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。

Designated critical habitats for U.S.imperiled species are not protected from climate and land-use change

Designation of critical habitat is an important conservation tool for species listed as threatened or endangered under the United States(U.S.)Endangered Species Act(ESA).While this is an important protective mechanism,lands designated as critical habitat could still be subject to degradation and fragmentation if they are not also in a protected status that prioritizes biodiversity conservation.Additionally,most designations of critical habitat do not explicitly take climate change into account.The objective of our study was to determine whether and to what extent critical habitats for species listed under the ESA are located within protected areas and areas previously identified as climate refugia or climate corridors,to inform management strategies to better conserve and recover these species.We mapped the designated critical habitats of 153 ESA-listed species and measured their overlap with previously-identified areas of climate refugia and corridors(CRC),and also with lands designated as nature-protected by U.S.Geological Survey’s Gap Analysis Project(GAP Status 1 or 2)and working lands with wildlife habitat potential(GAP Status 3).Only 18%of all designated critical habitat is located on lands that are both in CRC and nature-protected,and only 9%of species had over half of their designated critical habitats in such lands.84%of species had<25%overlap of their critical habitats with these areas.Critical habitats may therefore not fulfill their essential role of helping imperiled species persist and recover.

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。

Hepatitis C virus eradication in people living with human immunodeficiency virus:Where are we now?

Hepatitis C virus(HCV)/human immunodeficiency virus(HIV)co-infection still involves 2.3 million patients worldwide of the estimated 37.7 million living with HIV,according to World Health Organization.People living with HIV(PLWH)are six times greater affected by HCV,compared to HIV negative ones;the greater prevalence is encountered among people who inject drugs and men who have sex with men:the risk of HCV transmission through sexual contact in this setting can be increased by HIV infection.These patients experience a high rate of chronic hepatitis,which if left untreated progresses to end-stage liver disease and hepato-cellular carcinoma(HCC)HIV infection increases the risk of mother to child vertical transmission of HCV.No vaccination against both infections is still available.There is an interplay between HIV and HCV infections.Treatment of HCV is nowadays based on direct acting antivirals(DAAs),HCV treatment plays a key role in limiting the progression of liver disease and reducing the risk of HCC development in mono-and coinfected individuals,especially when used at an early stage of fibrosis,reducing liver disease mortality and morbidity.Since the sustained virological response at week 12 rates were observed in PLWH after HCV eradication,the AASLD has revised its simplified HCV treatment algorithm to also include individuals living with HIV.HCV eradication can determine dyslipidemia,since HCV promotes changes in serum lipid profiles and may influence lipid metabolism.In addition to these apparent detrimental effects on the lipid profile,the efficacy of DAA in HCV/HIV patients needs to be considered in light of its effects on glucose metabolism mediated by improvements in liver function.The aim of the present editorial is to describe the advancement in HCV treatment among PLWH.

Redefining the tumor microenvironment with emerging therapeutic strategies

The environment surrounding a tumor,known as the tumor microenvironment(TME),plays a role in how cancer progresses and responds to treatment.It poses both challenges and opportunities for improving cancer therapy.Recent progress in understanding the TME complexity and diversity has led to approaches for treating cancer.This perspective discusses the strategies for targeting the TME,such as adjusting networks using extracellular vesicles to deliver drugs and enhancing immune checkpoint inhibitors(ICIS)through combined treatments.Furthermore,it highlights adoptive cell transfer(ACT)therapies as an option for tumors.By studying how components of the TME interact and utilizing technologies like single-cell RNA sequencing and spatial transcriptomics,we can develop more precise and efficient treatments for cancer.This article emphasizes the need to reshape the TME to boost antitumor immunity and overcome resistance to therapy,providing guidance for research and clinical practices in precision oncology.

虚拟生存经验与中国网络文学的起点

中国网络文学的起点问题关乎对其本质属性的认定,使其能与传统文学和西方网络文学区分开来。从网络社会出发,虚拟性、虚拟经验或许是探寻网络文学起点的重要角度。虚拟生存体验构成了网络文学与传统文学、西方电子文学的重要区别。在虚拟生存体验中,交往性(数字交往/虚拟交往)是重要方面。可以发现,虚拟交往是贯穿于网络文学发展始终的一条线索与推动力,不仅构成其外部活动特征,也改造了其内在文本结构。从交往性出发,1993年海外华文网络文学的ACT可被看作中国网络文学的起点。

Academic productivity correlates with industry earnings in foot and ankle fellowship programs in the United States:A retrospective analysis

BACKGROUND The study investigates the connection between academic productivity and industry earnings in foot and ankle orthopedic surgery fellowships.Utilizing metrics like the H-index and Open Payments Database(OPD)data,it addresses a gap in understanding the relationship between scholarly achievements and financial outcomes,providing a basis for further exploration in this specialized medical field.AIM To elucidate the trends between academic productivity and industry earnings across foot and ankle orthopedic surgery fellowship programs in the United States.METHODS This study is a retrospective analysis of the relationship between academic productivity and industry earnings of foot and ankle orthopedic surgery fellowships at an individual faculty and fellowship level.Academic productivity was defined via H-index and recorded from the Scopus website.Industry earnings were recorded from the OPD.RESULTS Forty-eight foot and ankle orthopedic surgery fellowships(100%of fellowships)in the United States with a combined total of 165 physicians(95.9%of physicians)were included.Mean individual physician(n=165)total life-time earnings reported on the OPD website was United States Dollar(USD)451430.30±1851084.89(range:USD 25.16-21269249.85;median:USD 27839.80).Mean physician(n=165)H-index as reported on Scopus is 14.24±12.39(range:0-63;median:11).There was a significant but weak correlation between individual physician H-index and individual physician total life-time earnings(P<0.001;Spearman’s rho=0.334)and a significant and moderate positive correlation between combined fellowship H-index and total life-time earnings per fellowship(P=0.004,Spearman’s rho=0.409).CONCLUSION There is a significant and positive correlation between academic productivity and industry earnings at foot and ankle orthopedic surgery fellowships in the United States.This observation is true on an individual physician level as well as on a fellowship level.

Expression level of myocardial enzymes in patients with schizophrenia: Predictive value in the occurrence of violence

BACKGROUND Schizophrenic patients are prone to violence,frequent recurrence,and difficult to predict.Emotional and behavioral abnormalities during the onset of the disease,resulting in active myocardial enzyme spectrum.AIM To explored the expression level of myocardial enzymes in patients with schizo-phrenia and its predictive value in the occurrence of violence.METHODS A total of 288 patients with schizophrenia in our hospital from February 2023 to January 2024 were selected as the research object,and 100 healthy people were selected as the control group.Participants’information,clinical data,and labo-ratory examination data were collected.According to Modified Overt Aggression Scale score,patients were further divided into the violent(123 cases)and non-violent group(165 cases).RESULTS The comparative analysis revealed significant differences in serum myocardial enzyme levels between patients with schizophrenia and healthy individuals.In the schizophrenia group,the violent and non-violent groups also exhibited different levels of serum myocardial enzymes.The levels of myocardial enzymes in the non-violent group were lower than those in the violent group,and the patients in the latter also displayed aggressive behavior in the past.CONCLUSION Previous aggressive behavior and the level of myocardial enzymes are of great significance for the diagnosis and prognosis analysis of violent behavior in patients with schizophrenia.By detecting changes in these indicators,we can gain a more comprehensive understanding of a patient’s condition and treatment.

自动化码头同时考虑握手区容量和位置的双ASC调度

为了提高自动堆垛起重机(ASC)在自动化集装箱码头(ACT)存取箱同步模式下的调度效率,对不可跨越式双ASC在同一箱区的调度进行了研究,考虑了堆场海侧和陆侧存箱、取箱任务的混合堆放,同时考虑握手区容量和位置约束,建立了以最小化最大ASC完工时间为目标的双ASC调度混合整数规划(MIP)模型。以作业任务顺序为编码设计了排列编码的混沌离散粒子群优化算法(CDPSO),通过设计的混沌因子序列提高了算法收敛速度。通过改变不同的握手区位置和容量设计了三组实验,实验结果表明,最优的握手区位置和容量有助于降低双ASC的最大完工时间、冲突时间,同时,不同的算法对比实验表明所设计的算法可以有效求解双ASC调度混合整数规划模型,相较于其他算法,得到的最优解具有更优的双ASC的空载时间和最大完工时间。

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.

Expanding the liver donor pool worldwide with hepatitis C infected livers, is it the time?

Liver transplantation(LT)provides a life-saving option for cirrhotic patients with complications and hepatocellular carcinoma.Despite the increasing number of liver transplants performed each year,the number of LT candidates on the waitlist remains unchanged due to an imbalance between donor organ supply and the demand which increases the waitlist time and mortality.Living donor liver transplant had a great role in increasing the donor pool and shortened waitlist time for LT candidates.Nevertheless,further strategies can be implemented to increase the pool of potential donors in deceased donor LT,such as reducing the rate of organ discards.Utilizing hepatitis C virus(HCV)seropositive liver grafts is one of the expanded donor organ criteria.A yearly increase of hundreds of transplants is anticipated as a result of maximizing the utilization of HCV-positive organs for HCV-negative recipients.Direct-acting antiviral therapy's efficacy has revolutionized the treatment of HCV infection and the use of HCV-seropositive donors in transplantation.The American Society of Transplantation advises against performing transplants from HCV-infected liver donors(D+)into HCV-negative recipient(R-)unless under Institutional Review Board-approved study rules and with full informed consent of the knowledge gaps associated with such transplants.Proper selection of patients to be transplanted with HCV-infected grafts and confirming their access to direct-acting antivirals if needed is im-portant.National and international consensuses are needed to regulate this process to ensure the maximum benefit and the least adverse events.

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.

Discourse Analysis Based on Face-Threatening Theory-A Case Study of TucaodahuiⅢ

Face and politeness are very important parts in people’s daily communication.But people will violate the principle of politeness for protecting their own face.Therefore,they usually choose to use more humorous words or jocular words to communicate in order to avoid direct contradictions.Starting from the face-threatening acts in the face theory and politeness principle,this paper briefly analyzes the face-threatening acts and its humorous usage in the TucaodahuiⅢ.

基于强制性运动治疗的ACTED护理模式在脑卒中偏瘫患者中的应用

目的研究基于强制性运动治疗的ACTED护理模式在脑卒中偏瘫患者中的应用效果。方法选取2020年3月—2023年5月本院收治的70例脑卒中偏瘫患者为研究对象,采用随机数字表法将其分为对照组、观察组。两组患者均实施强制性运动治疗,在此基础上,对照组采用常规护理模式,观察组采用ACTED护理模式。比较两组患者护理前后的神经功能、肢体功能和生活质量。结果护理后,两组患者的美国国立卫生研究院卒中量表评分、上肢功能评定表各维度(身体功能、疼痛症状、情绪与社会功能)评分及总分、生活质量综合评定问卷各维度(生活环境、心理健康、社会关系、躯体功能)评分均明显较护理前改善(P<0.05),且观察组的美国国立卫生研究院卒中量表评分、上肢功能评定表各维度评分及总分均低于对照组(P<0.05),生活质量综合评定问卷各维度评分均高于对照组,差异有统计学意义(P<0.05)。结论将基于强制性运动治疗的ACTED护理模式应用于脑卒中偏瘫患者中,可有效改善患者的神经功能及肢体功能,提高患者的生活质量,值得临床推广应用。

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。