基于AHP-熵权-TOPSIS改进风险矩阵的连续刚构桥施工风险评价研究

针对传统风险矩阵法(LS法)的不足,提出将ALARP准则引入风险矩阵,并建立了关于连续刚构桥的桥梁施工风险评价指标体系,运用层次分析法从横向角度对准则层风险指标赋予权重,再使用熵权法从纵向角度对指标层风险指标的风险发生概率和风险损失分别赋予权重,最后结合TOPSIS法(逼近理想排序法)对给出的风险值进行精确排序,得出基于AHP-熵权-TOPSIS改进风险矩阵,解决了传统风险矩阵无法针对同一级别的风险因素继续细分排序的问题,便于项目管理人员合理分配人力、物力、财力等安全资源的投入。

The Shandong Shidao Bay 200 MW_e High-Temperature Gas-Cooled Reactor Pebble-Bed Module(HTR-PM) Demonstration Power Plant: An Engineering and Technological Innovation

In 2005, the US passed the Energy Policy Act of 2005 mandating the construction and operation of a high-temperature gas reactor （HTGR） by 2021. This law was passed after a multiyear study by national experts on what future nuclear technologies should be developed. As a result of the Act, the US Congress chose to develop the so-called Next-Generation Nuclear Plant, which was to be an HTGR designed to produce process heat for hydrogen production. Despite high hopes and expectations, the current status is that high temperature reactors have been relegated to completing research programs on advanced fuels, graphite and materials with no plans to build a demonstration plant as required by the US Con- gress in 2005. There are many reasons behind this diminution of HTGR development, including but not limited to insufficient government funding requirements for research, unrealistically high temperature requirements for the reactor, the delay in the need for a ＂hydrogen＂ economy, competition from light water small modular light water reactors, little utility interest in new technologies, very low natural gas prices in the US, and a challenging licensing process in the US for non-water reactors.

Impact of Mandatory Provisions on the Validity of Juristic Acts: A Path for Legal Policy Analysis

Contrary to the approach in judicial practice,Paragraph 1,Article 153,of the Civil Code of the People’s Republic of China,as a rule of invalidity for violating mandatory provisions,does not adopt a dichotomy towards mandatory provisions with effectiveness and administrative characteristics,yet it maintains the legislative philosophy of differentiation.It leaves unspecified whether mandatory provisions that do not explicitly render a juristic act invalid impact the act’s validity,entrusting this determination to the discretion of judges on a case-by-case basis.When judges,under the authority of Paragraph 1,Article 153 of the Civil Code,explore the normative intent of mandatory provisions to assess their effect on the validity of juristic acts,they should engage in legal policy analysis centered on consequence-based argumentation to overcome the limitations of norm typological analysis.This analysis employs a reasoning model predicated on the normative purpose,utilizing a consequencefocused interpretative approach for formulating and arguing propositions of rules applicable to pending cases,thereby arriving at case-specific conclusions.Since the invalidation of juristic acts serves as an auxiliary regulatory tool for the state economy and society,a consequence-oriented interpretation needs to be based on the idea of mutual instrumentalization of public and private laws.This entails predicting the outcomes of negating the validity of a juristic act in industrial regulatory scenarios and assessing these outcomes within the framework of public and private regulatory instruments.

Domestic Cyberterrorism & Strategic Communications: Literature Review

Cyberterrorism poses a significant threat to the national security of the United States of America (USA), with critical infrastructure, such as commercial facilities, dams, emergency services, food and agriculture, healthcare and public health, and transportation systems virtually at risk. Consequently, this is due primarily to the country’s heavy dependence on computer networks. With both domestic and international terrorists increasingly targeting any vulnerabilities in computer systems and networks, information sharing among security agencies has become critical. Cyberterrorism can be regarded as the purest form of information warfare. This literature review examines cyberterrorism and strategic communications, focusing on domestic cyberterrorism. Notable themes include the meaning of cyberterrorism, how cyberterrorism differs from cybercrime, and the threat posed by cyberterrorism to the USA. Prevention and deterrence of cyberterrorism through information sharing and legislation are also key themes. Finally, gaps in knowledge are identified, and questions warranting additional research are outlined.

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.

一种基于异或运算的属性撤销CP-ABE方案

针对属性撤销CP-ABE方案中密钥更新时属性授权机构与用户之间的通信开销过大及密文更新时云存储中心的计算复杂度过高的问题,本文提出一种基于异或运算的、支持属性级撤销的密文策略属性基加密方案.在该方案中,属性授权机构先将需要撤销的属性名称、被撤销用户的标识及新的时间参数发送给云存储中心,然后云存储中心根据用户标识和新的时间参数的异或结果与密文的一部分进行异或运算,得到新密文.收到新密文后,正常用户可以利用自己的密钥解密得到原密文,进而得到明文,而被撤销用户则只能使用已撤销属性的新密钥才能解密得到原密文,从而实现属性级撤销.理论分析和数值模拟表明,在保证系统安全性的前提下,该方案能够减少属性授权机构与用户间的通信开销,降低云存储中心的计算复杂度.

基于熵权TOPSIS法综合评价应用PDCA法管控抗菌药物的成效——以某三甲医院为例

目的 探讨某三甲医院构建抗菌药物科学化管理策略与实施成效,为医疗机构加强抗菌药物管理提供参考依据。方法 使用计划、执行、检查、处理(PDCA)管理工具,构建科学有效的抗菌药物管理系统,选取抗菌药物管理相关5个维度、14个指标构建质量评价考核体系,并采用熵权逼近理想解排序法(TOPSIS)法对实施PDCA改进后各项指标的变化情况进行综合评价与分析。结果 基于熵权TOPSIS法分析,2018年的相对接近度(Ci)值为0.313 5,该年抗菌药物管理质量最低;2022年的Ci值为0.747 4,该年抗菌药物管理质量最高。抗菌药物合理使用5个维度方面,使用强度维度2017年Ci值最高;使用率维度2021年Ci值最高;送检率维度2022年Ci值最高;Ⅰ类切口预防用药维度2022年Ci值最高;住院患者抗菌药物费用维度2022年Ci值最高。应用PDCA法进行抗菌药物管理,管理质量整体呈现改善趋势。结论 基于PDCA法通过多部门协作进行抗菌药物管理干预效果显著,熵权TOPSIS法可用于评价抗菌药物管理成效,为医院抗菌药物管控方向指导及政策制定提供参考。

Patient Advocacy and the Affordable Care Act: The Growing Need for Nurses to Be Culturally Aware

The nurse-patient relationship is centered on patient advocacy. Patient advocacy is essential in providing individualized care and improving health outcomes. With the recent implementation of the Affordable Care Act, the patient advocacy concept requires further exploration. Published literature involving patient advocacy’s history, uses, definition, past analyses and nursing perceptions were examined. Outcomes of this literature review lead to further examining patient advocacy and how it is applied to culturally diverse patient populations, patient advocacy in nursing curricula and related research. Overall study results indicate that patient advocacy is associated with enhanced health encounters that include nurses presenting patients with understandable healthcare options and supporting patients with their healthcare preference. Although, this review identified positive outcomes of patient advocacy, nursing research must be directed toward creating a patient advocacy definition and measuring advocacy from a patient’s perspective. There is also a need for nursing leaders to consider placing a higher emphasis on cultural awareness research and education due to an increased rate of culturally diverse patients now seeking care through the Affordable Care Act.

蜡梅CpBEAT3启动子克隆及其互作蛋白的初步验证

苯甲醇乙酰基转移酶(benzyl alcohol acetyltransferase,BEAT)能够以苯甲醇和乙酰辅酶A(acetyl-CoA)为底物催化合成乙酸苄酯,是植物乙酸苄酯生物合成代谢途径下游的关键酶。CpBEAT3是蜡梅叶中调控乙酸苄酯生物合成的关键基因,为了解析其在蜡梅乙酸苄酯生物合成中的转录调控机制,本研究克隆得到了CpBEAT3基因启动子区序列,使用生物信息学软件预测分析了该基因核心启动子区、顺式作用元件、CpG岛等结构特征,并通过酵母单杂交技术筛选可能与CpBEAT3结合的上游调控因子。结果表明,2115 bp的CpBEAT3核心启动子区可能位于-1844~-1794 bp处,有一个位于-1869~-1459 bp处且长度为410 bp的CpG岛,含有多种与光响应、激素调节、胁迫响应相关的顺式作用元件及多个转录因子结合位点。通过酵母单杂交技术筛选获得1个MYB类的转录因子,可以与CpBEAT3启动子结合。

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.

From Credit Fraud to Meaningful Recovery： The Role of Credit Rating Agencies and How Auditors Might Be Affected by the Dodd-Frank Act

The way investors, banks and constituents rely on rating agencies will drastically change with the implementation of the Dodd-Frank Act. The historical background of rating agencies including potential changes in the process of issuing their reports after the Dodd-Frank act is explored by the authors. CPAs （Certified Public Accountant） audit the financial statements of Securities and Exchange Commission [SEC] regulated issuers and are subject to the provisions of the Dodd-Frank act. Accountants may have new potential liabilities with clients that rely on credit agencies representations in financial statements. Analysis is made and conclusions are drawn on the effects of new credit rating agency responsibilities and that of auditors.

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.

Ethical Awareness： Do We Need to Teach Accounting Ethics？ The Case of Bahrain

Based on the premise that ethics education leads to creation of the required （acceptable level of） ethical awareness, the general streamline of accounting ethics literature is strongly in favor of teaching adequate, efficient, and effective accounting ethics. This paper takes the position that this premise must be checked in an educational setting in which accounting ethics education lacks the characteristics of being adequate, efficient, and effective. Accordingly, a questionnaire with two parts was distributed to accounting students about to graduate from the University of Bahrain （UoB）. The first part is an exploratory investigation consisting of 21 variables/questions. The second part is an experimental investigation consisting of 13 hypothetical accounting cases representing various ethics violations. The general tendency by an accounting student based on the two parts indicates that he/she holds an acceptable level of ethical awareness, despite the fact that accounting education programs lack an adequate, efficient, and effective approach to teaching accounting ethics.

Efficacy and Tolerability of Long-Acting Injectable Formulation of Nalmefene (Nalmefene Consta 393.1 mg) for Opioid Relapse Prevention: A Multicentre, Open-Label, Randomised Controlled Trial

Objective: To determine the efficacy and tolerability of a long-acting intramuscular formulation of Nalmefene (Nalmefene Consta 393.1 mg) for the treatment of opioid-dependent patients. Design, Setting, and Participants: A 12 weeks, open-label, randomised controlled trial conducted between June 2009-July 2011, at 14 Hospital-based drug clinics, in the 12 countries. Participants were 18 years or older, had Diagnostic and Statistical Manual of Mental Disorders-5 opioid use disorder. Of the 3200 individuals screened, 3000 (93.7%) adults were randomized 1500 participants to receive injections of Long-acting depot formulations ofNalmefene (Nalmefene Consta 393.1 mg) given intramuscularly once in 12 weeks and 1500participants to receive extended-release Naltrexone (Vivitrol 380 mg), administered intramuscularly every fourth week for 12 weeks. Main Outcomes and Measures: The primary endpoints (protocol) were: Confirmed Opioid abstinence (percentage i.e. the number of patients who achieved complete abstinence during week 12). Confirmed abstinence or “opioid-free” was defined as a negative urine drug test for opioids and no self-reported opioid use. Weeks 1 - 4 were omitted from this endpoint to allow for stabilization of abstinence. Secondary end points included a number of days in treatment, treatment retention and craving. The study also investigated, on 275 participants, degree and time course of mu-opioid receptor occupancy following single doses of Nalmefene extended-release injection (Nalmefene Consta 393.1 mg) as well as the plasma concentration of Nalmefene and Nalmefene-3-O-glucuronide. Safety was assessed by adverse event reporting. Results: Of 3000 participants, mean (SD) age was 27.1 (±4.8) years and 831 (27.7%) were women. 1500 individuals were randomized to receive injections of Long-acting depot formulations of Nalmefene (Nalmefene Consta 393.1 mg) and 1500 to receive injections of extended-release Naltrexone (Vivitrol 380 mg);2088 participants (69.6.0%) completed the trial. Primary endpoints: Confirmed Opioid Abstinence: Complete abstinence was sustained by 86% (n = 1290) of Nalmefene patients (patients treated with Nalmefene Consta 393.1 mg, long-acting depot formulations) compared with 43% (n = 645) of patients treated with extended-release Naltrexone 380 mg (Vivitrol), during weeks 5 - 12 (χ2 = 672.34, P Secondary Endpoint: Craving: A statistically and clinically significant reduction in opioid craving was observed with Nalmefene (Nalmefene Consta 393.1 mg, long-acting depot formulations) vs. Naltrexone (extended-release Naltrexone, Vivitrol 380 mg) by week 4 (P =0.0048), which persisted every week through 12 (P < 0.0001). Patients given Nalmefene (Nalmefene Consta 393.1 mg, long-acting depot formulations) had a 75% decrease in craving from baseline to week 12. Patients given a Naltrexone (extended-release Naltrexone, Vivitrol 380 mg) had a 3% increase in craving from baseline to week 12 (Mean change in self-reporting craving). Secondary Endpoint: Treatment Retention: Long-acting intramuscular formulation of Nalmefene (Nalmefene Consta 393.1 mg) helped significantly more patients complete 12 weeks treatment (n = 1245, 83%) compared with extended-release Naltrexone (Vivitrol 380 mg) (n = 570, 38%) (χ2 = 635.53, P < 0.0001). Patients on long-acting intramuscular formulation of Nalmefene (Nalmefene Consta 393.1 mg) had longer treatment retention than patients on extended-release Naltrexone (Vivitrol 380 mg). Concentrations of Nalmefene and Nalmefene-3-O-Glucuronide in Plasma: Analyses were made of 275 study sample. There was no statistically significant difference for plasma nalmefene concentrations between days 2 and 84 (p = 0.416). The plasma concentration of Nalmefene were 20.3 and 28.5 ng/ml and concentrations of nalmefene-3-O-glucuronide were 2.1 and 4.1 ng/ml, respectively. Plasma levels of Nalmefene remained above 20 ng/ml for approximately 12 weeks after administration of Nalmefene, long-acting depot formulations (Nalmefene Consta 393.1 mg). PET Assessments: Very high mu-opioid receptor occupancy by Nalmefene was detected 1 day after treatments at which time point the occupancy was 100.0% after Nalmefene injection (Nalmefene Consta 393.1 mg). Nalmefene Consta 393.1 mg injection (long-acting intramuscular formulation of Nalmefene) led to a very high occupancy ofmu-opioid receptors in all brain areas examined;the thalamus, caudate nucleus, and frontal cortex. Depending on the brain area mu-opioid receptor occupancy varied between 83.0% and 85.8% 84 days after dosing. Adverse Reactions: Adverse events were similar in opioid-dependent patients treated with long-acting intramuscular formulation of Nalmefene (Nalmefene Consta 393.1 mg) vs. patients treated with extended-release Naltrexone (Vivitrol 380 mg). Conclusions and Relevance: Long-acting depot formulations of Nalmefene (Nalmefene Consta 393.1 mg) was more effective then extended-release Naltrexone (Vivitrol 380 mg) in maintaining short-term abstinence from heroin and should be considered as a treatment option for opioid-dependent individuals.

Prolonged overall survival in gastric cancer patients after adoptive immunotherapy

AIM:To assess the efficacy of immunotherapy with expanded activated autologous lymphocytes(EAALs) in gastric cancer.METHODS:An observational study was designed to retrospectively analyze the clinical data of 84 gastric cancer patients,of whom 42 were treated by EAAL immunotherapy plus conventional treatment and another 42 only received conventional treatment(control group).EAALs were obtained by proliferation of peripheral blood mononuclear cells from patients followed by phenotype determination.Clinical data including age,gender,clinical stage,chemotherapeutic regimens,hospitalization,surgical,radiotherapy,and survival data were collected along with EAAL therapy details and side effects.Patients were followed and the relationship between treatment and overall survival(OS) data obtained for the immunotherapy and control groups were compared retrospectively.The safety of EAAL immunotherapy was also evaluated.RESULTS:After in vitro culture and proliferation,the percentages of CD3+,CD3+CD8+,CD8+CD27+,CD8+CD28+,and CD3+CD16+/CD56+cells increased remarkably(P < 0.05),while the percentages of CD3+CD4+,CD4+CD25+,and CD3-CD16+/CD56+(natural killer cells) were overtly decreased(P < 0.05); no significant change was observed in CD4+CD25+CD127- cells(P =0.448).Interestingly,OS in the immunotherapy group was significantly higher than that in the control group,with 27.0 and 13.9 mo obtained for the two groups,respectively(P =0.028,HR =0.573,95%CI:0.347-0.945).These findings indicated a 42.7% decrease in the risk of death.In addition,we found that clinical stage and application of EAAL immunotherapy wereindependent prognostic factors for gastric cancer patients.Indeed,the OS in stage Ⅲc and Ⅳ patients that had received surgery was prolonged after EAAL immunotherapy(P < 0.05).Importantly,in vitro induction and proliferation of EAAL were easy and biologically safe.CONCLUSION:Overall,EAAL adoptive immunotherapy might prolong the OS in gastric cancer patients.

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.

Management guidelines for behavioural and psychotic symptoms in persons with dementia—A review article

This paper is a review article which has systematically gathered contemporary evidence, the best practice guidelines for the management, treatment of behavioural and psychological symptoms of dementia and the various approaches including pharmacological and non-pharmacological approaches. It sets out to outline the various types of behaviour in different subtypes of dementia and a practical approach for clinicians in managing these behaviours.

长效干扰素对HBeAg阳性CHB患者肝功能指标及QLS-CHB评分的影响

目的研究长效干扰素对乙型肝炎E抗原(HBeAg)阳性慢性乙型肝炎(CHB)患者肝功能以及慢性乙型肝炎患者特异性生活质量量表(QLS-CHB)评分的影响。方法42例HBeAg阳性CHB患者为研究对象,以随机数字表法分为观察组和对照组,各21例。对照组使用恩替卡韦分散片治疗,观察组使用聚乙二醇干扰素α-2b注射液治疗。比较两组治疗效果,乙型肝炎病毒脱氧核糖核酸(HBV DNA)、乙型肝炎表面抗原(HBsAg)水平及HBeAg、HBV DNA转阴情况,肝功能指标[血清谷丙转氨酶(ALT)、血清谷草转氨酶(AST)、血清白蛋白(ALB)],生活质量,不良反应发生情况。结果治疗后,观察组治疗总有效率90.48%高于对照组的47.62%,差异有统计学意义(P<0.05)。治疗后,两组HBV DNA、HBsAg水平均低于本组治疗前,且观察组HBV DNA(2.48±0.37)U/ml、HBsAg(56.56±8.59)U/L均低于对照组的(3.55±0.44)U/ml、(98.43±12.87)U/L,差异有统计学意义(P<0.05)。治疗后,观察组HBeAg、HBV DNA转阴率分别为57.14%、85.71%,均高于对照组的23.81%、52.38%,差异有统计学意义(P<0.05)。治疗后,两组ALT、AST水平均低于本组治疗前,ALB水平高于本组治疗前,且观察组ALT(32.94±4.17)U/L、AST(31.15±4.32)U/L均低于对照组的(45.22±5.56)、(44.28±5.46)U/L,ALB(36.92±4.21)g/L高于对照组的(30.55±4.74)g/L,差异有统计学意义(P<0.05)。治疗后,两组症状、生理、心理、社会评分均高于本组治疗前,且观察组高于对照组,差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论长效干扰素治疗HBeAg阳性CHB患者能够有效降低HBV DNA、HBsAg水平,提高HBeAg、HBV DNA转阴率,改善患者肝功能水平,提升其生活质量,疗效更佳。

恩替卡韦配合长效干扰素治疗乙肝的临床效果及对HBV-DNA和HBeAg转阴率的影响

目的 探讨恩替卡韦配合长效干扰素治疗乙肝的临床效果及对乙肝病毒脱氧核糖核酸(hepatitis B virus DNA, HBV-DNA)和乙肝e抗原(hepatitis B e antigen, HBeAg)转阴率的影响。方法 随机选取2021年1月—2022年12月龙岩市第二医院收治的120例乙肝患者,采取随机数表法分为两组,各60例。对照组给予恩替卡韦治疗,观察组给予恩替卡韦联合长效干扰素治疗。对比两组肝功能、HBV-DNA及HBeAg转阴率、不良反应发生率。结果 经过48周治疗后,观察组丙氨酸氨基转移酶为(34.37±5.54)U/L、天门冬氨酸氨基转移酶(35.84±7.06)U/L及总胆红素为(23.92±2.17)μmol/L低于对照组,白蛋白为(39.23±3.67)g/L高于对照组,差异有统计学意义(P<0.05);观察组HBV-DNA转阴率为88.33%,HBeAg转阴率为25.00%均高于对照组,差异有统计学意义(χ^(2)=5.208、4.675,P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 与单一恩替卡韦药物治疗相比,对乙肝患者实施恩替卡韦联合长效干扰素治疗,可取得更为理想的治疗效果,有效改善其肝功能,提高HBV-DNA及HBeAg转阴率,且药物安全性相对较高,加用药物治疗过程中,虽不良反应略有增加,但是均在治疗结束后1~3月内完全恢复。

Retrospective study of the associations between hepatitis C virus infection and metabolic factors

AIMTo evaluate the bidirectional association between metabolic syndrome (MS) components and antiviral treatment response for chronic hepatitis C virus (HCV) infection. METHODSThis retrospective cohort study included 119 HCV + patients treated with pegylated-interferon-α and ribavirin. Metabolic characteristics and laboratory data were collected from medical records. Differences in baseline clinical and demographic risk factors between responders and non-responders were assessed using independent samples t-tests or χ2 tests. The effects of sustained viral response (SVR) to antiviral treatment on de novo impairments in MS components, including impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM), were assessed using univariable and multivariable logistic regression analysis, while the effect of MS components on SVR was assessed using univariable logistic regression analysis. RESULTSOf the 119 patients, 80 (67%) developed SVR over the average 54 ± 13 mo follow-up. The cumulative risks for de novo T2DM and IFG were 5.07- (95%CI: 1.261-20.4, P = 0.022) and 3.87-fold higher (95%CI: 1.484-10.15, P = 0.006), respectively for non-responders than responders, when adjusted for the baseline risk factors age, sex, HCV genotype, high viral load, and steatosis. Post-treatment triglyceride levels were significantly lower in non-responders than in responders (OR = 0.27; 95%CI: 0.069-0.962, P = 0.044). Age and HCV genotype 3 were significantly different between responders and non-responders, and MS components were not significantly associated with SVR. Steatosis tended to attenuate SVR (OR = 0.596; 95%CI: 0.331-1.073, P = 0.08). CONCLUSIONSVR was associated with lower de novo T2DM and IFG incidence and higher triglyceride levels. Patients infected with HCV should undergo T2DM screening and antidiabetic treatment.