Chronic hepatitis C virus (HCV) infection remains a widespread public health concern and many people are infected with HCV. HCV is one of the leading indications for liver transplantation. Direct-acting antiviral agents (DAAs) against HCV have changed the course of chronic HCV infection, however, making it a curable disease. DAA treatment may be initiated before or after liver transplantation. In the present review, we present the available data on DAA treatment of HCV in liver transplant recipients.
Great achievements have been made in human cancer research, but most of this research is focused on conditions at the microscopic rather than the systemic level. Recent studies have increasingly cited the ancient Chinese theory of yin-yang in an effort to expand beyond the microscopic level. Various cancer-associated genes and proteins such as mitogen-activated protein kinase (MAPK), p38, p53, c-Myc, tumor necrosis factor (TNF)-α, NF-κB, Cyclin D1, and cyclin-dependent kinase (CDK) and cells such as T cells, B cells, macrophages, neutrophils, and fibroblasts have been reported to regulate various types of cancers in a yin-yang manner. These studies have brought the theory of yin-yang into vogue in cancer research worldwide.
This study shed light on the amount and structure of utilization and medical expenses on Shanghai permanent residents based on big data, simulated lifetime medical expenses through combining of expenses data and life table model, and explored the dynamic pattern of aging on medical expenditures. 5 years were taken as the class interval, the study collected and did the descriptive analysis on the medical services utilization and medical expenses information for all ages of Shanghai permanent residents in 2015, simulated lifetime medical expenses by using current life table and cross-section expenditure data. The results showed that in 2015, outpatient and emergency visits per capita in the elderly group (aged 60 and over) was 4.1 and 4.5 times higher than the childhood group (aged 1-14), and the youth and adult group (aged 15-59); hospitalization per capita in the elderly group was 3.0 and 3.5 times higher than the childhood group, and the youth and adult group. People survived in the 60-64 years group, their expected whole medical expenses (105,447 purchasing power parity Dollar) in the rest of their lives accounted for 75.6% of their lifetime. A similar study in Michigan, US showed that the expenses of the population aged 65 and over accounted for 1/2 of lifetime medical expenses, which is much lower than Shanghai. The medical expenses of the advanced elderly group (aged 80 and over) accounted for 38.8% of their lifetime expenses, including 38.2% in outpatient and emergency, and 39.5% in hospitalization, which was slightly higher than outpatient and emergency. There is room to economize in medical expenditures of the elderly people in Shanghai, especially controlling hospitalization expenses is the key to saving medical expenses of elderly people aged over 80 and over.
The COMmunity Pharamcists ASSist for Blood Pressure (COMPASS-BP) study aimed to assess the effectiveness of lifestyle support programs administered in community pharmacies on hypertension control. This open-label, two-armed parallel group, cluster-randomized controlled trial included 73 pharmacies (clusters) in Japan randomized to a control or intervention group. Eligible hypertensive patients (n = 125), aged 20-75 years, received the intervention (n = 64) or the control treatment (n = 61), as dictated by their pharmacy randomization. Patients in the intervention group received brochures and healthy lifestyle advice from pharmacists using motivational interviewing methods during pharmacy visits over a 12-week period, with their usual pharmacy care. Conversely, the control group just received usual care. The main outcome measure was a change in morning systolic blood pressure (SBP) from baseline to week 12. The intervention group exhibited a decrease in morning SBP that was 6.0 mmHg greater than that of the control group (95% confidence interval [CI]: −11.0 to −0.9, p = 0.021). In a mixed-effect model for repeated measures analysis, the intergroup difference in morning SBP decrease was −4.5 mmHg (95% CI: −8.5 to −0.6, p = 0.024). Our findings indicate that implementation of a lifestyle advice program in pharmacies is feasible and may lead to reduced blood pressure.
Shenqi detoxification granule (SDG), a traditional Chinese herbal formula, has been shown to have nephroprotective and anti-fibrotic activities in patients with chronic kidney disease (CKD). However, its mechanisms in renal fibrosis and the progression of CKD remain largely unknown. P311, a highly conserved 8-kDa intracellular protein, plays a key role in renal fibrosis by regulating epithelial-mesenchymal transition (EMT). Previously, we found P311 might be involved in the pathogenesis of renal fibrosis by inhibiting EMT via the TGF-β1-Smad-ILK pathway. We also found SDG combined with P311 could ameliorate renal fibrosis by regulating the expression of EMT markers. Here we further examined the effect and mechanism of SDG combined with P311 on TGF-β1-mediated EMT in a rat model of unilateral ureteral occlusion (UUO) renal fibrosis. After establishment of the UUO model successfully, the rats were gavaged with SDG daily and/or injected with recombinant adenovirus p311 (also called Ad-P311) through the tail vein each week for 4 weeks. Serum creatinine (Cr), blood urea nitrogen (BUN) and albumin (ALB) levels were tested to observe renal function, and hematoxylin eosin (HE) and Masson staining were performed to observe kidney histopathology. Furthermore, the expression of EMT markers (E-cadherin and α-smooth muscle actin (α-SMA)) and EMT-related molecules TGF-β1, pSmad2/3, Smad7 and ILK were observed using immunohistochemical staining and Western blot analysis. Treatment with SDG and P311 improved renal function and histopathological abnormalities, as well as reversing the changes of EMT markers and EMT-related molecules, which indicated SDG combined with P311 could attenuate renal fibrosis in UUO rats, and the underlying mechanism might involve TGF-β1-mediated EMT and the TGF-β1-Smad-ILK signaling pathway. Therefore, SDG might be a novel alternative therapy for treating renal fibrosis and delaying the progression of CKD. Furthermore, SDG combined with P311 might have a synergistic effect on attenuating renal fibrosis.
The obligate intracellular bacteria Anaplasma phagocytophilum is the etiological agent of human granulocytic anaplasmosis (HGA), an acute febrile tick-borne disease. A. phagocytophilum has a complex lifecycle within both vertebrate reservoirs and tick vectors, and employs a range of different molecules to infect and multiply within the host cells. Enolase is an essential glycolytic enzyme in intracellular glucose metabolism, but is also a multifunctional protein expressed on the pathogen surface, that binds to and promotes plasminogen conversion to plasmin. In this study, we generated recombinant ApEno protein (rApEno), and confirmed that rApEno retains its enzymatic activity. Furthermore, we demonstrated that rApEno binds to human plasminogen, and that this binding could be significantly reduced in the presence of lysine analogs (ε-aminocaproic acid). Additionally, rApEno promotes plasminogen to plasmin conversion in the presence of plasminogen activator. In conclusion, A. phagocytophilum enolase is a multifunctional protein which can catalyze the dehydration of 2-phospho-D-glycerate to phosphoenolpyruvate, and facilitate binding to host plasminogen.
Postmenopausal osteoporosis affected most elderly women with co-existence of lipid and bone metabolism disorders. However, the cellular and molecular mechanisms underlying the parallel progression and cross-talk of these systems remained unclear. In the present study, low-density lipoprotein receptor knockout (LDLR-/-) mice were chosen to elucidate the effect of LDLR in regulating the differentiation of osteoblasts, which were responsible for bone formation and modulation of osteoclastogenesis. Primary osteoblasts were isolated from the calvarium of newborn LDLR-/- or wild-type mice followed by osteoblastic differentiation culture in vitro. Alkaline phosphatase activity was significantly decreased in LDLR-/- osteoblasts compared to wild-type controls, combined with calcium deposit formation delay, implying impaired osteoblastogenesis in vitro. Consistent with these findings, the expression of runt-related transcription factor 2 (Runx2) was decreased 3 days after differentiation in LDLR-/- osteoblasts compared to wild-type controls. Moreover, the expression of Osterix was decreased 7 days after differentiation in LDLR-/- osteoblasts compared to wild-type controls, later than Runx2.However, the osteoclastogenesis modulation role of osteoblasts was unaffected by the LDLR deficiency, evidenced by the same level of osteoprotegerin (OPG)/receptor activator of nuclear factor-κ B ligand (RANKL) axis between LDLR-/- and wild-type control osteoblasts. Our results provide a novel insight into the role of LDLR during osteoblastic differentiation and improve understanding of cross-talk between bone and lipid metabolisms.
Plethysmographic variability index (PVI) is a dynamic index used for the purpose of fluid responsiveness in patients, and the effect of pneumoperitoneum on PVI is still unclear. We therefore attempted to determine whether PVI and perfusion index (PI) change before/after pneumoperitoneum in patients receiving combined epidural and general anesthesia, which is a common anesthesia method with intravenous remifentanil. Twenty patients underwent laparoscopic cholecystectomy or colectomy. Immediately before pneumoperitoneum, variables were measured at baseline I and were then measured every min for 5 min after pneumoperitoneum start. Immediately before pneumoperitoneum release, variables were measured at baseline II and were measured every min for 5 min after pneumoperitoneum release. Compared with baseline I values, after pneumoperitoneum start, significant increases occurred in stroke volume variation (SVV) at 1–5 min, and significant decreases occurred in PI at 1–5 min. PVI did not change. Compared with baseline II values, after pneumoperitoneum release, significant increases occurred in PI at 1–5 min, and significant decreases occurred in PVI at 4–5 min and SVV at 1–5 min. In patients receiving combined epidural and general anesthesia, we newly found that PI decreased but PVI remained unchanged with a sufficient dose of remifentanil and epidural anesthesia that can block noxious stimuli and also most sympathetic activity. Furthermore, we reconfirmed that PI increased and PVI decreased upon release of pneumoperitoneum. PI and PVI values must be estimated cautiously during and after pneumoperitoneum.
Our purpose was to explore the remission of insulin resistance after bariatric surgery to discover the mechanism of diabetes remission excluding dietary factors. A retrospective case control study was conducted on patients with type 2 diabetes, who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric bypass surgery (LGB) in Beijing Shijitan Hospital from April 1, 2012 to April 1, 2013. The laboratory and anthropometric data was analyzed pre-surgery and during a 2-year follow-up. HOMA-IR was calculated and evaluated. The two surgical procedures were compared. No significant difference in complete remission rate was observed between the two groups (LGB group: 62.1%, LSG group: 60.0%, p = 0.892). HOMA-IR was reduced to a stable level at the 3rd month after surgery. The cut-off value of HOMA-IR was 2.38 (sensitivity: 0.938, specificity: 0.75) and 2.33 (sensitivity: 0.941, specificity: 0.778) respectively for complete remission after LSG or LGB surgery. Insulin resistance was improved while GLP-1 and Ghrelin was changed significantly in patients with type 2 diabetes prior to weight loss either in the LSG or LGB group. HOMA-IR decreased to less than the cut-off value at the 3rd month and was closely related to complete remission. The mechanism of bariatric surgery was not due just to simply dietary factors or body weight loss but also the remission of insulin resistance.
Hematoma expansion (HE) is a major determinant of a poor outcome in patients with a spontaneous intracerebral hemorrhage (sICH). The blend sign and the black hole sign are distinguished from non-contrast CT (NCCT) in patients with sICH, and both are independent neuroimaging predictors of HE. The purpose of the current study was to compare the value of the two signs in the prediction of HE. We retrospectively analyzed clinical and neuroimaging data from 228 patients with sICH who were treated at our hospital between August 2015 and September 2017. NCCT of the brain was performed upon admission (within 6 h of the onset of symptoms) to identify the blend sign and the black hole sign. HE was determined based on CT during a follow-up 24 h later. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with which the blend sign and the black hole sign predicted HE were calculated. Receiver operating characteristic (ROC) curve analysis was performed in order to compare the accuracy of the two signs in predicting HE. The blend sign was identified in 46 patients (20.2%) and the black hole sign was identified in 38 (16.7%) based on NCCT of the brain upon admission. Of the 65 patients with HE, the blend sign was noted in 28 and the black hole sign was noted in 22. The blend sign had a sensitivity of predicting HE of 43.1%, a specificity of 89.0%, a PPV of 60.9%, and an NPV of 79.7%. In contrast, the black hole sign had a sensitivity of predicting HE of 33.9%, a specificity of 90.2%, a PPV of 57.9%, and an NPV of 77.4%. The area under the ROC curve was 0.660 for the blend sign and 0.620 for the black hole sign (p = 0.516). In conclusion, the blend sign and the black hole sign on CT are both good predictors of HE in patients with sICH, though the blend sign seems to have a higher level of accuracy.
We developed electrolyzed water (EW) using carbon electrodes and investigated the ability of the developed EW to inhibit the proliferation of human cervical carcinoma HeLa cells. We observed that EW-containing media inhibited HeLa cell proliferation. Many very small black dots were produced in EW and these were associated with the inhibitory effect on the cell proliferation. Furthermore, the very small black dots that could inhibit cell proliferation were produced only at pH 3 to 3.5 of EW. Additional experiments showed that this inhibition of proliferation is reversible. These results suggest that the effect of EW on HeLa cells is cytostatic and not cytotoxic. Thus, our results indicate that the EW developed in this study may be used to inhibit cell proliretation.
By the end of 2014, China had an elderly population age 60 or over totaling 212 million; this group accounted for 15.5% of the country's total population of 1.37 billion, which means that China has passed the threshold for an aging population. As China's population ages and the disease spectrum changes, nursing services for the elderly must be expanded. Given differences in the health status, financial situation, and family composition of each elderly person, modern society is tending towards individual nursing care for the elderly. Adapting to the changing composition of society by age will present new challenges.
Severe fever with thrombocytopenia syndrome (SFTS) has spread throughout Asia, including China, South Korea, and Japan. In China, the main victims of SFTS were farmers. Measures to protect farmers were urgently needed but limited, and health education and promotion was proposed as an option. A pilot community trial was conducted to provide health education about SFTS in 2013 in Daishan County, Zhejiang Province, China, and results indicated that health education had promise. An educational campaign was conducted for three years. The incidence of SFTS decreased 0.3 per 1,000 person-years, and rural residents' awareness of SFTS increased substantially. Numerous habits or work practices that increased the likelihood of tick bites have also been changed. In the future, education could emphasize adopting healthy habits or work practices to reduce tick bites and thus reduce the incidence of SFTS, like regularly weeding around a house surrounded by shrubs, not sitting or lying on the ground when resting, and protecting one's self when doing farm work.
Precise diagnosis is a key measure for malaria control and elimination, and malaria microscopy is still the gold standard method recommended by the World Health Organization (WHO) for malaria diagnosis. Analysis of the competency in malaria microscopy in China will benefit to identify the challenges in this skill and provide some suggestions for improvement in order to reach the requirement of WHO procedures for certification of malaria elimination, and finally contribute to malaria elimination by 2020 in China. According to a series of external assessment activities about malaria microscopy, malaria microscopists from both the national and provincial level but not the levels below provincial level performed quite well in Plasmodium spp identification, but their competency in differentiation of P. ovale and P. vivax and parasite counting by microscopy were not good enough at all levels. Therefore, it is necessary to strengthen the competency in species identification and parasite counting especially at the lower levels in the first line through training and practice as well as regular quality assurance with enough policy support.
As the number of elderly and the size of the total population increase, population aging will become a major problem because of an increase in diseases associated with aging, such as chronic obstructive pulmonary disease (COPD). The 2017 Japan-China Joint Medical Workshop on Aging and Health was held at The University of Tokyo on December 2, 2017 with a focus on management of COPD. More than 50 experts in the fields of respiratory medicine, emergency medicine, traditional Chinese medicine, and Kampo (traditional Japanese medicine) from Japan and China presented the results of their research and shared their experiences treating COPD from different perspectives. Guidelines for diagnosis and management of COPD in different countries were described at the workshop, and advances in recent research into the treatment of COPD with Kampo and traditional Chinese medicine were fully discussed. The results of the workshop should help to improve GOLD guidelines and they should greatly help to optimize COPD treatment.