Unraveling the Impact of Direct-Acting Antivirals on Hepatitis-Linked Cirrhosis: A Comprehensive Analysis of Fibrosis, Child Score, and Disease Progression

The treatment of hepatitis C has undergone a significant boom since the advent of direct acting antivirals (DAA). Indeed, the interferon-ribavirin combination that has been used to treat hepatitis C has a virological response in only 45% of cases with significant side effects. The advent of direct-acting antivirals has changed the prognosis of cirrhotic patients with hepatitis C. DAAs have ensured a sustained viral response in the majority of patients. Our work aims to see the evolution of hepatitis C patients at the cirrhosis stage under DAA. We conducted a retrospective study over 15 years (January 2009, January 2024) including all patients with post-viral cirrhosis C, whom we divided into two groups: group A, cirrhotic patients who received ribavirin and interferon, and group B, patients on DAA. From January 2009 to January 2024, we conducted a study of 182 patients with viral hepatitis C, including 102 cirrhotic patients. The mean age was 55 years. 66% of patients were initially treated with the ribavirin interferon combination, while 34% received direct-acting antivirals (DAAs). Since the introduction of DAAs, the most commonly used regimens have been sofosbuvir/daclatasvir with or without ribavirin and sofosbuvir/ledipasvir with or without ribavirin. Group A achieved sustained virological response (SVR) in 60% of cases, with notable side effects. In Group B, SVR was 98.18%, with improved tolerability and fewer side effects than previous treatments. Fifteen patients developed hepatocellular carcinoma (HCC), with a significantly lower mortality rate in those treated with DAAs compared with pegylated dual therapy (p: 0.001).

基于ACT反馈的延续性护理对老年间质性肺炎患者治疗依从性的影响评价

分析以ACT反馈为基础的延续性护理模式,对老年间质性肺炎患者的影响价值。方法 从2022年7月开始,截至2023年7月,本院总计选入老年间质性肺炎患者60例,经抽签法进行两组均分。30例对照组实施基础护理,30例研究组实施基于ACT反馈的延续性护理。比较两组护理后肺功能水平、临床恢复结果、生活质量以及总依从率。结果 研究组各肺功能结果、生活质量评分高于对照组;恢复时间短于对照组;总依从率高于对照组,差异有统计学意义(P<0.05)。结论 老年间质性肺炎患者,进行基于ACT反馈的延续性护理,可提升生活质量和依从性,稳定肺功能水平。

麦粒灸对神经根型颈椎病大鼠脊髓及神经根Activin A/ActRⅠ/Smad4表达的影响

目的:通过观察麦粒灸“大椎”穴对神经根型颈椎病大鼠激活素A(Act A)、ActⅠ型受体(ActRⅠ)及受体后信号传导蛋白Smad4表达的影响,探讨麦粒灸治疗神经根型颈椎病(CSR)的镇痛机制。方法:将30只SPF级雌雄各半SD大鼠随机分为空白组、模型组、麦粒灸组,每组10只。采用椎管插线法制备CSR模型。模型组及麦粒灸组均于造模后待伤口恢复7 d,第8天开始干预。空白组正常喂养且不做任何干预措施,模型组仅予腹腔注射1 ml的0.9%氯化钠溶液,麦粒灸组在模型组基础上予麦粒灸“大椎”穴,6壮/次,1次/d。连续干预7 d后,观察各组大鼠步态评分,测量机械痛阈值,采用蛋白免疫印迹检测脊髓及神经根组织Act A、ActRⅠ及Smad4的蛋白。PCR检测脊髓及神经根组织Act A和ActRⅠ的mRNA表达水平,苏木素-伊红染色观察脊髓及神经根组织的形态结构,免疫荧光染色观察Smad4阳性表达水平。结果:与空白组比较,模型组、麦粒灸组大鼠步态评分升高、机械痛阈降低(P<0.05)。与模型组比较,麦粒灸组大鼠脊髓及神经根组织Act A、ActRⅠ及其mRNA表达水平均升高(P<0.05)。Western blotting和免疫荧光结果均显示Smad4表达增加;HE染色观察麦粒灸组脊髓形态损伤较模型组有所减轻,灰质区神经元固缩,尼氏小体减少,神经胶质细胞和毛细血管数量比模型组减少。结论:麦粒灸“大椎”穴能改善CSR大鼠疼痛阈值和运动功能,促进神经元损伤后修复,这与激活Activin A/ActRⅠ/Smad4信号通路有关。

专业认证背景下高校师范生知向行转化的逻辑路向--基于ACT认知模型视角

专业认证背景下高校师范生的“知”和“行”是师范生将“践行师德、学会教学、学会育人、学会发展”等“他知”内化后形成的结构化“我知”以及外化后生成的关联化教育行动。由“知”化“行”是师范生知识形态从陈述性向程序性自然变迁及其职业素养发展的基本要求。从ACT认知模型视角看,这种转化遵循“认知”“编辑”“调适”的逻辑发展规律。其中:“认知”是师范生以学习理解“他知”意义为任务,学以致知;“编辑”是师范生以整合碎片化意义为目标,学以致道;“调适”是师范生依托教育场域,应用“我知”,以知化形。

ACTED模式下综合康复训练在脑卒中患者住院-随访中的应用

目的探讨ACTED模式下综合康复训练在脑卒中患者住院-随访中的应用。方法选取2021年1月至2023年10月郑州大学第一附属医院康复医学科收治的150例脑卒中患者,按随机数字表法分为对照组和观察组,各75例。给予对照组常规康复训练,观察组在此基础上接受ACTED模式下综合康复训练。比较两组DE Morton活动指数(DEMMI)、平衡能力(BBS)、肢体功能(FMA)、步态参数、自我管理能力、生活质量(SIS)。结果观察组出院后3个月DEMMI、BBS、上下肢FMA评分高于对照组(P<0.05);观察组出院后3个月的步频、步长、步速高于对照组,双支撑期百分比低于对照组(P<0.05);观察组出院后3个月的自我管理能力、SIS评分评分高于对照组(P<0.05)。结论ACTED模式下综合康复训练能有效提高脑卒中患者自我效能与自我管理能力,改善患者运动功能,提高患者生活质量。

Tourism Officials Turn to Social Media

Recent years have seen a growing number of local officials choosing to promote their areas as influencers In the digital age,online celebrities attract public attention and influence followers more easily on issues such as what to buy and where to go.The latest trend spreading among civil servants:becoming social media influencers to promote their hometowns.

Awareness of the Termination of Pregnancy Act of the Laws of Zambia among Women of Reproductive Age at Kanyama First Level Hospital in Lusaka District Zambia

Background: Termination of pregnancy (TOP) in Zambia is guided by the Termination of Pregnancy (TOP) Act of 1972 and as amended in 1994 of the laws of Zambia. However, despite provision of Comprehensive abortion care services with the liberal law, statistics at Kanyama First Level Hospital in relation to unsafe illegal abortions are alarming. This study sought to understand the Awareness on the TOP Act of the laws of Zambia among women of reproductive age 15 - 49 years at Kanyama First Level Hospital in Lusaka District. Purpose of the Study: To assess awareness on the TOP Act among women of reproductive age at Kanyama First Level Hospital in Lusaka, Zambia. Methodology: A convergent parallel mixed method design was conducted using both survey and in-depth interviews among women of reproductive age at Kanyama First Level Hospital in Lusaka District. The study surveyed 370 randomly sampled women aged 15 to 49 years old while the in-depth interviews included eight women purposively sampled from the survey population. Survey data was analyzed using descriptive and inferential statistics while qualitative data thematic analysis was used. Results: The study found that 37% of the participants were aware of the TOP Act while 63.8% viewed legalization of abortion for any reason as wrong. The study results also showed that widowed women were 8 times more likely to be aware of the TOP Act compared to single women (AOR: 8.262;95% CI: 1.105, 61.778). Women in business were significantly more likely to be aware of the TOP Act compared to those who reported having no occupation. (AOR: 2.61;95% CI: 1.246, 5.499). Limited access to information, the social stigma attached to abortion, health care providers’ attitudes, cultural norms, values and religious beliefs, restrictive legal requirements, and absence of a supportive network were some of the barriers affecting awareness and utilization of available safe abortion care services. Conclusions: The research findings concluded that a significant lack of awareness among women of reproductive age regarding the Termination of Pregnancy (TOP) Act. The majority of respondents held the view that abortion should only be legalized for medical reasons. Furthermore, there was a notable gap in knowledge concerning the penal code’s provisions on abortion.

User Perspective of Misplaced PPIUCD and Factors Resulting in PPIUCD Removal: Qualitative Pilot Study

Objective: The aim of the current study was to assess the impact of operative interventions for misplaced device among women who opted for PPIIUCD and the evaluation of reasons for PPIUCD removal within the follow up period of two years. Design: A descriptive exploratory study was conducted over three months among fourteen PPIUCD acceptors at a tertiary care health facility in Delhi, India. Face-to-face & telephonic in-depth interviews were conducted with a selected sample of PPIUCD acceptors who had later opted for its removal. Results: Participants (n = 14) aged 24 – 40 exhibited generally positive attitudes towards PPIUCDs indicating an indicate an understanding of the importance of PPIUCD in preventing unintended pregnancies. Menstrual disturbance and misplaced IUCD were major reasons for removal. despite their own experience necessitating the removal of IUCD, positive experience by other family members (mothers in law) in this study helped to keep the confidence on the contraceptive. Themes included (a) general experience of PPIUCD use (b) Health Facility accessed for removal of IUCD (c) Would she recommend it to others? (d) preferred contraceptive after removal of IUCD. Conclusion: Misplaced IUCD, missing thread, menstrual irregularities, and pain are all associated with PPIUCD and are important reasons for dissatisfaction. Appropriate, timely and supportive individualized care that address knowledge gaps, societal perceptions, and healthcare system challenges would certainly help in reducing dissatisfaction due to PPIUCD and thereby the removal rates.

ACTED康复护理模式在肩袖损伤合并冻结肩术病人中的应用

目的:探讨ACTED康复护理模式在肩袖损伤合并冻结肩术病人中的应用效果。方法:选取2022年1月—12月医院收治的90例肩袖损伤合并冻结肩术病人为研究对象,采用随机数字表法将病人分为观察组、对照组,每组45例,对照组行常规康复训练,观察组实施ACTED康复护理模式,比较两组病人干预前后功能锻炼自我效能、依从性及康复效果[疼痛视觉模拟评分(VAS)、肩功能活动度、肩关节功能评分(CMS)、日常生活功能评分(ADL)]。结果:干预后观察组病人功能锻炼自我效能、依从性评分较对照组明显提升(P<0.05),疼痛情况、肩袖关节活动能力及日常生活能力改善效果明显优于对照组(P<0.05)。结论:ACTED康复护理模式可提升肩袖损伤合并冻结肩术病人术后功能锻炼自我效能及依从性,从而改善病人肩关节功能,提升病人日常生活能力。

ACTED康复护理在重度子宫脱垂术后患者中的应用效果

目的:观察ACTED康复护理在重度子宫脱垂术后患者中的应用效果。方法:选取2019年12月至2022年7月该院收治的66例重度子宫脱垂术后患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各33例。对照组采用常规康复护理,观察组在对照组基础上采用ACTED康复护理。比较两组康复优良率,护理前后盆底功能[盆底功能障碍问卷(PFDI-20)]、心理困扰程度[简易凯斯勒心理困扰量表(K10)]和健康行为能力[健康行为能力自评量表(SRAHP)]评分。结果:观察组康复优良率为93.94%(31/33),高于对照组的75.76%(25/33),差异有统计学意义(P<0.05);护理3个月后,两组膀胱、肠道、盆腔等各项PFDI-20评分均低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);两组K10评分均低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);两组SRAHP评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:ACTED康复护理应用于重度子宫脱垂术后患者,可提高康复优良率与健康行为能力,减轻盆底功能障碍和心理困扰程度,效果优于常规康复护理。

密旋链霉菌Act12发酵液对石油胁迫下紫花苜蓿幼苗生长及生理特性的影响

[目的]考察密旋链霉菌Act12发酵液对石油胁迫下紫花苜蓿幼苗生长及生理特性的影响,探讨其缓解石油胁迫的作用机制。[方法]以‘中苜3号’紫花苜蓿为供试植物,采用盆栽试验,考察质量分数3%(W/W)石油胁迫和不同浓度(0、1%、10%和100%)Act12发酵液处理下紫花苜蓿幼苗生长、根系构型、光合特性、渗透调节物质含量和抗氧化能力等指标的变化。[结果]相较于对照组(CK),3%石油胁迫显著抑制了幼苗的光合作用和生物量,同时增加了丙二醛(MDA)的积累,降低了可溶性糖和可溶性蛋白含量,改变了超氧化物歧化酶(SOD)和过氧化物酶(POD)活性。中低浓度(1%和10%)的发酵液处理可以有效缓解石油胁迫对紫花苜蓿幼苗的毒害,并以10%的Act12发酵液效果最佳;与不施用Act12发酵液处理相比,10%Act12发酵液处理幼苗的株高、地上部干质量、地下部干质量、茎耐受指数、根耐受指数、总根长、根表面积、根体积和根尖数均显著增加,地上部分和地下部分MDA含量分别降低了42.49%和56.45%,可溶性糖含量分别增加了79.25%和89.83%,可溶性蛋白含量分别增加了167.63%和256.15%,根系SOD和POD活性分别提升了35.81%和57.33%。[结论]中低浓度密旋链霉菌Act12发酵液能有效增强石油胁迫下紫花苜蓿幼苗的抗氧化酶活性和渗透调节能力,降低MDA含量,提高光合作用能力,增加生物量,有效缓解石油胁迫对幼苗生长的抑制。

Factors Influencing the Choice between IUD and Implant among Long-Acting Reversible Contraceptive (LARCs) Users in Burkina Faso

Background: Long-acting and reversible contraceptive methods hold great potential as solutions to address the unmet need for contraception and the significant discontinuation rates, especially in sub-Saharan Africa. Among these methods, the Implant has gained popularity in sub-Saharan Africa, whereas the utilization of Intrauterine Devices (IUDs) has remained comparatively low, particularly in Burkina Faso. This study aims to evaluate the shifts in IUD and Implant usage from 2010 to 2020 and to pinpoint the factors influencing the choice of IUDs among LARCs users in Burkina Faso. Data and Methods: We conducted an analysis using data from Burkina Faso, drawn from the 2010 Demographic and Health Survey (DHS) and the 2020 PMA Phase 1 data. The 2010 DHS garnered responses from 17,087 women aged 15 - 49, achieving a response rate of 98.4%. The 2020 PMA data collected responses from 6590 women aged 15 - 49, with a response rate of 95.8%. The final sample of Long-Acting Reversible Contraceptives (LARCs) users consisted of 1502 women, including 576 women from the 2010 survey and 926 women from the 2020 survey. Results: The study demonstrates an expansion of IUD usage to include socioeconomically disadvantaged segments among LARC users. However, higher levels of education, older age, and decisions influenced by healthcare providers are correlated with the preference for IUDs over Implants. The choice of IUDs is also connected to a comprehensive understanding of contraceptive methods, suggesting potential biases in the counseling process. Conclusion: Facilitating the broader adoption of IUDs among disadvantaged groups could be achieved by improving the accessibility of IUD products and services in rural areas. Nevertheless, there should be focused initiatives to enhance access to removal services, as this factor could dissuade specific users. Further efforts are required to train healthcare providers, aiming to mitigate biases in delivering Long-Acting Reversible Contraceptives (LARCs). Providers should provide impartial counseling, irrespective of the selected type of LARC.

基于ACT反馈的延续性护理干预用于老年间质性肺炎中的效果分析

观察分析对老年间质性肺炎患者实施基于ACT反馈的延续性护理干预的临床效果和应用价值。方法:选择我院于2022年02月~2023年02月内就诊的60例老年间质性肺炎患者,随机均分为对照组(行常规护理)和实验组(行基于ACT反馈的延续性护理干预),收集分析护理效果。结果:实验组SAS、SDS评分,并发症发生率均明显低于对照组,生存质量评分、PaO2、FEV1、FVC、护理满意度均明显高于对照组,差异有统计学意义(P<0.05)。结论:基于ACT反馈的延续性护理干预可以有效减少老年间质性肺炎患者并发症发生率,缓解负性情绪,提高生存质量,改善肺功能,提高护理满意度,有较高的应用价值。

ACTED护理模式联合虚拟情景康复训练对中青年脑卒中偏瘫患者的影响

目的:探讨ACTED护理模式联合虚拟情景康复训练对中青年脑卒中偏瘫患者的影响。方法:选取2021年9月1日~2022年9月30日收治的68例中青年脑卒中偏瘫患者为研究对象,以抛硬币随机法分为联合组和对照组各34例,对照组采用脑卒中常规康复训练,联合组在此基础上采用ACTED护理模式联合虚拟情景康复训练,两组均护理至出院;比较两组护理前后肢体功能[采用上肢功能评定表(DASH)]、神经功能[采用美国国立卫生研究院卒中量表(NIHSS)]、自我效能[采用中文版脑卒中康复自我效能量表(SSEQ)]、生活质量[采用健康调查简表(SF-36)]、出院准备度[采用出院准备度评估量表(RHDS)]及护理满意度。结果:护理后,两组DASH、NIHSS评分均低于护理前(P<0.05),且联合组低于对照组(P<0.01);护理后,两组SSEQ、SF-36评分均高于护理前(P<0.05),且联合组高于对照组(P<0.01);联合组RHDS、护理满意度评分均高于对照组(P<0.01)。结论:对中青年脑卒中偏瘫患者行ACTED护理模式联合虚拟情景康复训练,可促进上肢功能、神经功能的恢复,提升患者自我效能感、出院准备度,提高其生活质量、护理满意度。

行为追溯安全培训法(ACT)理论构建与应用

为减少作业人员不安全行为,提高现场作业安全绩效,以案例教学和事故致因“2-4”模型(24Model)为指导,结合策划、实施、检查、处理(PDCA)循环理论,构建以事故-原因-培训(ACT)为关系链的行为追溯安全培训法,亦称ACT安全培训法。该方法将事故案例贯穿培训全程,发挥案例教学优势,利用事故致因24Model追溯导致事故的组织层面和个人层面的不安全因素,基于分析结果制定针对性的培训方案,并以有限空间作业课程培训体系设计实施为例,验证ACT安全培训法的实际应用效果。结果表明:在有限空间作业培训课程体系实施过程中,参训人员数量及考核成绩均呈整体上升趋势,受训人员参与积极性及学习效果都得到有效提高,验证了ACT安全培训法具有良好的实用效果。

应用Act活水器对不结球白菜生长及品质的影响

以不结球白菜华王为研究对象,应用Act活水器,分析了Act活化水和普通水灌溉后不结球白菜生物量和营养品质的差异。试验结果表明,Act活水器处理具灭菌、降浊的效果,提高了水质溶解氧的含量,降低了电导率,能提高不结球白菜的可溶性蛋白、可溶性糖、维生素C含量,对降低硝酸盐含量也有一定效果。

Impact of direct acting antivirals on occurrence and recurrence of hepatocellular carcinoma: Biologically plausible or an epiphenomenon?

Hepatocellular carcinoma(HCC) is a major cause of morbidity and mortality worldwide. Chronic hepatitis C virus infection(HCV) is the most common cause of HCC in many European countries, Japan and Pakistan. Introduction of the new direct acting antivirals(DAAs) has revolutionized the management of HCV worldwide, with high rates of sustained virologic response in patients who could not have tolerated the previous interferon based treatments. However, recently there have been reports raising caution about the long term effects of DAAs, particularly a possible increased risk of HCC. Therefore this review explores the current molecular studies as well as clinical data that investigate the impact of DAAs on occurrence and recurrence of HCC.

A method of elevated temperatures coupled with magnetic stirring to predict real time release from long acting progesterone PLGA microspheres

The object of the study was to develop a quick and reproducible accelerated in vitro release method to predict and deduce the function of the real time(37 °C) release for long acting PLGA microspheres. The method could be described in several steps. First, the release of the microspheres were studied using the sample and separate method at 37 °C with normal orbital shaking and elevated temperatures with magnetic stirring to further accelerate the release. Second, the most similar profile at elevated temperatures with the real time release was chosen with the help of the n value in the fitted Korsmeyer-Peppas Function. Third,the Weibull function and conversion ratio were used to deduce the function of real time release according to the chosen profile at elevated temperatures. The key point in this study was to provide a quick and precise method to predict the real time release for long acting progesterone PLGA microspheres. So the elevated temperatures coupled with magnetic stirring were used to accelerate the release further, and when there have many similar release profiles with the real time release at elevated temperatures, releasing time at elevated temperatures and the R2 of the final deduced function will be used to help choosing the most similar release profile with the real time release. Four different types of progesterone PLGA microspheres were used to verify the method, and all the deduced function correlated well with the real time releases, for R2 = 0.9912, 0.9781, 0.9918 and 0.9972, respectively.

Future of liver disease in the era of direct acting antivirals for the treatment of hepatitis C

Hepatitis C virus(HCV) infection has been a global health problem for decades, due to the high number of infected people and to the lack of effective and welltolerated therapies. In the last 3 years, the approval of new direct acting antivirals characterized by high rates of virological clearance and excellent tolerability has dramatically improved HCV infection curability, especially for patients with advanced liver disease and for liver transplant recipients. Long-term data about the impact of the new direct acting antivirals on liver fibrosis and liver disease-related outcomes are not yet available, due to their recent introduction. However, previously published data deriving from the use of pegylatedinterferon and ribavirin lead to hypothesizing that we are going to observe, in the future, a reduction in mortality and in the incidence of hepatocellular carcinoma, as well as a regression of fibrosis for people previously affected by hepatitis C. In the liver transplant setting, clinical improvement has already been described after treatment with the new direct acting antivirals, which has often led to patients delisting. In the future, this may hopefully reduce the gap between liver organ request and availability, probably expanding liver transplant indications to other clinical conditions. Therefore, these new drugs are going to change the natural history of HCV-related liver disease and the epidemiology of HCV infection worldwide. However, the global consequences will depend on treatment accessibility and on the number of countries that could afford the use of the new direct acting antivirals.

Long acting octreotide in the treatment of advanced hepatocellular cancer and overexpression of somatostatin receptors: Randomized placebo-controlled trial

AIM: To estimate if and to what extent long acting octreotide (LAR) improves survival and quality of life in patients with advanced hepatocellular carcinoma (HCC). METHODS: A total of 127 cirrhotics, stages A-B, due to chronic viral infections and with advanced HCC, were enrolled in the study. Scintigraphy with 111Indium labeled octreotide was performed in all cases. The patients with increased accumulation of radionuclear compound were randomized to receive either oral placebo only or octreotide/octreotide LAR only as follows: octreotide 0.5mg s.c. every 8 h for 6 wk, at the end of wk 4-8 octreotide LAR 20 mg i.m. and at the end of wk 12 and every 4 wk octreotide LAR 30mg i.m.. Follow-up was worked out monthly as well as the estimation of quality of life (QLQ-C30 questionnaire). Patients with negative somatostatin receptors (SSTR) detection were followed up in the same manner. RESULTS: Scintigraphy demonstrated SSTR in 61 patients. Thirty were randomized to receive only placebo and 31 only octreotide. A significantly higher survival time was observed for the octreotide group (49 ± 6 wk) as compared to the control group (28 ± 1 wk) and to the SSTR negative group (28 ± 2 wk), LR = 20.39, df = 2, P < 0.01. The octreotide group presented 68.5% lower hazard ratio [95% CI (47.4%-81.2%)]. During the f irst year, a 22%, 39% and 43% decrease in the QLQ-C30 score was observed in each group respectively.CONCLUSION: The proposed therapeutic approach has shown to improve the survival and quality of life in SSTR positive patients with advanced HCC.