Effect of antiviral therapy on the survival and incidence of major complications in HBV-associated cirrhotic patients after splenectomy for hypersplenism and portal hypertension

BACKGROUND: Splenectomy remains a common approach for the management of hypersplenism and portal hypertension in hepatitis B virus (HBV)-associated cirrhotic patients in China and some other Asian countries. The effects of antiviral therapy on the survival and occurrence of complications in asplenic HBV-associated cirrhotic patients are unknown. This study analyzed the effect of antiviral therapy on survival and occurrence of major complications in HBV-associated cirrhotic patients after splenectomy for hypersplenism and portal hypertension. RESULTS: Of the 57 eligible patients for analysis, 28 patients received nucleos(t)ide analogs (treatment group) for antiviral treatment after splenectomy, while 29 patients received no antiviral treatment (control group). After a median of 3 years and 9 months, the overall survival and complication-free survival in the treatment group were higher though not statistically significant than those in the control group. Multivariate analysis showed that antiviral treatment was associated with increased but not statistically significant overall survival (hazard ratio (HR): 2.272, 95% confidence interval (CI): 0.952–5.424, P = 0.064) and the antiviral treatment was significantly associated with increased complication-free survival of the patients (HR: 7.229, 95% CI: 1.271–41.117, P = 0.026). The complication-free survival in patients aged ≤ 40 years was higher than that in patients aged > 40 years in the antiviral treatment patients (P = 0.020). CONCLUSIONS: Antiviral therapy initiating after splenectomy may reduce the incidence of complications and tend to improve the survival in asplenic HBV-associated cirrhotic patients, especially in younger patients, supporting the use of antiviral therapy in these patients after splenectomy

Effect of antiviral therapy on the survival and incidence of major complications in HBV-associated cirrhotic patients after splenectomy for hypersplenism and portal hypertension

Abstract Background Splenectomy remains a common approach for the management of hypersplenism and portal hypertension in hepatitis B virus (HBV)-associated cirrhotic patients in China and some other Asian countries. The effects of antiviral therapy on the survival and occurrence of complications in asplenic HBV-associated cirrhotic patients are unknown. This study analyzed the effect of antiviral therapy on survival and occurrence of major complications in HBV-associated cirrhotic patients after splenectomy for hypersplenism and portal hypertension. Results Of the 57 eligible patients for analysis, 28 patients received nucleos(t)ide analogs (treatment group) for antiviral treatment after splenectomy, while 29 patients received no antiviral treatment (control group). After a median of 3 years and 9 months, the overall survival and complication-free survival in the treatment group were higher though not statistically significant than those in the control group. Multivariate analysis showed that antiviral treatment was associated with increased but not statistically significant overall survival (hazard ratio (HR): 2.272, 95% confidence interval (CI): 0.952–5.424, P = 0.064) and the antiviral treatment was significantly associated with increased complication-free survival of the patients (HR: 7.229, 95% CI: 1.271–41.117, P = 0.026). The complication-free survival in patients aged ≤ 40 years was higher than that in patients aged > 40 years in the antiviral treatment patients (P = 0.020). Conclusions Antiviral therapy initiating after splenectomy may reduce the incidence of complications and tend to improve the survival in asplenic HBV-associated cirrhotic patients, especially in younger patients, supporting the use of antiviral therapy in these patients after splenectomy.</p

Virus-Inspired Self-Assembled Nanofibers with Aggregation-Induced Emission for Highly Efficient and Visible Gene Delivery

High-efficiency gene transfer and suitably low cytotoxicity are the main goals of gene transfection systems based on nonviral vectors. In addition, it is desirable to track the gene transfer process in order to observe and explain the mechanism. Herein, inspired by viral structures that are optimized for gene delivery, we designed a small-molecule gene vector (TR4) with aggregation-induced emission properties by capping a peptide containing four arginine residues with tetraphenylethene (TPE) and a lipophilic tail. This novel vector can self-assemble with plasmid DNA to form nanofibers in solution with low cytotoxicity, high stability, and high transfection efficiency. pDNA@TR4 complexes were able to transfect a variety of different cell lines, including stem cells. The self-assembly process induces bright fluorescence from TPE, which makes the nanofibers visible by confocal laser scanning microscopy (CLSM). This allows us for the tracking of the gene delivery process

Transperitoneal vs retroperitoneal laparoscopic radical nephrectomy: a double-arm, parallel-group randomized clinical trial

Abstract Objective To compare the outcomes of patients undergoing Retroperitoneal laparoscopic Radical nephrectomy (RLRN) and Transperitoneal laparoscopic Radical nephrectomy (TLRN). Methods A total of 120 patients with localized renal cell carcinoma were randomized into either RLRN or TLRN group. Mainly by comparing the patient perioperative related data, surgical specimen integrity, pathological results and tumor results. Results Each group comprised 60 patients. The two group were equivalent in terms of perioperative and pathological outcomes. The mean integrity score was significantly lower in the RLRN group than TLRN group. With a median follow-up of 36.4 months after the operation, Kaplan–Meier survival analysis showed no significant difference between RLRN and TLRN in overall survival (89.8% vs. 88.5%; P = 0.898), recurrence-free survival (77.9% vs. 87.7%; P = 0.180), and cancer-specific survival (91.4% vs. 98.3%; P = 0.153). In clinical T2 subgroup, the recurrence rate and recurrence-free survival in the RLRN group was significantly worse than that in the TLRN group (43.2% vs. 76.7%, P = 0.046). Univariate and multivariate COX regression analysis showed that RLRN (HR: 3.35; 95%CI: 1.12–10.03; P = 0.030), male (HR: 4.01; 95%CI: 1.07–14.99; P = 0.039) and tumor size (HR: 1.23; 95%CI: 1.01–1.51; P = 0.042) were independent risk factor for recurrence-free survival. Conclusions Our study showed that although RLRN versus TLRN had roughly similar efficacy, TLRN outperformed RLRN in terms of surgical specimen integrity. TLRN was also significantly better than RLRN in controlling tumor recurrence for clinical T2 and above cases. Trial registration Chinese Clinical Trial Registry ( https://www.chictr.org.cn/showproj.html?proj=24400 ), identifier: ChiCTR1800014431, date: 13/01/2018

Additional file 1 of Transperitoneal vs retroperitoneal laparoscopic radical nephrectomy: a double-arm, parallel-group randomized clinical trial

Additional file 1: Supplementary Table 1. Univariate and multivariate analysis of recurrence-free survival in patients with clinical T2 stage RCC