癌症患儿症状管理中数字健康技术应用效果的系统评价

目的癌症患儿在治疗和生存期间都会出现多种症状。数字健康技术提供了一种症状管理创新性服务方式。这篇综述旨在探讨应用数字医疗技术对癌症患儿进行症状管理的干预效果。方法系统检索英文数据库(Cochrane Library,Joanna Briggs Institute Library,PubMed,CINAHL,EMBASE,Web of Science)和中文数据库(万方数据库、中国期刊全文数据库、中国生物医学数据库)建库至2019年11月30日的相关文章。采用Downs等提出的随机和非随机研究评估工具评价文章质量,对符合纳入标准的文献进行资料提取和分析。结果最终纳入11篇文章,425例研究对象。研究包括4项随机对照试验、3项类实验和5项前后对照试验。方法质量等级为中等。研究共涉及7种症状(焦虑、抑郁、疼痛、愤怒、疲乏、恐惧、心理痛苦)和7种数字医疗技术(虚拟现实、网站、机器人、应用程序、可穿戴设备、短信、视频会议)。因干预措施之间存在显著异质性,对资料采用描述性分析。结论本研究显示,当前有关支持数字健康技术对癌症患儿症状管理效果的证据并不明确,但趋势显示交互功能的数字健康技术有积极的干预效果。需开展更多设计严谨的研究来明确数字健康技术对癌症患儿症状管理的效果,需从症状、参与者和环境水平等多方面考虑相关影响因素,促进开发更好的应用数字健康技术的干预措施。

Efficacy and Safety of All-oral Emitasvir and Sofosbuvir in Patients with Genotype 1b HCV Infections without Cirrhosis

Publications>Journals>Journal of Clinical and Translational Hepatology>Article Full Text ORIGINAL ARTICLE OPEN ACCESS Efficacy and Safety of All-oral Emitasvir and Sofosbuvir in Patients with Genotype 1b HCV Infections without Cirrhosis Huiying Rao1,Xingxiang Yang2,Youwen Tan3,Qin Ning4,Daokun Yang5,Jiefei Wang6,Yongfeng Yang7,Sujun Zheng8,Dongliang Yang9,Jinlin Hou10,Qing Xie11,Caiyan Zhao12,Lunli Zhang13,Xiaorong Mao14,Tong Sun15,Lang Bai16,Fuchun Zhang17,Jinglan Jin18,Yingren Zhao19,Maorong Wang20,Wen Xie21,Yingjie Ma22,Jun Quan23,Xuebing Yan24,Ping An25,Feng Lin26,Jidong Jia27,Xiaoxuan Hu28,Zuojiong Gong29,Jie Wu30,Yongping Chen31,Zhansheng Jia32,Minghua Lin33,Guiqiang Wang34,Yueyong Zhu35,Yingjun Zhang*,36,Hongming Xie36,Lin Luo36,Qingyun Ren36,Rui Huang1 and Lai Wei*,37 Author information Journal of Clinical and Translational Hepatology 2020;8(3):255-261DOI:10.14218/JCTH.2020.00031 Abstract Background and Aims:Emitasvir is a new type of hepatitis C virus(HCV)nonstructural protein 5A(NS5A)inhibitor,and the data of phase 2 trial has shown emitasvir-sofosbuvir to have good safety and tolerance.We conducted this phase 3 trial to further verify the efficacy and safety.Methods:We evaluated the antiviral activity and safety of a 12-week regimen of emitasvir phosphate(100 mg)combined with sofosbuvir(400 mg)once daily in non-cirrhotic patients with genotype 1 HCV infection.The primary endpoint was a sustained virological response at 12 weeks(SVR12)after the end of treatment.Results:Of the 362 patients enrolled in the trial,39.8%were male,99.2%had HCV genotype 1b,0.8%had genotype 1a and 79.8%were treatment-naïve.The average age was 47.2 years.All patients completed the treatment and follow-up.All 3 patients with genotype 1a achieved SVR.Two genotype 1b treatment-naïve patients experienced virologic relapse.The rate of SVR12 was 99.7%(358/359),and SVR24 was 99.4%(357/359)in genotype 1b.Overall,36.2%had resistance-associated substitutions(RASs)in NS5A and 98.3%had RASs in NS5B at baseline.The RASs at baseline had no effect on the rates of response.Serious adverse events were reported in 16 patients and were not related to emitasvir-sofosbuvir.Most adverse events did not require therapy.Conclusions:The 12 weeks of treatment with emitasvir-sofosbuvir was a highly efficient and safe treatment for a wide range of patients with HCV genotype 1b infection without cirrhosis,who had not been treated or who had been treated with interferon-based regimen previously.

Establishment of the Psychometric Properties of a Disaster Resilience Measuring Tool for Healthcare Rescuers in China:A Cross-Sectional Study

The aim of this study was to test the validity and reliability of a tool for measuring the disaster resilience of healthcare disaster rescuers.A cross-sectional study involving 936 healthcare disaster rescuers of the Sichuan Disaster Response Team was conducted to establish the psychometric properties of the disaster resilience measuring tool(DRMT).Item analysis,exploratory factor analysis,confirmatory factor analysis,and correlation analysis were adopted to analyze the data.Item analysis showed that all but three items had the critical ratio over 3,which indicates adequate discriminability for inclusion in the measuring tool.The exploratory factor analysis showed that 65.93%of the total variance was explained by four factors—self-efficacy,social support,positive growth,and altruism.The confirmatory factor analysis showed goodness of fit for the four-factor model:CMIN/DF(2.846),GFI(0.916≥0.90),CFI(0.949≥0.90),AGFI(0.891≥0.80),and RMSEA(0.063≤0.08).Criterion validity demonstrated significant associations of the DRMT and the Connor-Davidson Resilience Scale(P<0.01,r=0.566).Convergent validity was established by correlation with stress(P<0.05,r=-0.095),depression(P<0.01,r=-0.127),posttraumatic stress disorder-PCL-C(P<0.05,r=-0.100),compassion satisfaction(P<0.01,r=0.536),and burnout(P<0.01,r=-0.330).The DRMT demonstrated adequate internal consistency(Cronbach’s alpha>0.84)and stability over the two-week study period(intraclass correlation coefficient>0.85),and a cut-off point of 61 was suggested.The disaster resilience measuring tool has satisfactory psychometric properties and is a valid,reliable,and valuable instrument for assessing disaster resilience in healthcare rescue workers.The scale needs to be tested further among other populations and those from other cultures.

Th17/Treg balance and factors related to autoimmune hepatitis

Background:Although Th17 cells and regulatory T cells play critical roles in autoimmune hepatitis,the balance between them in acute and chronic immune hepatitis is not well‐studied.The objective of this study was to explore the role of Th17/Treg balance in autoimmune hepatitis.Methods:Thirty female Wistar rats were randomly divided into the following three groups:acute model(AC),chronic model(CC),and healthy control(HC).Aspartate aminotransferase,alanine aminotransferase,and bilirubin levels were measured.Peripheral blood interleukin(IL)‐17,IL‐6,IL‐10,and transforming growth factor‐βcytokine levels were also assessed.Flow cytometry was used to detect changes in the Th17 cell and Treg cell frequency,and the Th17/Treg ratio was calculated.Results:The frequency of Th17 cells and Treg cells were both increased(p<0.05)and the Th17/Treg ratio was higher in the AC group compared with those in the HC group(p<0.05).Th17 cell levels were significantly lower and Treg cell levels were significantly higher in the CC group,compared with those in the AC group(p<0.05).In addition,the Th17/Treg ratio was lower in the CC group compared with that in the HC group(p<0.05).Conclusion:The Th17/Treg ratio was increased in the acute immune liver injury model and decreased in the chronic liver injury model.Th17/Treg imbalance may play a critical role in liver injury occurrence and development.