Objective: To analyze the current situation and problems of primary health care personnel since the new round of China's health care reform, and to provide a reference for stabilizing the primary health care personnel. Methods: This paper uses descriptive statistical analysis to calculate Gini coefficient and Theil index in order to ana-lyze the equity in headcount, structure and distribution of primary health care personnel among all health care institu-tions nationwide. Results: Between 2008 and 2013, the number of primary health care personnel significantly in-creased and their quality was improved. Moreover, although the Gini coefficient and Theil index of primary health care personnel continuously decreased in China's eastern, central and western provinces the difference inside the east-ern China is the main factor affecting the overall difference. Conclusions:Not only the problems of insufficient num-ber and loss of personnel still coexist in the primary health care personnel in China, but also there are other issues such as the structural imbalance of professional titles is especially prominent, the urban-rural and regional gaps are still large, etc. The main reasons for these issues are related to the irrational incentive mechanism, the inefficiency of the synergistic effects of administrative staffing policy and some reform measures, etc. This paper suggests further re-forming the income distribution system and improving primary governance capability in order to strengthen the policies to synergically attract and stabilize primary healthcare personnel.

Objective To investigate the antiviral efficacy of standard treatment with interferon (IFN)-α 2b and ribavirin (RBV) in patients with chronic hepatitis C (CHC) originating from a same blood donor.Methods The test group consisted of 65 CHC patients originating from a same blood donor,and was treated with IFN-α 2b 3-5 MU every other day in combination with RBV 0.6-1.0 g/d.Meantime,the control group consisted of 32 CHC patients who visited the Department of Infectious Diseases in Qiannan People's Hospital,and was treated with Peg-interferon (PEG-IFN)-α 2a 180 μg every week in combination with RBV 0.6-1.0 g/d.All the patients in the two groups were treated for 48 weeks and followed up for 96 weeks.Assessment indictors included sustained virological response (SVR),early virological response (EVR),end of treatment virological response (ETVR),biochemical response after withdrawal of treatment.Side effects during treatment were also evaluated.Measurement data were analyzed by x2 test.Results In test group,SVR rate was 83.1％ (54/65),EVR rate was 93.8％ (61/65),ETVR rate was 86.2％ (56/65) and biochemical response rate after withdrawal of treatment was 100.0％.In control group,SVR rate was 87.5％ (28/32),EVR rate was 96.9 ％ (31/32),ETVR rate was 90.6 ％ (29/32) and biochemical response rate after withdrawal of treatment was 100.0 ％.SVR rates of the two groups were not significantly different (x2 =0.072,P=0.086).Patients of the two groups were divided into two subgroups according to viral load:hepatitis C virus (HCV) RNA＜1.0 × 106 copy/mL and HCV RNA≥1.0 × 106 copy/mL.SVR rates of patients with low and high viral load in test group were 88.9％ and 54.5％,respectively (x2=7.67,P=0.008),those in control group were 96.0％ and 57.1％,respectively (x2 =4.41,P=0.038).SVR rates were higher in the subgroup of patients with low viral load.Leukopenia and thrombocytopenia were more common in control group than in test group (x2 =9.805,P =0.003 ; x2 =6.643,P=0.009).Conclusion IFN-α 2b and RBV combination therapy has similar antiviral efficacy to that of PEG-IFN-α 2a and RBV combination therapy,and has a lower rate of side effects as well.

OBJECTIVETo investigate the clinical features and rate of natural viral clearance in patients with hepatitis C virus (HCV) infection acquired by blood transfusion from a single donor.

METHODSNinety-six patients who acquired HCV infection between January 1998 and December 2002, upon receipt of donated blood from a single infected individual in Guizhou,were included in this retrospective cross-sectional study. Patients were clinically assessed to determine levels of anti-HCV antibodies, HCV RNA and biochemical indicators of liver function,as well as features of liver structure (by abdominal B ultrasonography and elastography). HCV genetic testing was used to determine the virus genotype. Measurement data were expressed as mean ± standard deviation. Count data were analyzed by the x² test,with P less than 0.05 indicating statistical significance.

RESULTSAll 96 patients tested positive for antiHCV antibodies. The majority of patients (70%; 34:33 male:female) had HCV RNA more than or equal to 1.0 * 103 copies/ml. All patients carried the same HCV genotype as the single blood donor:genotype lb. The overall rate of natural HCV clearance was 30.2%. but males had a significantly lower rate (19.0% (8/42) vs. females:38.9% (21/54);x²=4.41,P=0.023) as did older patients (more than 40 years-old:16.1% (5/31) vs .less than or equal to 40 years-old:36.9% (24/65);x²=4.30,P=0.028). The overall rate of chronic HCV infection (CHC) was 69.8%,but the rate was significantly lower in younger patients (less than or equal to 40 years-old:63.1% (41/65) vs. more than 40 years-old:83.9% (26/31);x²=6.67,P=0.028). Among the 67 patients with CHC,12 had symptoms of mild weakness,anorexia and abdominal distention,11 had elevated serum alanine aminotransferase (116.25 +/- 24.65 U/L) and stage 3 or 4 fibrosis (liver elasticity values more than or equal to 5.1 kPa),and three had mildly abnormal serum bilirubin (32.56 ± 5.28 mumol/L). Fifteen patients showed signs of chronic hepatitis and one patient showed signs of cirrhosis by abdominal B ultrasonography. None of the patients showed signs of hepatocellular carcinoma.

CONCLUSIONThe course of blood transfusion acquired HCV infection is largely unknown and natural viral clearance rate may be associated with sex-and age-related factors.

Adolescent ; Adult ; Aged ; Blood Donors ; Child ; Cross-Sectional Studies ; Female ; Genotype ; Hepacivirus ; genetics ; physiology ; Hepatitis C ; epidemiology ; virology ; Hepatitis C Antibodies ; blood ; Hepatitis C, Chronic ; epidemiology ; virology ; Humans ; Male ; Middle Aged ; RNA, Viral ; blood ; Remission, Spontaneous ; Retrospective Studies ; Transfusion Reaction ; Young Adult

Objective To study the clinical efficacy of pegylated interferon α-2a(PEG-IFN α-2a) and ribavirin combined with self-extracting traditional Chinese medicine(TCM) in the treatment of chronic hepatitis C(CHC) of gan-shen yin-deficiency and damp-heat syndrome.Methods A total of 59 cases of CHC of gan-shen yin-deficiency and damp-heat syndrome confirmed in our hospital was randomly divided into control group(n=29) and combined group(n=30).The patients in both groups were treated with PEG-IFN α-2a injection and ribavirin,and then the self-extracting TCM was added on the patients in combined group.The differences of quantitative score,improvement of liver function,RNA negative rate of HCV,the levels of IL-21,IL-6 and TNF-α,clinical treatment of total efficiency and adverse reactions were compared between the two groups before and after treatment.Results After treatment,the quantitative scores of TCM symptoms(rib-side pain,soreness and weakness of waist and knees,abdominal distension,red tongue with yellowish fur,dizziness with heavy body,insomnia and dreaminess) in combined group were significantly lower than those in control group(P＜0.05),but the difference of quantitative scores of other TCM symptoms between the two groups was not statistically significant(P＞0.05);The levels of alanine aminotransferase(ALT),aspartate aminotransferase (AST) and total bilirubin(TBIL) in combined group were better than those in control group(P＜0.05) after 48 weeks of treatment,but the difference of the levels of albumin(ALB) and glutamyl transpeptidase(GGT) were norstatistically significant in both groups(P＞0.05);The RNA negative rate of HCV in combined group was significantly higher than that in control group after 36-week or 48-week treatment(P＜0.05),but there was no statistically significant difference between the two groups after 12-week or 24-week treatment and 24-week follow-up;The levels of TNF-α,IL-17,IL-23 in combined group were significantly lower than those in control group(P＜0.05) after 48 weeks of treatment;The total efficiency of combined group is better than that of control group (93.33％ vs.72.41％,P＜0.05).There was no significant difference in adverse reactions between the two groups(P＞0.05).Conclusion The application of PEG-IFN α-2a and ribavirin combined with the self-extracting TCM in the treatment of CHC can obviously ameliorate the clinical symptoms and liver function indexes,improve the RNA negative rate of HCV,reduce the levels of inflammatory factors,and improve the clinical efficacy.

Objective To discuss the diagnostic value of HIT-antibodies in suspected HIT patients with heart diseases.Methods A single center study.We collected 242 blood samples of suspected HIT patients whose platelet count decreased after heparin application during July 1 st ,2012 to June 30th ,2016 in Wuhan Asia Heart Hospital and detected the concentration of HIT antibodies , meanwhile the 4T′s score were calculated.Among the study objects , there are 206 patients received cardiac surgery , 28 received cardiac interventional therapy and 8 received drug therapy.And we divided them into HIT group (44, median age 57.5, 23 females ) and non-HIT group ( 198, median age 63.5, 87 females ) according to clinical diagnosis.Quantitative data was analyzed by independent t-test or Mann-Whitney U test.Qualitative data was analyzed by Fisher′s exact test.We drew ROC curve according to the statistical analysis to determine the optimal threshold value of antibodies in diagnosis of HIT andsensitivity , specificity, negative likelihood ratio, positive likelihood ratio of the HIT antibody detection .Therefore, we can assess the value of HIT antibody detection in HIT clinical diagnosis and treatment .Moreover, we used the optimal threshold value of antibodies to testify the suspected HIT patients .Results The HIT antibody concentration of HIT group (44) and non-HIT group ( 198 ) are 3.2 ( 95% CI:1.8 -5.5 ) U/ml and 0.4 ( 95% CI:0.3 -0.4 ) U/ml, respectively.The concentration of HIT group is much higher than the non-HIT group(P<0.000).When the cut-off value of HIT-Ab is set at 0.9 U/ml, sensitivity and specificity are 93.2%and 91.9%, respectively. And negative likelihood ratio and positive likelihood ratio are 0.07 and 11.53, respectively.When the cut-off value of HIT-Ab is set at 0.6 U/ml, sensitivity and specificity are 100.0%and 73.7%.HIT-Ab and 4T′s score of ROC-AUC are 0.971 and 0.745, respectively.The diagnosis value of HIT-Ab in HIT is significantly higher than the 4T′s score ( P<0.000).Conclusions HIT antibody detection is a simple and effective auxiliary diagnostic method in HIT exclusion .And HIT antibody detection is more optimal than the 4T′s score in HIT diagnosis and treatment .

Objective: To investigate the association between D-dimer levels and clinical events in patients with mechanical heart valve replacement under oral anticoagulation therapy. Methods: This prospective study included 640 consecutive patients underwent mechanical heart valve replacement in Wuhan Asia Heart Hospital between January 2013 and June 2014.Patients were assigned to abnormal D-dimer group (D-dimer level>cut off value, n=88) and normal D-dimer group (D-dimer level≤cut off value, n=552) according to D-dimer levels measured at 3 months after the initiation of oral anticoagulation therapy.All patients were followed up for 24 months or until the observation of the end points, which included thrombotic events, bleeding events and all-cause deaths.The anticoagulation therapy was monitored once per 1-2 months by the international normalized ratio (INR), and the target value was 1.8-3.0. Results: During a follow-up period of 24 months, rates of total clinical events (19.30%(17/88) vs. 5.8%(32/552), P<0.01), thrombotic events (11.4%(10/88) vs. 2.3%(13/552), P<0.01), and all-cause deaths (8.0%(7/88) vs. 2.0%(11/552), P<0.01) were all significantly higher in abnormal D-dimer group than in normal D-dimer group.There were no significant difference in bleeding events between the two groups (2.3%(2/88) vs. 3.1%(17/552), P=0.77). Multivariate Cox regression analysis showed that high D-dimer level was an independent risk factor of total clinical events (HR=3.86, 95%CI 1.92-7.76, P<0.01), thrombotic events(HR=5.29, 95%CI 2.12-13.10, P<0.01), and all-cause deaths(HR=5.32, 95%CI 1.71-16.60, P<0.01), but which was not correlated with bleeding events(HR=1.36, 95%CI 0.27-6.84, P=0.71). Conclusion Elevated D-dimer levels are linked with clinical events in patients with mechanical heart valve replacement under oral anticoagulation therapy.

Objective To investigate the predictive value of HIT-antibodies(HIT-Ab) detection for new thrombus in suspected Heparin-Induced thrombocytopenia (HIT). Methods Retrospective cohort study. 472 suspected HIT patients were collected from July 2016 to November 2018, and all subjects under-went a 4Ts score and were sent for HIT-Ab tests. According to the results of HIT-Ab, there were four groups:412 cases of negative HIT-Ab (0-0.9 U/ml), 45 cases of weak-positive HIT-Ab (1.0-4.9 U/ml), 12 cases of moderate-positive HIT-Ab (5.0-15.9 U/ml), and 3 cases of strong-positive HIT-Ab (≥16.0 U/ml) respective-ly. Ultrasound or CT examination was used to confirm new thrombosis as a standard to evaluate the value of HIT-Ab for predicting new thrombus. The diagnostic efficacy of HIT-Ab for HIT was evaluated in clinically confirmed HIT. Results The incidence rates of new thrombus in each group were: 15.8％ in Negative HIT-Ab group (62/412), 48.9％in Weak-positiveHIT-Ab group (22/45), 75.0％in Moderate-positive HIT-Ab group (9/12), and100％in Strong-positive HIT-Ab group (3/3)(P<0.00). When HIT-Ab≥1.0 U/ml, the speci-ficity for diagnosing new thrombus was 93.0％, the sensitivity was 34.2％, the negative predictive value (NPV) was 84.2％, and the positive predictive value (PPV) was 56.5％. The diagnostic rates of HIT in each group were:negative 0％(0/412), weak-positive 62.2％(28/45), moderate-positive (12/12) and strong-positive (3/3) were 100％. When HIT-Ab≥ 1.0 U/ml, the specificity for HIT diagnosis was 96.0％, the sensitivity was 100％, NPV was 100％, and PPV was 71.5％. Conclusions In suspected HIT patients, the incidence of new thrombosis increases with the elevated HIT-Ab level. HIT-Ab detection can be used as a crucial tool for new thrombosis prediction and HIT diagnosis in suspected HIT patients. Clinicians can develop treatment strategies based on HIT-Ab levels.

Objective:By using balloon occlusive hepatic angiography in cirrhotic portal hypertension to evaluate contrast doses on the detection rate of intrahepatic venous-lateral branch shunt (HVVC), and the effect on hepatic venous pressure gradient (HVPG) and portal vein pressure gradient (PPG).Methods:From Jan 2018 to Jun 2021, 131 patients received transjugular intrahepatic portosystemic shunt (TIPS) at Beijing Shijitan Hospital.Results:A positive correlation between PVP and weged hepatic venous pressure (WHVP) ( r=0.241, P=0.001) was found when only by right hepatic vein approach. Ten ml of iodine contrast medium when compared to 5ml doses found more cases of intrahepatic venous-venous lateral branch shunt. The mean PPG of patients with HVVC was significantly higher than the mean of HVPG( P<0.05).The right hepatic vein was the only reliable vein by which WHVP was measured. Conclusions:Right hepatic vein manometry,adequate ballon occlusion and using 10ml of iodine contrast help get reliable WHVP and found HVVC; HVVC can affect the consistency of HVPG and PPG.

Hepatocellular carcinoma (HCC) is one of the malignant tumors with the highest morbidity and mortality in the world. The morbidity and mortality of HCC are increasing every year. Liver cancer is a serious threat to public health in China and the death rate of patients with liver cancer in China is the highest in the world. Beyond surgery, chemotherapy and radiotherapy, immunotherapy is an emerging treatment for cancer, which could control and kill tumor cells by relieving the inhibitory status of immune cells in the tumor microenvironment and activating the immune function of the body. Immune checkpoint inhibitors, adoptive immunotherapy and tumor vaccine are the major treatments of immunotherapy. Compared with traditional therapy methods, immunotherapy could enhance immune function, delay tumor progression, prolong the survival time of patients, and becomes a hotspot in the basic and clinical cancer research. This article reviews the research progress of immunotherapy for liver cancer.
Cancer Vaccines ; Carcinoma, Hepatocellular ; therapy ; China ; Humans ; Immunotherapy ; Liver Neoplasms ; therapy ; Tumor Microenvironment