Objective To investigate the current status of self-management action of patients with chronic kidney disease (CKD) during early-mid stage and its influencing factors. Methods 80 patients were recruited in a tertiary hospital in Beijing from March to June 2011.They were surveyed with a self-designed self-management action questionnaire of patients with CKD. Results The total score of self-management action in patients with CKD was(69.10±5.63 ).1.25％ patients with CKD had bad self-management ability and 88.75％ patients had moderate self-management ability,only 10.00％ patients had good self-management ability.Patients of younger age,with higher education level,ever attending lectures or having inpatient experience had better self-management ability.And the methods of payment also had significant influence on the self-management of patients with CKD. Conclusions When taking care of patients with CKD,health care providers should be more individual case-based,especially paying more attention to those who are older,with low education degree,never have attended health education lectures and do not have inpatient experience,in order to increase patients' self-management ability and help them improve their health status.

Objective To probe the difference of MSCT features between clear cell renal cell carcinoma (ccRCC)and renal oncocytoma (RO),to improve the diagnostic accuracy.Methods 31 cases of ccRCC and 16 cases of RO which were confirmed by pathology were analyzed retrospectively,and the difference in some CT features including the morphology and CT value of plain scanning and three phases of enhancement scanning were analyzed.Results The diameter of the tumor of the ccRCC group was (5.04 ± 1.9 1 4)cm,meanwhile that of the RO group was (3.5 9±2.1 6)cm,exhibiting statistically significant difference in the diameter which was bigger in ccRCC group than that in RO group (P＝0.023).There were 90.32% (28/31)of cases with cystic necrosis in the ccRCC group and 18.75%(3/16)in the RO group,which was statistically significant that the patients with cystic deterioration in the ccRCC group were more than those in the RO group (P＜0.001).35.48% (11/31)of cases with peritumoral or intratumoral neovascularization in the ccRCC group and no cases in the RO group were found,and there was a statistically significant difference (P＝0.009).The enhancement degree in the ccRCC group was greater than that in the RO group in cortical phase and excretory phase,but lower in parenchy phase.However, there was no significant difference in the enhancement degree and the enhancement index in three phases of enhancement scanning (P＞0.05). Conclusion MSCT can demonstrate the renal tumor with or without cystic necrosis and neovascularization around or inside the tumor,which is helpful to differentiate ccRCC from RO.

Head and neck osteosarcoma is a rare tumor. Its clinical features and recurrence pattern are different from those of osteosarcoma in other parts. Osteosarcoma of the head and neck occurs late with a high local recurrence rate and a low distant metastasis rate. Local recurrence is the main cause of death. Surgery is the main treatment. Postoperative radiotherapy is recommended for patients with positive surgical margin, proximal incisional margin and uncertain surgical margin. The role of chemotherapy remains controversial. Effective molecular targeted therapeutics need to be further explored for recurrent, metastatic and unresectable osteosarcoma, .

Background:China's accelerating development and increasingly important role in global health engagement create a great demand for global health professionals including international consulting experts.This study reported the detailed development and evaluation of an international consulting training for global health workforce.Methods:Based on Kirkpatrick's model,a mixed-methods approach was used to evaluate the effectiveness of the training.Quantitative and qualitative data on participants' reaction,learning,and application of the learned knowledge and skills were collected by a training evaluation survey at the ending of training and a follow-up interview in three months after the training.Results:Thirty-six participants attended the training and 34 of them completed quantitative investigation.The training satisfaction evaluations were positive,for which participants rated the training program highly and over 90％ of them agreed with the usefulness of the training.About knowledge and skills change,participants showed improved consulting knowledge and skills from pre-to post-training (P ＜ 0.001).A total of 23 participants accepted follow-up interview,and most participants applied knowledge and skills learned from the training in their daily work or study.However,only 30.4％ of participants applied their learning in the consulting program.The largest barrier of application was the lack of consulting opportunities.In addition,almost all the participants reported that they would be glad to attend more training courses in the future.Conclusion:The international consulting training program was well-received,and was feasible to improve the consulting service competence of global health professionals.According to participants' feedback,it is essential to develop and expand consulting training in the field of global health.

Objective    To evaluate the relationship between four classic inflammatory biomarkers, including C-reactive protein (CRP), white blood cell (WBC), IL (interleukin family), tumor necrosis factor-α (TNF-α), and postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) and valve replacement (VR) surgeries. Methods    We searched PubMed, EMBase, the Cochrane Library, Ovid, Chinese Journal Full-text Database, Chinese Biomedical Literature Database, VIP database and WanFang database from the inception to April 2020. Studies on the relationship between POAF and the above four inflammatory biomarkers were analyzed. Two researchers independently reviewed the literature, extracted data and evaluated the quality of the literature. RevMan 5.3 software was used for meta-analysis. Results    A total of 47 articles were included, covering 10 711 patients. The levels of preoperative CRP (SMD=0.38, 95%CI 0.14-0.62, Z=3.12, P=0.002) and postoperative CRP (SMD=0.40, 95%CI 0.06-0.74, Z=2.33, P=0.02), IL-6 (SMD=1.34, 95%CI 0.98-1.70, Z=7.26, P<0.001) and TNF-α (SMD=−0.33, 95%CI −0.65-−0.01, Z=2.02, P=0.040) were related to POAF, while preoperative IL-8 (SMD=−0.05, 95%CI −0.28-0.18, Z=0.42, P=0.68) and TNF-α (SMD=−0.43, 95%CI −1.22-0.36, Z=1.07, P=0.28), postoperative WBC (WMD=1.16, 95%CI −0.09-2.42, Z=1.82, P=0.07) and IL-10 (SMD=0.21, 95%CI −0.35-0.77, Z=0.73, P=0.46) were not related to POAF. The relationships between preoperative WBC and IL-10, postoperative IL-8 and POAF were inclusive, which needed further verification. Furthermore, the relationship between postoperative CRP and POAF were not consistent, as they were not significantly correlated in sub-group analysis. Conclusion    The inflammatory substrate before the surgery and inflammatory reaction induced by the operation is related to the occurrence and maintenance of POAF. Compared with preoperative inflammatory status, postoperative inflammatory factors may have a greater predictive value for POAF. Preoperative CRP, postoperative IL-6 and TNF-α levels are reliable biomarkers of POAF.

OBJECTIVETo investigate the correlation of serum osteoprotegerin (OPG) with the progression of nonalcoholic fatty liver disease (NAFLD) and the noninvasive prediction and diagnosis of nonalcoholic steatohepatitis (NASH).

METHODSA total of 136 patients with NAFLD were enrolled, and their tissue samples for liver biopsy and serum samples obtained at 1 week after liver biopsy were collected; 83 healthy subjects without the symptoms of fatty liver disease proved by ultrasound examination were enrolled as controls. The physiological indicators including height, body weight, and waist circumference were measured, and body mass index was calculated. The biochemical parameters including alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST/ALT, alkaline phosphatase, gamma-glutamyl transferase, total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were measured. Double-antibody sandwich enzyme-linked immunosorbent assay was used to determine the serum level of OPG. The rank sum test, chi-square test, t-test, one-way analysis of variance, Spearman correlation analysis, least significant difference test, and receiver operating characteristic (ROC) curve were applied for statistical analysis of various data.

RESULTSSerum OPG level was correlated with AST and TG (P < 0.05), and was highly correlated with hepatocyte fatty degeneration, ballooning degeneration, intralobular inflammation, portal inflammation, and fibrosis degree (P < 0.01). With the increasing NAFLD activity score (NAS), serum OPG level decreased, and there was a highly negative correlation between them (r = -0.928, P < 0.01). Serum OPG level was significantly lower in NASH patients than non-NASH patients. The area under the ROC curve of serum OPG level was 0.963, and according to the Youden index, its optimal sensitivity and specificity were 96.1% and 97.4%, respectively, at an optimal cut-off value of 242.96 ng/L, which suggested a high diagnostic power.

CONCLUSIONIn NASH patients, serum OPG level decreases significantly. Serum OPG level can be used as an independent predictive factor to evaluate NASH and its severity, as well as a noninvasive diagnostic index for NASH.

Alanine Transaminase ; blood ; Alkaline Phosphatase ; blood ; Aspartate Aminotransferases ; blood ; Biopsy ; Body Mass Index ; Case-Control Studies ; Cholesterol ; blood ; Disease Progression ; Enzyme-Linked Immunosorbent Assay ; Fibrosis ; Humans ; Inflammation ; pathology ; Liver ; pathology ; Non-alcoholic Fatty Liver Disease ; blood ; diagnosis ; Osteoprotegerin ; blood ; ROC Curve ; Triglycerides ; blood ; gamma-Glutamyltransferase ; blood

Objective:To analyse the clinical characteristics and antiviral therapy in immunosuppressed hospitalized patients with influenza.Methods:The clinical data of 273 patients with positive influenza A or B virus nucleic acid admitted in Peking University People’s Hospital from November 2015 to March 2022 were retrospectively analyzed. Among them, 123 were immunosuppressed and 150 were non-immunosuppressed. The clinical characteristics and antiviral therapy in immunosuppressed patients with influenza were analyzed. SPSS 22.0 software was used to analyze the data.Results:Chemotherapy for malignancies was the most common cause of immunosuppression (61.8%, 76/123), followed by haemopoietic stem cell transplantation (24.4%, 30/123). The common symptoms were fever (93.5%, 115/123) and cough (41.5%, 51/123). The proportions of co-infections (22.8%, 28/123) and complications (43.9%, 54/123) in immunosuppressed hospitalized patients were higher than those in non-immunosuppressed patients ( χ2=9.365 and 7.496, both P<0.01). Compared with single drug therapy, combination of antiviral drugs did not shorten the fever time, negative conversion time of virus nucleic acid and the length of hospital stay, and reduce the death ( U/ χ2=312.5, 356.0, 749.5 and 0.185, all P>0.05). Compared to patients without corticosteroids use, the use of corticosteroids did not increase mortality in immunosuppressed patients ( χ2=2.508, P=0.113). Conclusions:Classical symptoms may be absent in immunosuppressed patients with influenza, and early detection of influenza virus is still an important means of early diagnosis. Co-infections and complications are more common in immunosuppressed influenza patients. Immunosuppressed influenza patients did not benefit from the combination of antiviral therapy.

Objective    To investigate the changes of fibrinogen and classical markers of collagen metabolism [carboxy-terminal propeptide of type Ⅰ procollagen (PICP) and carboxy-terminal cross-linked peptide of type Ⅰ collagen (ICTP)] in peripheral blood and pericardial drainage after coronary artery bypass grafting (CABG) and/or heart valve replacement (VR), and to evaluate their relationship with postoperative atrial fibrillation (POAF) after cardiac surgery. Methods    Patients who underwent CABG and/or VR in the Heart Center of Beijing Chao-Yang Hospital from March to June 2021 were included. Peripheral blood and pericardial drainage fluid samples were collected before surgery and at 0 h, 6 h, 24 h and 48 h after surgery to detect PICP, ICTP and fibrinogen levels, and preoperative, intraoperative and postoperative confounding factors were also collected. PICP, ICTP and fibrinogen levels were measured by enzyme-linked immunosorbent assay (ELISA). Results    A total of 26 patients with 125 blood samples and 78 drainage samples were collected. There were 18 males and 8 females with an average age of 64.04±7.27 years. The incidence rate of POAF was 34.6%. Among the factors, the fibrinogen level in pericardial drainage showed two peaks within 48 h after operation (0 h and 24 h after operation) in the POAF group, while it showed a continuous downward trend in the sinus rhythm (SR) group, and the change trend of fibrinogen in pericardial drainage was significantly different over time between the two groups (P=0.022). Fibrinogen in blood, PICP and ICTP in blood and drainage showed an overall decreasing trend, and their trends over time were not significantly different between the two groups of patients (P>0.05). Univariate analysis showed that fibrinogen at 24 h and 48 h after pericardial drainage, fibrinogen in preoperative blood, PICP immediately after surgery and right atrial long axis diameter were significantly higher or longer in the POAF group than those in the SR group. Multiple regression showed that fibrinogen≥11.47 ng/mL in pericardial drainage 24 h after surgery (OR=14.911, 95%CI 1.371-162.122, P=0.026), right atrial long axis diameter≥46 mm (OR=10.801, 95%CI 1.011-115.391, P=0.049) were independent predictors of POAF. Conclusion    This study finds the regularity of changes in fibrinogen and collagen metabolic markers after CABG and/or VR surgery, and to find that fibrinogen in pericardial drainage 24 h after surgery is a potential novel and predictive factor for POAF. The results provide a new idea for exploring the mechanism of POAF, and provide a research basis for the accurate prediction and prevention of clinical POAF.

At present, antiviral therapy for chronic hepatitis B (CHB) has a low clinical cure rate and hardly remove cccDNA. With the progress of medical science, more and more new drugs are in the stage of research and development. This article focuses on the research and development of representative drugs with relatively detailed clinical trial data. Rapid progress has been made in the new drugs such as small-interfering RNA and core protein allosteric modulators in recent years. The results of clinical trials show that it still takes some time for new drugs to enter clinical use, and multi-drug combination therapy may become the trend of treatment in the future.

Hepatitis B vaccination is the most economical and effective way to prevent HBV infection.The advances in molecular biology and genetic engineering have continuously improved the manufacturing process of vaccines,and hepatitis B vaccine has gradually developed from the initial plasma-derived vaccine to the currently used recombinant vaccine.Preventive hepatitis B vaccine has been clinically tested in patients with HBsAg seroclearance to increase the level of anti-HBs,with certain safety and efficacy.As one of the multiple targets for new drugs in the treatment of chronic hepatitis B,a therapeutic hepatitis B vaccine based on HBsAg is already in the stages of research and development and clinical trial.