Comparison of the efficacy of lamivudine and telbivudine in the treatment of chronic hepatitis B: a systematic review

<p>Abstract</p> <p>Background</p> <p>Chronic viral hepatitis B remains a global public health concern. Currently, several drugs, such as lamivudine and telbivudine, are recommended for treatment of patients with chronic hepatitis B. However, there are no conclusive results on the comparison of the efficacy of lamivudine (LAM) and telbivudine (LdT) in the treatment of chronic hepatitis B.</p> <p>Results</p> <p>To evaluate the comparison of the efficacy of LAM and LdT in the treatment of chronic hepatitis B by a systematic review and meta-analysis of clinical trials, we searched PUBMED (from 1990 to April 2010), Web of Science (from 1990 to April 2010), EMBASE (from 1990 to April 2010), CNKI (National Knowledge Infrastructure) (from 1990 to April 2010), VIP database (from 1990 to April 2010), WANFANG database (from 1990 to April 2010), the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Review. At the end of one-year treatment, LdT was better than LAM at the biochemical response, virological response, HBeAg loss, therapeutic response, while less than at the viral breakthrough and viral resistance, but there was no significant difference in the HBeAg seroconversion and HBsAg response. LdT was better than LAM at the HBeAg seroconversion with prolonged treatment to two years.</p> <p>Conclusions</p> <p>In summary, LdT was superior in inhibiting HBV replication and preventing drug resistance as compared to LAM for CHB patients. But LdT may cause more nonspecific adverse events and can lead to more CK elevation than LAM. It is thus recommended that the LdT could be used as an option for patients but adverse events, for example CK elevation, must be monitored.</p

Activation of the kynurenine pathway is associated with poor outcome in Pneumocystis pneumonia patients infected with HIV: results of 2 months cohort study

Abstract Background Indoleamine 2, 3-dioxygenase (IDO) is a key enzyme in the degradation of tryptophan (Trp) to kynurenine (Kyn). We measured IDO activity as the Kyn to Trp ratio, and investigated whether IDO could be used to assess prognosis of acquired immune deficiency Sydrome (AIDS) patients with pneumocystis pneumonia (PCP). Methods The Kyn and Trp concentration were measured by UPLC-MS/MS in plasma samples. A total of 49 AIDS-PCP patients were included in the analysis. Clinical characteristics and Kyn/Trp ratio were compared between survivors and non-survivors. Results Kyn/Trp ratio was significantly lower after anti-PCP treatment in AIDS patients with PCP (P  300 mmHg (P = 0.007). Kyn/Trp ratio, D-dimer and CRP showed much higher AUC for predicting death of AIDS-PCP patients. Kyn/Trp ratio was useful for predicting the mortality of AIDS-PCP due to a significantly higher Kyn/Trp ratio in the non-survivors (P = 0.002). And the high Kyn/Trp ratio group had higher mortality rate than low Kyn/Trp group (32.1% vs. 9.1%, respectively, p = 0.024). Conclusion Activation of the kynurenine pathway is associated with the severity and fatal outcomes of AIDS patients with pneumocystis pneumonia

Comprehensive assessment of river ecological environment in nature reserve based on TOPSIS combined with grey correlation method

The main driving factors of river ecological environment were analyzed to reveal the response mechanism of river ecosystem to ecological environmental factors. The results showed that the driving factors of river water quality were resistivity, COD and reoxidation potential, the driving factors of soil environment along river banks were total phosphorus, total nitrogen and pH, and the driving factors of plant nutrition along river banks were total potassium and total nitrogen. The contribution rates of water quality, soil and plant to river ecological environment health were 43, 51 and 70%, respectively. The comprehensive ecological environment of Menghuo River, Gongyihai, Arulendi River, Yiniu River, Dahonggou River and Nanya River is superior to each other, with the comprehensive proximity index of 0.6258, 0.5908, 0.5524, 0.5265, 0.5195 and 0.3889, respectively. Each detection index can accurately and truly invert the ecological environment health status of rivers in the protected areas. HIGHLIGHTS The main driving factors of river ecological environment were analyzed.; To reveal the response mechanism of river ecosystem to ecological environmental factors.

Clinical Study of Mesenchymal Stem Cell Treatment for Acute Respiratory Distress Syndrome Induced by Epidemic Influenza A (H7N9) Infection: A Hint for COVID-19 Treatment

H7N9 viruses quickly spread between mammalian hosts and carry the risk of human-to-human transmission, as shown by the 2013 outbreak. Acute respiratory distress syndrome (ARDS), lung failure, and fulminant pneumonia are major lung diseases in H7N9 patients. Transplantation of mesenchymal stem cells (MSCs) is a promising choice for treating virus-induced pneumonia, and was used to treat H7N9-induced ARDS in 2013. The transplant of MSCs into patients with H7N9-induced ARDS was conducted at a single center through an open-label clinical trial. Based on the principles of voluntariness and informed consent, 44 patients with H7N9-induced ARDS were included as a control group, while 17 patients with H7N9-induced ARDS acted as an experimental group with allogeneic menstrual-blood-derived MSCs. It was notable that MSC transplantation significantly lowered the mortality of the experimental group, compared with the control group (17.6% died in the experimental group while 54.5% died in the control group). Furthermore, MSC transplantation did not result in harmful effects in the bodies of four of the patients who were part of the five-year follow-up period. Collectively, these results suggest that MSCs significantly improve the survival rate of H7N9-induced ARDS and provide a theoretical basis for the treatment of H7N9-induced ARDS in both preclinical research and clinical studies. Because H7N9 and the corona virus disease 2019 (COVID-19) share similar complications (e.g., ARDS and lung failure) and corresponding multi-organ dysfunction, MSC-based therapy could be a possible alternative for treating COVID-19

A Modified MELD Model for Chinese Pre-ACLF and ACLF Patients and It Reveals Poor Prognosis in Pre-ACLF Patients

<div><p>Background & Aims</p><p>Acute-on-chronic liver failure (ACLF) is one of the most deadly, prevalent, and costly diseases in Asia. However, no prognostic model has been developed that is based specifically on data gathered from Asian patients with ACLF. The aim of the present study was to quantify the survival time of ACLF among Asians and to develop a prognostic model to estimate the probability of death related to ACLF.</p><p>Methods</p><p>We conducted a retrospective observational cohort study to analyze clinical data from 857 patients with ACLF/pre-ACLF who did not undergo liver transplantation. Kaplan–Meier and Cox proportional hazards regression model were used to estimate survival rates and survival affected factors. The area under the receiver operating characteristic curve (auROC) was used to evaluate the performance of the models for predicting early mortality.</p><p>Results</p><p>The mortality rates among patients with pre-ACLF at 12 weeks and 24 weeks after diagnosis were 30.5% and 33.2%, respectively. The mortality rates among patients with early-stage ACLF at 12 weeks and 24 weeks after diagnosis were 33.9% and 37.1%, respectively. The difference in survival between pre-ACLF patients and patients in the early stage of ACLF was not statistically significant. The prognostic model identified 5 independent factors significantly associated with survival among patients with ACLF and pre-ACLF: the model for end-stage liver disease (MELD) score; age, hepatic encephalopathy; triglyceride level and platelet count.</p><p>Conclusion</p><p>The findings of the present study suggest that the Chinese diagnostic criteria of ACLF might be broadened, thus enabling implementation of a novel model to predict ACLF-related death after comprehensive medical treatment.</p></div

Flowchart of the study group selection process.

<p>LT: patients underwent liver transplantation; NLT: patients without liver transplantation.</p

Underlying survival function for the new ACLF prognostic model.

*<p>S₀(t) gives the estimated survival probability for the average ACLF or pre-ACLF patient (risk score 2.501). To calculate the survival of any given patient, the following equation is used: S (t) = S₀(t)^exp(R-2.501). R is calculated from the model provided in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0064379#pone-0064379-t004" target="_blank">Table 4</a>.</p

Candidate variables for survival predicting through multivariate analysis.

<p>Abbreviations: RR, relative risk; 95% CI, 95% confidence interval; MELD, Model for End-Stage Liver Disease.</p

Comparison of actual survival among patients with pre-ACLF, early-stage ACLF, intermediate-stage ACLF and late-stage ACLF.

<p>No significant differences existed between patients with pre-ACLF and early-stage ACLF (P>0.05). However, the difference in survival between pre-ACLF patients and intermediate-stage ACLF patients was statistically significant (P<0.0001). The difference in survival between intermediate-stage ACLF patients and late-stage ACLF patients was also statistically significant (P<0.0001).</p