerging viral pathogen that causes diarrhea in newborn piglets. A total of 254 small intestinal or fecal samples collected from 10 provinces including Henan, Hunan, Zhejiang, Jiangxi, Anhui, Hebei, Heilongjiang, Jiangsu, Shandong and Shanghai between 2014 and 2015, were screened by quantitative RT-PCR targeting the viral M gene. Eleven PDCoV positive samples were identified with a total positive rate of 4.33%. An indirect enzyme-linked immunosorbent assay (ELISA) was developed based on the recombinant S1 protein of PDCoV. This assay was used to test 609 serum samples of pigs with diarrhea symptoms collected from 10 provinces between 2015 and 2016. The positive rate of PDCoV antibody was 44.17% (269/609). The two methods can be used to monitor the PDCoV epidemiology in the levels of PDCoV specific RNA or antibody, helping better prevent and control PDCoV.
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Objective:This thesis aims to construct the evaluation index system ethics management in Beijing medical institutions for application research.Method:The author applied the evaluation system which was agreed and adjusted by expert groups in four medical and health institutions.Result:After three rounds of expert groups have reached the agreement,the Evaluation Index System on Human Research Ethics Management in Beijing Medi-cal Institutions is established,which contains 6 first-class indicators,16 second-class indicators and 39 third-class indicators.The application on four medical and health institutions show that the evaluation index system is practical,operable and is of high degree of distinction.Conclusion:The evaluation index system is scientific,rea-sonable,practical and is of high degree of validity,credibility and distinction.
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Objective:To understand the similarities and differences of medical ethics education between Chinese and American medical colleges and universities,grasp the advantages and disadvantages,and analyze the enlightenment of American medical ethics education to our country.Methods:We used individual interview method of qualitative research methods and conducted semi-open interview.Results:China can adjust the curriculum provision appropriately,enrich the content of medical ethics education,improve the medical ethics practice education,enrich teaching approaches and diversify examination form in medical students moral education cultivation.Conclusion:Both China and the United States attach great importance to medical professionalism education,medical ethics training and the doctor-patient relationship education.However,there are significant differences in their history,culture,religion and morality,as well as the medical systems,education on medical students and medical ethics education.Views formed in the interview provide certain reference and guidance for Chinese medical ethics education at a certain level.
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This paper discussed the development of hospice care in our country form five respects , detailed e-laborated our country the main manifestations of lacking hospice medical service policy : relevant policies render fragments;relevant policy interoperability is not strong;Relevant policy lack of financial support;the lack of pub-licity related policy .On this basis , put forward the hospice career development needs of related policies , inclu-ding:set up complete medical security system;establish perfect hospice service classification management mecha-nism;establish and perfect the government funds allocated for hospice care medical services .
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Based on the analysis of survey results and random interviews on medical students , this paper dis-cussed from the perspective of medical students under the present situation of doctor -patient relationship:satisfied with prescriptions basic medical quality , but there are still a large room to improve;to cure medical ethics appraisal is higher , but still need to strengthen medical ethics education; the parties are still lack of trust in the prescrip-tions;the doctor-patient relationship nervous .And put forward the following countermeasures on how to relieve the strain on the doctor -patient relationship , strengthening medical ethics education , strengthen the study and practice of doctor-patient communication , pay attention to legal consciousness propaganda and training , use media power to improve direction of publit opinion .
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The tralning system for orthopedic surgeon in Britaln is mature and complete. After completing education in medical college, medical students receive a 2-year base tralning (FY1, FY2), which focus on learning and consolidating basic medical knowledge and clinical skill, followed by a 6-year specialist tralning, which subdivides into tralning of ankle and foot, hand, should and elbow, hip, knee, spine, and pediatric surgery, provided by several district hospital (Peripheral hospitals). Students are required to return to teaching center for review, ward inspection, case discussion at regular inter-vals. Compared with the specialist tralning system based on the hospital staffs in chi-na, the role ofsocial workersin British during the period of tralning makes better mobility of tralnee among medical institutions and medical treatments, which makes the tralning more comprehensive and professional. In addition, there is no consistent system for examination and admittance of specialist, and awareness of specialist tralning among medical institutions and doctors is weak. Therefore, it should be done to form a single tralning system and unify the tralning specification and assessment standard.
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With more details of end-of-life-care such as moral principle and standard management,the development condition of end-of-life-care in China is compendiously introduced, and "1,3,9——PSD"service mode of end-of-life-care is also put forward in this artical.
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Objective To investigate the curative effect of laparoscopic or laparoscopically-assisted repair of gastrointestinal perforation. Methods Eighteen patients with gastroduodenal perforation underwent laparoscopic full-thickness repair with greater omentum covering. One patient with intestinal perforation underwent double-layer suture.Three patients with intestinal perforation were treated with mini-incisional repair or partial enterectomy.One patient with perforation of the sigmoid colon received laparoscopically-assisted loop sigmoidostomy.Results Laparoscopic repair was successfully accomplished in 18 patients,while laparoscopically-assisted repair was carried out in 3 patients with intestinal perforation and 1 patient with perforation of the sigmoid colon.The operation time was 35～80 min(mean,50 min).No complications occurred.Follow-up observations in 23 patients for 6～24 months(mean,18 months) revealed no recurrence of peptic ulcer in 18 patients with gastroduodenal perforation within 6～8 months and no intestinal obstruction. Conclusions Laparoscopic operations for gastrointestinal perforation is micro-invasive and effective.
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In order to find out the social attitude towards euthanasia and related issues,we conduct a questionnaire investigation on medical staff,patients,medical school students,and community groups in Beijing.From the survey,we find out that there is a relatively high degree of awareness of euthanasia,and the different attitudes for euthanasia are relevant to the educational backgrounds and professional backgrounds.In addition,by analyzing the mentality of people talking about the death,we find out that people with a healthy outlook on life and death are more inclined to agree with active euthanasia.
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Wenchuan earthquate brought great misfortune to people,but this disaster has evoken human beings' moral power greatly.Love is the source of moral power,altruism is basic point of moral power and charity is performence of moral power.In this paper,we discuss moral powers' meanings and founctions in three aspects: great devotion of love,altruistic sacrifice and all kinds of charity without the boundary of counties and field.
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The hospitalpice enterprise has developed vigorously in China ever since 1980s.However,influenced by the long history and traditional Chinese culture,there are some ethical dilemmas in the issues of choice of death and palliative treatment.Choice of death and palliative treatment for the dying patients have been restricted by the traditional Chinese philosophy of death,traditional principles of filial piety,and the absence of support from euthanasia legislation.It is suggested that during the introduction of hospitalpice into china,the traditional Chinese value be respected.Meanwhile,people's cognition of hospitalpice should also be shifted to decrease the constraint of traditional ideas.The whole social power should be united and professional regulation construction should also be strengthened.Besides,it is also important to improve training for related professionals,promote the process of hospitalpice legislation as well as go abide by the current laws in order to achieve a high-quality hospitalpice.