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Prospective study of hepatitis B and D epidemiology and risk factors in Romania:A 10-year update

World Journal of Hepatology 2024年第4期16卷 640-649页

作者： Speranta Iacob Liana Gheorghe Mirela Onica Laura Huiban Corina Silvia Pop Ciprian Brisc Roxana Sirli Carmen Ester Cristina Mihaela Brisc Sorina Diaconu Ion Rogoveanu Larisa Sandulescu Deiana Vuletici Anca Trifan Department of Gastroenterology Carol Davila University of Medicine and PharmacyBucharest 050474Romania Department of Gastroenterology and Hepatology Fundeni Clinical InstituteBucharest 022328Romania Department of Gastroenterology Grigore T Popa University of Medicine and PharmacyIasi 700115Romania Institute of Gastroenterology and Hepatology Saint Spiridon County HospitalIasi 700111Romania Department of Gastroenterology and Medical Oncology University Emergency Clinical HospitalBucharest 050098Romania Faculty of Medicine and Pharmacy University of OradeaOradea 410087Romania Department of Gastroenterology Emergency County HospitalOradea 410169Romania Center for Advanced Research in Gastroenterology and Hepatology Department of Gastroenterology and Hepatology“Victor Babeş”University of Medicine and PharmacyTimisoara 300041Romania Department of Gastroenterology and Hepatology TimişCounty Emergency Clinical Hospital"Pius Branzeu"Timisoara 300723Romania Department of Internal Medicine II and Gastroenterology University Emergency Clinical HospitalBucharest 050098Romania Department of Gastroenterology University of Medicine and PharmacyCraiova 200349Romania Department of Cardiology Emergency County HospitalCraiova 200642Romania Department of Gastroenterology Research Center of Gastroenterology and HepatologyUniversity of Medicine and PharmacyCraiova 200349Romania Department of Gastroenterology Emergency County HospitalCraiova 200642Romania Department of Gastroenterology Faculty of MedicineGrigore T Popa University of Medicine and PharmacyIasi 700115Romania

BACKGROUND The global burden of hepatitis D virus(HDV)infection represents a major medical challenge and a public health crisis ***,there is a lack of accurate data on the epidemiology and risk factors for *** B virus(HBV)and HDV coinfection causes the most severe form of viral hepatitis,leading to a higher cumulative incidence of liver-related events compared with HBV monoinfection,including the need for liver transplantation and *** To investigate the epidemiology,natural history,risk factors and clinical management of HBV and HDV coinfection in Romanian *** This prospective study was conducted between January and July 2022 in six tertiary gastroenterology and hepatology referral centres in *** consecutive adults admitted for any gastroenterology diagnosis who were HBV-positive were *** with acute hepatitis or incomplete data were *** the 25390 individuals who presented with any type of gastroenterology diagnosis during the study period,963 met the inclusion *** for anti-HDV antibodies and HDV RNA was performed for all *** and risk factor data were collected by investigators using medical charts and patient *** data were stored in an anonymized online database during the *** The prevalence of HBV was 3.8%;among these patients,the prevalence of HBV/HDV coinfection was 33.1%.The median age of the study population was 54.0 years,and it consisted of 55.1%men.A higher prevalence of HBV/HDV coinfection was observed in patients 50–69 years *** with HBV/HDV coinfection were significantly older than those with HBV monoinfection(P=0.03).Multivariate multiple regression analysis identified female gender(P=0.0006),imprisonment(P<0.0001),older age at diagnosis(P=0.01)and sexual contact with persons with known viral hepatitis(P=0.0003)as significant risk factors for *** This study shows that HDV infection among those with HBV re

关键词： Epidemiology Hepatitis B Hepatitis D Natural history Risk factors Romania

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Changes in blood lipid levels and influencing factors among treatment-naïve adult male HlV/AlDS patients following BlC/FTC/TAF vs.3TC+EFV+TDF

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Chinese Medical Journal 2024年第12期137卷 1447-1452页

作者： Xi Wang An Liu Zaicun Li Hongwei Zhang Ruojun Esther Wu Ying Shao Jianwei Li Jiangzhu Ye Wei Liu Lijun Sun Clinic of Center for Infection Beijing Youan HospitalCapital Medical UniversityBeijing 100069China Harvard School of Dental Medicine BostonMAUSA Department of Pharmacy Beijing Youan HospitalCapital Medical UniversityBeijing 100069China Chinese Association of STD and AIDS Prevention and Control Beijing 100050China

Background:Antiretroviral therapy(ART)was often associated with dyslipidemia among human immunodeficiency virus(HIV)/acquired immunodeficiency syndrome(AIDS)*** study aimed to assess treatment-naïve adult male patients with HIV/AIDS who initiated ART with either co-formulated bictegravir,emtricitabine,and tenofovir alafenamide(BIC/FTC/TAF)or lamivudine,efavirenz,and tenofovir disoproxil fumarate(3TC+EFV+TDF),monitoring at weeks 4,12,24,and ***:A case-control retrospective study was *** newly diagnosed HIV-infected individuals attending the sexual transmission disease(STD)/AIDS clinic of Beijing Youan Hospital,Capital Medical University,from January to December *** patients were divided into BIC/FTC/TAF group or 3TC+EFV+TDF ***-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),triglyceride(TG),and total cholesterol(TC)at different time points over 48 weeks between two groups were compared.A multivariate Cox regression model was used to identify relevant influencing factors for the population at high risk of increased ***:A total of 870 participants,with 510 in BIC/FTC/TAF group and 360 in 3TC+EFV+TDF *** were no statistically significant differences in median age,baseline CD4/CD8 ratio,median body mass index(BMI)between the two *** both two groups,levels of TG,TC,and LDL-C were higher at 4 weeks,12 weeks,and 24 weeks of treatment(all P0.05).In addition,the differences in average changes of the level of TG,TC,HDL-C,and LDL-C from weeks 4,12,24,and 48 to baseline between two groups were not statistically significant(all P>0.05).Multivariate Cox proportional risk model analysis showed that initiating ART with HIV RNA≥10^(5)copies/mL(compared with<10^(5)copies/mL)was associated with an increased risk of elevated LDL-C(hazard ratio=1.26,95%confidence interval:1.07-1.48,

关键词： Antiretroviral therapy Blood lipids Bictegravir/emtricitabine/tenofovir alafenamide Lamivudine,efavirenz,and tenofovir disoproxil fumarate BIC/FTC/TAF 3TC+EFV+TDF HIV AIDS

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Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease

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Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 241-248页

作者： Chao Sun George Boon-Bee Goh Wan-Cheng Chow Wah-Kheong Chan Grace Lai-Hung Wong Wai-Kay Seto Yi-Hsiang Huang Han-Chieh Lin I-Cheng Lee Hye Won Lee Seung Up Kim Vincent Wai-Sun Wong Jian-Gao Fan Center for Fatty Liver Disease Department of GastroenterologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai Key Lab of Pediatric Gastroenterology and NutritionShanghai 200092China Department of Gastroenterology&Hepatology Singapore General HospitalSingaporeSingapore Gastroenterology and Hepatology Unit Department of MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia Department of Medicine and Therapeutics and State Key Laboratory of Digestive Disease The Chinese University of Hong KongHong KongChina Department of Medicine The University of Hong KongHong KongChina Institute of Clinical Medicine National Yang Ming Chiao Tung University School of MedicineTaipeiTaiwanChina Division of Gastroenterology and Hepatology Taipei Veterans General HospitalTaipeiTaiwanChina Faculty of Medicine National Yang Ming Chiao Tung University School of MedicineTaipeiTaiwanChina Department of Internal Medicine Yonsei University College of MedicineSeoulKorea

Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic ***,the prevalence and risk factors for impaired renal function in patients with NAFLD remain *** objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD ***:All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective *** fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase(FAST),Agile 3+and Agile 4 *** renal function and chronic kidney disease(CKD)were defined by an estimated glomerular filtration rate(eGFR)with value of<90 mL/min/1.73 m^(2) and<60 mL/min/1.73 m^(2),respectively,as estimated by the CKD-Epidemiology Collaboration(CKD-EPI)***:Among 529 included NAFLD patients,the prevalence rates of impaired renal function and CKD were 37.4%and 4.9%,*** multivariate analysis,a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+and Agile 4 scores were independent risk factors for CKD(P<0.05).Furthermore,increased fasting plasma glucose(FPG)and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome(P<0.05).Compared with patients with normoglycemia,those with prediabetes[FPG≥5.6 mmol/L or hemoglobin A1c(HbA1c)≥5.7%]were more likely to have impaired renal function(P<0.05).Conclusions:Agile 3+and Agile 4 are reliable for identifying NAFLD patients with high risk of *** glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.

关键词： Nonalcoholic fatty liver disease Impaired renal function Agile 3+ Agile 4 Metabolic syndrome

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Hepatology|小鼠肝细胞限制HBV感染的分子机制

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临床肝胆病杂志 2024年第7期40卷 1419-1419页

作者：赵凯涛武汉大学泰康医学院(基础医学院)

2023年4月,病毒学国家重点实验室/武汉大学泰康医学院(基础医学院)医学病毒学研究所夏宇尘教授团队系统性地探究了HBV在小鼠肝细胞中的感染过程。在实验方法上,该研究构建了多种稳定表达人源牛磺胆酸钠共转移多肽(hNTCP)的人及小鼠肝细... 详细信息

2023年4月,病毒学国家重点实验室/武汉大学泰康医学院(基础医学院)医学病毒学研究所夏宇尘教授团队系统性地探究了HBV在小鼠肝细胞中的感染过程。在实验方法上,该研究构建了多种稳定表达人源牛磺胆酸钠共转移多肽(hNTCP)的人及小鼠肝细胞,并进行了HBV及其卫星病毒HDV的感染;体外合成了HBV前基因组RNA(pgRNA)、共价闭合环状DNA(cccDNA)及不同形式的松弛环状不完全双链DNA(rcDNA)修复中间体;采用DNA体外修复体系及小鼠高压尾静脉注射模型探究了rcDNA修复形成cccDNA的能力;通过Southern blotting及原位杂交技术对感染过程中HBV DNA的形式及定位进行了检测。实验结果表明,HDV可以在表达hNTCP的小鼠肝细胞中建立感染,而HBV不能;pgRNA转染人肝细胞可以建立HBV感染,转染小鼠肝细胞则不能;HBV复制型质粒、cccDNA及重组cccDNA可以在小鼠肝细胞中进行转录;小鼠肝细胞支持不同形式的rcDNA修复中间体修复形成cccDNA;rcDNA可以被转运至小鼠肝细胞核;核酸酶敏感实验中小鼠肝细胞质中的蛋白结合rcDNA表现出完全的耐受性,这与在人肝细胞中有明显差异。

关键词：小鼠肝细胞基础医学院 HBV复制 cccDNA 感染过程蛋白结合质中国家重点实验室

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A Class Effect Network Meta-analysis of Lipid Modulation in Non-alcoholic Steatohepatitis for Dyslipidemia

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Journal of Clinical and Translational Hepatology 2022年第6期10卷 1042-1049页

作者： Jieling Xiao Cheng-Han Ng Yip-Han Chin Darren Jun Hao Tan Wen-Hui Lim Grace Lim Jingxuan Quek Ansel Shao Pin Tang Kai-En Chan Rou-Yi Soong Nicholas Chew Benjamin Tay Daniel Q.Huang Nobuharu Tamaki Roger Foo Mark Y.Chan Mazen Noureddin Mohammad Shadab Siddiqui Arun J.Sanyaland Mark D.Muthiah Yong Loo Lin School of Medicine National University of SingaporeSingapore Lee Kong Chian School of Medicine Nan-yang Technological UniversitySingapore Department of Cardiology National University Heart CenterNational University HospitalSingapore Division of Gastroenterology and Hepatology Department of MedicineNational University HospitalSingaporeSingapore National University Center for Organ Transplantation National University Health SystemSingapore NAFLD Research Center Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of California at San DiegoLa JollaCAUSA Department of Gastroenterology and Hepatology Musashino Red Cross HospitalTokyoJapan Cedars-Sinai Fatty Liver Program Division of Digestive and Liver DiseasesDepartment of MedicineComprehen-sive Transplant CenterCedars-Sinai Medical CenterLos AngelesCAUSA Division of Gastroenterology Hepatology and NutritionDepartment of Internal MedicineVirginia Commonwealth UniversityRichmondVAUSA

Background and Aims:Pharmaceutical therapy for NASH is associated with lipid modulation,but the consensus on drug treatment is limited and lacks comparative analysis of effectiveness.A network meta-analysis was conducted to compare NASH drug classes in lipid ***:Online databases were searched for randomized controlled trails(RCTs)evaluating NASH treatments in biopsy-proven NASH *** were classified into four groups:(1)inflammation,(2)energy,(3)bile acids,and(4)fibro-sis based on the mechanism of action.A Bayesian network analysis was conducted with outcome measured by mean difference(MD)with credible intervals(Crl)and surface un-der the cumulative ranking curve(SUCRA).Results:Forty-four RCTs were included in the *** acid modulat-ing treatments(MD:0.05,Crl:0.03-0.07)were the best treatment for improvement in high-density lipid(HDL)cho-lesterol,followed by treatments modulating energy(MD:0.03,Crl:0.02-0.04)and fibrosis(MD:0.01,Crl:−0.12 to 0.14)compared with *** top three treatments for reduction in triglycerides were treatments modulating energy(MD:−0.46,Crl:−0.49 to−0.43),bile acids(MD:−0.22,Crl:−0.35 to−0.09),and inflammation(MD:−0.08,Crl:−0.13 to−0.03)compared with *** found treatment modulating fibrosis(MD:−1.27,Crl:−1.76 to−0.79)was the best treatment for reduction in low-density lipid(LDL)cholesterol followed by treatment modulating in-flammation(MD:−1.03,Crl:−1.09 to−0.97)and energy(MD:−0.37,Crl:−0.39 to−0.34)compared with placebo,but LDL cholesterol was worsened by treatments modulat-ing bile ***:Network analysis comparing the class effects of dyslipidemia modulation in NASH found that treatment targets can include optimization of athero-genic *** studies are required to evaluate the cardiovascular outcomes.

关键词： Lipid modulation NASH Dyslipidemia

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Osteosarcopenia in autoimmune cholestatic liver diseases:Causes,management,and challenges

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World Journal of Gastroenterology 2022年第14期28卷 1430-1443页

作者： Nicola Pugliese Ivan Arcari Alessio Aghemo Andrea G Lania Ana Lleo Gherardo Mazziotti Department of Biomedical sciences Humanitas UniversityPieve Emanuele 20090MilanItaly Division of Internal Medicine and Hepatology Department of GastroenterologyIRCCS Humanitas Research HospitalRozzano 20089MIItaly Department of Endocrinology Diabetology and Medical Andrology UnitIRCCS Humanitas Research HospitalRozzano 20089MIItaly

Primary biliary cholangitis and primary sclerosing cholangitis(PSC)are the most common cholestatic liver diseases(CLD)in adults and are both characterized by an immune *** primary biliary cholangitis is a model autoimmune disease,with over 90%of patients presenting very specific autoantibodies against mitochondrial antigens,PSC is considered an immune mediated *** is the most common bone disease in CLD,resulting in frequent fractures and leading to significant ***,sarcopenia is emerging as a frequent complication of chronic liver diseases with a significant prognostic impact and severe implications on the quality of life of *** mechanisms underlying osteoporosis and sarcopenia in CLD are still largely unknown and the association between these clinical conditions remains to be *** timely diagnosis,prevention,and management of osteosarcopenia are crucial to limit the consequences,there are no specific guidelines for management of osteoporosis and sarcopenia in patients with *** guidelines recommend screening for bone disease at the time of diagnosis of ***,the optimal monitoring strategies and treatments have not been defined yet and vary among *** herein aim to comprehensively outline the pathogenic mechanisms and clinical implications of osteosarcopenia in CLD,and to summarize expert recommendations for appropriate diagnostic and therapeutic approaches.

关键词： Cholestatic liver diseases Primary biliary cholangitis Primary sclerosing cholangitis Osteoporosis Sarcopenia

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Efficacy and safety of semaglutide in non-alcoholic fatty liver disease

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世界胃肠病学杂志:英文版 2023年第37期29卷 5327-5338页

作者： Kai Zhu Rohan Kakkar Daljeet Chahal Eric M Yoshida Trana Hussaini Internal Medicine University of British ColumbiaVancouver V5Z 1M9BCCanada Department of Gastroenterology University of British ColumbiaVancouver V5Z 1M9BCCanada BC Liver Transplant Program Vancouver General HospitalVancouver V5Z 1M9BCCanada Pharmaceutical sciences University of British ColumbiaVancouver V5Z 1M9BCCanada

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the leading cause of chronic liver *** prevalence and disease burden of NAFLD are projected to exponentially increase resulting in significant healthcare expenditures and lower healthrelated quality of *** date,there are no approved pharmacotherapies for NAFLD or non-alcoholic steatohepatitis(NASH).Semaglutide has glycemic and weight loss benefits that may be advantageous for patients with *** To investigate the efficacy and safety of semaglutide in patients with *** MEDLINE,CENTRAL,and EMBASE were searched from inception to May 1,2023,to identify eligible randomized controlled trials(RCTs).Meta-analysis was performed using random effects model expressing continuous outcomes as mean differences(MD)or standardized MDs(SMD),and dichotomous outcomes as odds ratios(OR)with 95%confidence intervals(CI).Statistical heterogeneity was assessed using the Cochran’s Q test and I2 *** Three RCTs involving 458 patients were *** increased the likelihood of NASH resolution(OR:3.18,95%CI:1.70,5.95;P<0.001),improvement in steatosis(OR:2.83,95%CI:1.19,6.71;P=0.03),lobular inflammation(OR:1.81,95%CI:1.11,2.96;P=0.02),and hepatocellular ballooning(OR:2.92,95%CI:1.83,4.65;P<0.001),but not fibrosis stage(OR:0.71,95%CI:0.15,3.41;P=0.67).Radiologically,semaglutide reduced liver stiffness(SMD:-0.48,95%CI:-0.86,-0.11;P=0.01)and steatosis(MD:-4.96%,95%CI:-9.92,0.01;P=0.05).It also reduced alanine aminotransferase(MD:-14.06 U/L,95%CI:-22.06,-6.07;P<0.001)and aspartate aminotransferase(MD:-11.44 U/L,95%CI:-17.23,-5.65;P<0.001).Semaglutide led to improved cardiometabolic outcomes,including decreased HgA1c(MD:-0.77%,95%CI:-1.18,-0.37;P<0.001)and weight loss(MD:-6.53 kg,95%CI:-11.21,-1.85;P=0.006),but increased the occurrence of GIrelated side effects(OR:3.72,95%CI:1.68,8.23;P=0.001).Overall risk of serious adverse events was similar compared to placebo(OR:1.40,95%CI:0.75,2.62;P<0.29).CO

关键词： Non-alcoholic fatty liver disease Fatty liver Metabolic-associated fatty liver Semaglutide

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Research landscape on COVID-19 and liver dysfunction: A bibliometric analysis

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World Journal of Gastroenterology 2023年第27期29卷 4356-4367页

作者： Sa'ed H Zyoud Department of Clinical and Community Pharmacy College of Medicine and Health SciencesAn-Najah National UniversityNablus 44839Palestine Poison Control and Drug Information Center(PCDIC) College of Medicine and Health SciencesAn-Najah National UniversityNablus 44839Palestine Clinical Research Centre An-Najah National University HospitalNablus 44839Palestine

BACKGROUND The global spread of severe acute respiratory syndrome coronavirus 2,responsible for coronavirus disease 2019(COVID-19),poses a significant risk to public *** the respiratory issues initially associated with the condition,severe cases of COVID-19 can also lead to complications in other organs,including the *** with severe COVID-19 may exhibit various clinical signs of liver dysfunction,ranging from minor elevations in liver enzymes without symptoms to more serious cases of impaired liver *** damage is more commonly observed in patients with severe or critical forms of the *** To present the research landscape on COVID-19 and liver dysfunction while also offering valuable insights into the prominent areas of interest within this particular *** On 18 February 2023,Scopus was utilised to conduct a comprehensive exploration of the relationship between COVID-19 and the liver *** investigation encompassed the period from 1 January 2020 to 31 December *** sources were meticulously examined and organised in a Microsoft Excel 2013 spreadsheet,categorised by journal,institution,funding agency,country and citation *** version 1.6.18 was employed to explore the prominent topics and knowledge network related to the *** There were 2336 publications on COVID-19 and liver dysfunction analysed in this study,of which 558 were published in 2020,891 in 2021 and 887 in *** from 111 different countries participated in the retrieved *** United States contributed the most studies,with 497 documents,representing 21.28%of the total,followed by China with 393 documents(16.82%)and Italy with 255 documents(10.92%).In the context of research related to COVID-19 and the liver,co-occurrence analysis identified three distinct clusters of topics:(1)‘COVID-19 vaccines in liver transplant recipients’;(2)‘liver function tests as a predictor of the severity and clinical outcom

关键词： COVID-19 Bibliometric Scopus Vosviewer Liver

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An open-label evaluation of safety and tolerability of coformulated bictegravir/emtricitabine/tenofovir alafenamide for post-exposure prophylaxis following potential exposure to human immunodeficiency virus-1

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Chinese Medical Journal 2022年第22期135卷 2725-2729页

作者： An Liu Ruolei Xin Hongwei Zhang Lili Dai Ruojun(Esther)Wu Xi Wang Aixin Li Wei Hua Jianwei Li Ying Shao Yue Gao Zhangli Wang Jiangzhu Ye Gulimila A bu dou re xi ti Zaicun Li Lijun Sun Clinic of Center for Infection Beijing Youan HospitalCapital Medical UniversityBeijing 100069China Institute of STD/AIDS Prevention and Control Beijing Center for Disease Prevention and ControlBeijing 100013China Department of Chemistry Colgate UniversityHamilton NYUSA Care Center The Eighth Affiliated Hospital of Xinjiang Medical UniversityUrumchiXinjiang 830054China

Background: Single-tablet regimen (STR) provides a convenient once-daily regimen for the prevention of human immunodeficiency virus (HIV) infection. Here, we investigated the safety and tolerability of coformulated bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) as a three-drug, STR for post-exposure prophylaxis (PEP) in Chinese ***: This was a prospective, open-label, single-arm trial conducted in a sexually transmitted diseases and acquired immunodeficiency syndrome clinic of a tertiary hospital in Beijing, China. Adults requiring PEP were prescribed BIC/FTC/TAF one pill once a day for 28 days. Clinical and laboratory data were collected and analyzed at baseline, weeks 2, 4, 8, 12, and ***: Of 112 participants enrolled in the study, 109 (97.3%) were male and the mean age was 30 ± 8 years. PEP completion was 96.4% (95% confidence interval: 91.1-99.0%). Two participants stopped PEP after 2 days because the source partner was identified as HIV uninfected. One participant was excluded due to hepatitis B virus infection according to the exclusion criteria. One discontinued due to the participant’s decision. No participant acquired HIV through week 24. Adherence was 98.9% (standard deviation [SD]: 3.3%) by self-reporting and 98.5% (SD: 3.5%) by pill count. Only five participants experienced mild clinical adverse events attributed to the study drug (including headache, diarrhea, and nausea) and four participants had elevated serum creatinine (grade 1).Conclusions: A once daily, STR of BIC/FTC/TAF used as PEP was safe and well-tolerated with a high rate of completion and adherence in Chinese. BIC/FTC/TAF may be a good option for PEP.

关键词： Post-exposure prophylaxis Human immunodeficiency virus Bictegravir/emtricitabine/tenofovir alafenamide Adverse event

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Effects and safety of natriuretic peptides as treatment of cirrhotic ascites:A systematic review and meta-analysis

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World Journal of Hepatology 2022年第4期14卷 827-845页

作者： Rasmus Hvidbjerg Gantzel Mikkel Breinholt Kjær Peter Jepsen Niels Kristian Aagaard Hugh Watson Lise Lotte Gluud Henning Grønbæk Department of Hepatology and Gastroenterology Aarhus University HospitalAarhus N 8200Denmark Gastroenterology Unit Copenhagen University HospitalHvidovre 2650Denmark Department of Clinical Medicine University of CopenhagenHvidovre 2650Denmark

BACKGROUND Natriuretic peptides are involved in the cascade of pathophysiological events occurring in liver cirrhosis,counterbalancing vasoconstriction and anti-natriuretic *** effects of natriuretic peptides as treatment of cirrhotic ascites have been investigated only in small studies,and definitive results are *** To examine the effects and safety of natriuretic peptides in cirrhosis patients with *** We searched MEDLINE,Web of Science,Scopus,Cochrane Library and Embase for all available studies applying intravenous administration of any natriuretic peptide to patients suffering from cirrhotic *** was not limited by treatment duration or dose,or by follow-up *** randomised controlled trials and non-randomised studies were eligible for *** primary outcome was change in renal sodium *** outcomes included safety measures and changes in renal water excretion,plasma aldosterone concentration,and plasma renin *** Twenty-two studies were *** natriuretic peptide(ANP)was the only intensively studied *** excretion increased in response to continuous ANP infusion and was more pronounced when infusion rates of>30 ng/kg/min were administered compared with≤30 ng/kg/min(P<0.01).Moreover,natriuresis was significantly higher in study subgroups with mild/moderate ascites compared with moderate/severe and refractory ascites(P<0.01).ANP infusions increased renal water excretion,although without reaching a statistically significant dose-response *** aldosterone concentration and plasma renin activity were significantly lower at baseline in study subgroups achieving a negative sodium balance in response to an ANP administration compared with treatment non-responders(P<0.01).Blood pressure decreases occurred less frequently when ANP doses≤30 ng/kg/min were *** quality of evidence for a natriuretic response to ANP was low,mainly due to small sample size

关键词： Atrial natriuretic peptide B-type natriuretic peptide Urodilatin Cirrhosis Ascites Refractory ascites

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