The remodeling of B-cell subsets was correlated with the clearance of hepatitis B antigen during pegylated IFN α-2a therapy in CHB patients

BACKGROUND

B-cell may participate in the cellular immune process of hepatitis B antigen clearance. However, the function and specific mechanism of B-cell during interferon-pegylated interferon α-2a (Peg-IFN-α) treatment in chronic hepatitis B (CHB) patients have not yet been described.

METHODS

A total of 150 CHB patients enrolled in this study, who received 48 weeks of Peg-IFN α treatment. The differentiation clusters CD19, CD24, CD27, CD38, CD40, and CD80 of B cell surface markers in CHB patients were detected by flow cytometry. Spearman correlation and Logistic regression analysis were performed for the analysis.

RESULTS

The clearance rate of HBsAg increased significantly with the duration of Peg-IFN-α treatment, reaching 32.2% by 48 weeks. During the Peg-IFN-α therapy, the frequency of B-cell and its subsets increased significantly. However, we did not observe any significant difference in the frequency of the B-cell and its subsets in patients with or without HBsAg clearance after 48 weeks Peg-IFN-α treatment. The change in HBsAg value was negatively related to the change in plasmablasts (CD19+CD38+) level before and after 48 weeks treatment (r = -0.326, p = 0.006). Moreover, the results showed that HBsAg <288.70 IU/mL at baseline and HBsAg <58.05 IU/mL at 12 weeks were strong predictors of HBsAg clearance in patients with 48 weeks Peg-IFN-α treatment.

CONCLUSION

The remodeling of B cell subsets, especially plasmablasts (CD19+CD38+), during Peg-IFN-α treatment was closed associated with the clearance of hepatitis B antigen.

Cutting-edge biotherapeutics and advanced delivery strategies for the treatment of metabolic dysfunction-associated steatotic liver disease spectrum

Metabolic dysfunction-associated steatotic liver disease (MASLD), a condition with the potential to progress into liver cirrhosis or hepatocellular carcinoma, has become a significant global health concern due to its increasing prevalence alongside obesity and metabolic syndrome. Despite the promise of existing therapies such as thyroid hormone receptor-β (THR-β) agonists, PPAR agonists, FXR agonists, and GLP-1 receptor agonists, their effectiveness is limited by the complexity of the metabolic, inflammatory, and fibrotic pathways that drive MASLD progression, encompassing steatosis, metabolic dysfunction-associated steatohepatitis (MASH), and reversible liver fibrosis. Recent advances in targeted therapeutics, including RNA interference (RNAi), mRNA-based gene therapies, monoclonal antibodies, proteolysis-targeting chimeras (PROTAC), peptide-based strategies, cell-based therapies such as CAR-modified immune cells and stem cells, and extracellular vesicle-based approaches, have emerged as promising interventions. Alongside these developments, innovative drug delivery systems are being actively researched to enhance the stability, precision, and therapeutic efficacy of these biotherapeutics. These delivery strategies aim to optimize biodistribution, improve target-specific action, and reduce systemic exposure, thus addressing critical limitations of existing treatment modalities. This review provides a comprehensive exploration of the underlying biological mechanisms of MASLD and evaluates the potential of these cutting-edge biotherapeutics in synergy with advanced delivery approaches to address unmet clinical needs. By integrating fundamental disease biology with translational advancements, it aims to highlight future directions for the development of effective, targeted treatments for MASLD and its associated complications.

Long noncoding RNA USP30-AS1 promotes influenza A virus replication by enhancing PHB1 function

Long noncoding RNAs (lncRNAs) are important regulators of gene expression. Although evidence accumulated over the past decade shows that lncRNAs have key roles in the interaction between viruses and hosts, the functions of the majority of differentially expressed lncRNAs in response to viral infections remain uncharacterized so far. In this study, we have identified that USP30 antisense RNA 1 (USP30-AS1), a host antisense lncRNA, is hijacked by influenza A virus (IAV) to assist its replication. We show that USP30-AS1 is IAV-induced via the Janus protein tyrosine kinase-signal transducer and the activator of transcription (JAK-STAT) signaling pathway. Functionally, ectopic expression of USP30-AS1 significantly promotes IAV replication. Conversely, silencing USP30-AS1 suppresses IAV replication. Mechanistically, USP30-AS1 directly binds prohibitin 1 (PHB1) and modulates its protein stability and function. On the one hand, the binding of USP30-AS1 sequesters PHB1 away from the E3 ubiquitin ligase, tripartite motif containing 21 (TRIM21), thereby protecting the protein stability of PHB1. On the other hand, USP30-AS1 serves as a molecular scaffold for enhancing the interaction between PHB1 and interferon regulatory factor 3 (IRF3), which in turn impedes the nuclear import of IRF3. Therefore, our data unveil an important role of USP30-AS1 in promoting viral replication by modulating PHB1 stability and functions, providing a new insight into the role of lncRNAs in the interplay between IAV and host.

Effects of Different Antiviral Treatments on Liver Inflammation and Fibrosis in Patients With Chronic Hepatitis B

Oral nucleotide analogues (NAs) and peginterferon-α injections are commonly used for the treatment of patients with chronic hepatitis B (CHB). This study aims to evaluate the effects of different antiviral therapies on the degree of liver inflammation and fibrosis in CHB patients. This was a retrospective cohort study. A total of 101 CHB patients were admitted to the Liver Center of Xiamen Hospital of Traditional Chinese Medicine from 2017 to 2021 and were divided into three groups for different antiviral treatments: NAs therapy group (n = 36), peginterferon-α therapy group (n = 38) and nonantiviral therapy group (n = 27). The differences in degrees of liver inflammation and liver fibrosis between two histopathologic biopsies before and after treatment were analysed and compared to evaluate the efficacy of different treatments. The degrees of liver inflammation and liver fibrosis were improved after NAs or peginterferon-α therapy. In terms of improving the degree of liver inflammation, peginterferon-α therapy (74%) and NAs therapy (44%) were better than nonantiviral therapy (11%, p < 0.05), although no significant difference was shown between peginterferon-α therapy and NAs therapy (p = 0.974). For liver fibrosis improvement, peginterferon-α therapy showed significantly better efficacy than NAs therapy (68% vs. 33%, p = 0.044), while NAs therapy was better than nonantiviral therapy (33% vs. 11%, p = 0.028). Peginterferon-α and NAs can significantly improve the degree of liver inflammation and liver fibrosis in CHB patients. Peginterferon-α is superior to NAs in delaying and reversing liver fibrosis. This study provides a new basis for peginterferon-α therapy to prevent progression of fibrosis in CHB patients.

Global, regional and national temporal trends in Parkinson's disease incidence, disability-adjusted life year rates in middle-aged and older adults: a cross-national inequality analysis and Bayesian age-period-cohort analysis based on the global burden of disease 2021

BACKGROUND

Parkinson's disease (PD) ranks as the second most prevalent neurodegenerative disorder; however, its epidemiological characteristics among middle-aged and older adults at global, regional, and national levels remain inadequately documented.

METHODS

This study assessed temporal trends in PD among middle-aged and older adults by extracting incidence rates, disability-adjusted life year (DALY) rates, and corresponding age-specific rates (ASRs) from the Global Burden of Disease (GBD) database spanning 1990 to 2021. Estimated annual percentage change (EAPC) was employed to analyze trends over the past 30 years. The slope index of inequality (SII) and concentration index (CI) were utilized to evaluate disparities in the burden of PD across various countries. Additionally, Bayesian age-period-cohort (BAPC) modeling was applied to project DALY figures for the next 15 years.

RESULTS

In 2021, the global incidence and DALY rates for middle-aged and older adults with PD stood at 79.68 and 477.50 cases per 100,000 population, respectively. Both incidence and DALY rates have exhibited an upward trajectory over the past 32 years, with EAPCs of 1.2 (95% UI: 1.1-1.3) and 0.6 (95% UI: 0.5-0.7), respectively. Among the five sociodemographic index (SDI) regions, the high-middle SDI region reported the highest incidence and DALY rates for PD in 2021, at 93.93 and 512.29 cases per 100,000 population, respectively. A positive correlation was observed between the SDI and age-specific incidence rate (ASIR) as well as age-specific DALY rate (ASDR). Disparities in the burden of PD among middle-aged and older adults, associated with SDI, are on the rise and are primarily concentrated in high SDI countries. It is projected that the global incidence and DALY rates for middle-aged and older adults with PD will experience significant increases over the next 15 years.

CONCLUSIONS

The global burden of PD among middle-aged and older adults has markedly escalated over the past 32 years, particularly in high-middle SDI regions. These findings underscore the necessity for the development of effective interventions and public health policies, contributing to the attainment of the sustainable development goals established by the World Health Organization (WHO).

Efficacy assessment of glycyrrhetinic acid-modified liposomes loaded with doxorubicin hydrochloride and cucurbitine B for synergistic treatment of hepatocellular carcinoma

OBJECTIVE

Hepatocellular carcinoma (HCC) is characterized by a high incidence rate, aggressive invasion and metastasis, and a significant postoperative recurrence rate. Targeted therapy plays a crucial role in the precise treatment of HCC. Studies have demonstrated that Glycyrrhetinic acid (GA) specific receptors are overexpressed on the surface of HCC cells. Doxorubicin hydrochloride (Dox), a widely used chemotherapy agent for anti-tumor treatment, but is associated with substantial toxic side effects. Cucurbitacin B (CuB) also demonstrates promising anti-tumor activity, but its poor water solubility and low bioavailability limit its clinical application. The combination of Dox and CuB can exert a synergistic effect, thereby enhancing the overall anti-tumor efficacy. Therefore, we have developed GA-modified liposomes loaded with Dox and CuB (GA-Dox/CuB-Lips) to achieve synergistic therapy for HCC.

METHOD

In this study, GA-Dox/CuB-Lips were prepared using the thin film dispersion method and ammonium sulfate gradient method. In vitro, we evaluated the cellular uptake and cytotoxicity of the liposomes, as well as their anti-tumor effects in inhibiting tumor proliferation, promoting tumor apoptosis, and suppressing invasion and metastasis. In vivo, the targeting properties of GA-Dox/CuB-Lips were assessed through in vivo imaging. A tumor growth curve was generated by establishing a heterotopic nude mouse model. Additionally, an in-situ HCC model was established and the anti-tumor effects of liposomes were evaluated using HE staining, histological analysis and immunofluorescence staining.

RESULTS

We successfully prepared GA-Dox/CuB-Lips with a smooth, spherical morphology and uniform distribution. Both drugs exhibited high encapsulation efficiency, significantly enhancing the solubility of CuB. In vitro, GA-Dox/CuB-Lips demonstrated excellent targeting properties and exerted cytotoxic effects on Hepa1-6 cells, effectively inhibiting tumor cell proliferation, invasion, and metastasis while promoting tumor cell apoptosis. In vivo, GA-Dox/CuB-Lips selectively targeted tumor sites, disrupted tumor structures, inhibited tumor growth and proliferation, and promoted apoptosis.

CONCLUSION

GA-Dox/CuB-Lips exhibited excellent anti-HCC activity and represent a promising therapeutic approach for the treatment of HCC.

Green-synthesized selenium-hydroxytyrosol nanocomposites attenuate hepatocellular carcinoma in rats by modulating oxidative stress, inflammation, and apoptosis

Hepatocellular carcinoma (HCC) poses a significant health risk and greatly affects global rates of illness and death, highlighting an urgent requirement for new treatment strategies. This study examines the therapeutic effects of selenium-hydroxytyrosol nanocomposites (Se-HTNPs) in a rat model with HCC caused by diethylnitrosamine (DEN). Treatment with Se-HTNPs significantly inhibited serum activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin, while increasing serum albumin and total protein levels. Oxidative stress was alleviated, as evidenced by a marked reduction in hepatic malondialdehyde (MDA) levels and an increase in antioxidant markers, such as reduced glutathione (GSH), superoxide dismutase (SOD), and total antioxidant capacity (TAC). Se-HTNPs also significantly decreased hepatic inflammatory markers, such as tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β), as well as apoptotic markers (p53 and caspase-3) and vascular endothelial growth factor (VEGF). Furthermore, Se-HTNPs suppressed the mRNA expression of c-Jun N-terminal kinase (c-JNK) and nuclear factor kappa B (NF-κB) and improved histopathological alterations brought on by DEN. These findings suggest that Se-HTNPs mitigate DEN-induced HCC in rats through their potent antioxidant, anti-inflammatory, and anti-carcinogenic properties, underscoring their potential as a therapeutic strategy for HCC.

Comparative analysis of oral disorder burden in China and globally from 1990 to 2021 based on GBD data

Oral disorders are major global health issues, affecting 3.5 billion people and imposing significant economic burdens. This study analyzed the distribution and trends of oral disorder burden globally and in China from 1990 to 2021, aiming to inform resource allocation and prevention strategies. Data from the Global Burden of Disease (GBD) 2021 database were used to evaluate the incidence, prevalence, and years lived with disability (YLDs) of oral disorders. All statistical analyses and data visualizations were conducted using R. In 2021, the burden of oral disorders in China accounted for a significant proportion of the global burden. The incidence, prevalence, and YLDs increased by 15.49%, 52.44%, and 86.86% respectively compared with 1990. The global burden also showed an upward trend during the same period. The relevant indicators in China are at a relatively low level, and disparities were observed among regions with different sociodemographic indices (SDI). Oral disorder burden is on the rise globally, with females, children, adolescents, and the elderly being the key affected groups. Regions with middle SDI bear a heavier burden. This study provides a scientific basis for the formulation of relevant policies and emphasizes the necessity of interventions for specific groups.

Conserved spatial subtypes and cellular neighborhoods of cancer-associated fibroblasts revealed by single-cell spatial multi-omics

Cancer-associated fibroblasts (CAFs) are a multifaceted cell population essential for shaping the tumor microenvironment (TME) and influencing therapy responses. Characterizing the spatial organization and interactions of CAFs within complex tissue environments provides critical insights into tumor biology and immunobiology. In this study, through integrative analyses of over 14 million cells from 10 cancer types across 7 spatial transcriptomics and proteomics platforms, we discover, validate, and characterize four distinct spatial CAF subtypes. These subtypes are conserved across cancer types and independent of spatial omics platforms. Notably, they exhibit distinct spatial organizational patterns, neighboring cell compositions, interaction networks, and transcriptomic profiles. Their abundance and composition vary across tissues, shaping TME characteristics, such as levels, distribution, and state composition of tumor-infiltrating immune cells, tumor immune phenotypes, and patient survival. This study enriches our understanding of CAF spatial heterogeneity in cancer and paves the way for novel approaches to target and modulate CAFs.

2-Dodecyl-6-Methoxycyclohexa-2,5-Diene-1,4-Dione from Averrhoa carambola L. roots: Suppressing hepatocellular carcinoma progression through ROS accumulation and p53 pathway-mediated apoptosis

This study explores the anti-tumor effects of 2-dodecyl-6-methoxycyclohexa-2,5-diene-1,4-dione (DMDD), a compound derived from Averrhoa carambola L roots, on hepatocellular carcinoma (HCC) cells and a xenograft mouse model, focusing on its underlying mechanisms. Cell viability following DMDD treatment was assessed using the CCK-8 assay. Flow cytometry determined changes in cell cycle distribution and apoptosis rates, while migration and invasion capabilities were assessed using wound healing and transwell assays, respectively. Transcriptome sequencing (RNA-seq) was conducted to analyze differential gene expression and pathway enrichment. Z-VAD-FMK, a pan-caspase inhibitor, was used to confirm the apoptotic mechanism induced by DMDD. The expression levels of p53, Bax, Bcl-2, and cleaved caspase 3 were quantified via Western blot analysis. A xenograft mouse model was developed to assess the in vivo effects of DMDD on HCC. DMDD suppressed proliferation, migration, and invasion, and induced apoptosis in Huh7 and Hep3b cells. RNA-seq revealed significant enrichment of p53 and apoptosis signaling pathways among differentially expressed genes. DMDD downregulated Bcl-2 expression and upregulated p53, Bax and cleaved caspase 3. In addition, Z-VAD-FMK partially inhibited DMDD-induced apoptosis. DMDD also inhibited tumor growth in mice. DMDD effectively inhibited tumor growth in HCC cell lines and xenograft models, potentially through ROS elevation and p53-mediated activation of the intrinsic apoptotic pathway.

Role of Rifaximin in the Prognosis of Critically Ill Patients with Liver Cirrhosis

Background/Objectives: Critically ill patients with liver cirrhosis impose a substantial health burden on the world. Rifaximin is a potential treatment option for such patients. Methods: We extracted critically ill patients with liver cirrhosis from the Medical Information Mart for Intensive Care (MIMIC) IV database. Based on study outcomes, the current study included prevention and treatment cohorts. A 1:1 propensity score matching (PSM) analysis was performed to match the characteristics of patients. The risk of ICU admission and intensive care unit (ICU), in-hospital, 90-day, and 180-day death were explored. Cox regression analyses were conducted, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Kaplan-Meier curves were further drawn to demonstrate the cumulative 90-day and 180-day survival rate. Results: Overall, 5381 critically ill patients with liver cirrhosis were included. In the prevention cohort, rifaximin could decrease the risk of ICU admission (HR = 0.427, 95%CI: 0.338-0.539, p < 0.001). In the treatment cohort, rifaximin could decrease the risk of ICU (HR = 0.530, 95%CI: 0.311-0.902, p = 0.019) and in-hospital death (HR = 0.119, 95%CI: 0.033-0.429, p = 0.001) in critically ill patients with liver cirrhosis. However, rifaximin could not decrease the risk of 90-day (HR = 0.905, 95%CI: 0.658-1.245, p = 0.541) and 180-day (HR = 1.043, 95%CI: 0.804-1.353, p = 0.751) death in critically ill patients with liver cirrhosis. Kaplan-Meier curve analyses also showed that rifaximin could not significantly decrease the 90-day (p = 0.570) and 180-day (p = 0.800) cumulative mortality. Conclusions: This study suggests that rifaximin can significantly decrease the risk of ICU admission and improve short-term survival but does not impact long-term survival in critically ill patients with liver cirrhosis.

Public concerns analysis and early warning of Mpox based on network data platforms-taking Baidu and WeChat as example

With the outbreak of Mpox in non-endemic countries in May 2022, which has captured international attention. In response, this study leveraged the real-time, predictive, and wide coverage advantages of big data to reflect the public's needs and interests regarding the Mpox epidemic, and explore its potential early warning role. We carried out a systematic data search weekly on two major network data platforms-Baidu Search Index (BDI) and WeChat Search Index (WCI) in China, and the index data overview, main concern information, hotspot regional distribution were analyzed. Besides, the correlation between the search index and the number of new cases of Mpox globally and within China were also investigated. Our results showed that both BDI and WCI mirrored the trends of the Mpox epidemic, with peaks in interest aligning with the release of relevant policies and events. The public's interest evolved from basic knowledge of the disease to a focus on treatment and prevention, with attentiveness centrally placed in economically developed areas such as Guangdong, Beijing, and Shanghai. A positive correlation was observed between the Chinese epidemic and the BDI (r = 0.372, p = 0.047) and WCI (r = 0.398, p = 0.044), whereas non-correlation was noted globally. Notably, when the search time was delayed by 1 week, both BDI and WCI showed a positive correlation with the epidemic in China and globally. Overall, the integrated use of big data offers a platform for rapid understanding public concerns and early warning signs of emerging infectious diseases such as Mpox.

Diterpenes: Nature's Hidden Gems of Immunomodulation

Natural products, especially specific metabolites found in many medicinal plants, exhibit extensive therapeutic potential due to their diverse biological characteristics. Among these compounds, diterpenes stand out for their active principles described in phytochemical studies. Diterpenes exhibit immunomodulatory effects by influencing the production of cytokines and other signaling molecules involved in the immune response. These actions contribute to achieving a more balanced immune profile. The ability to selectively and harmoniously modulate the immune response positions compounds derived from natural products is a promising research field in the development of immunomodulatory therapies. Due to the broad biological activities of diterpenes, the use of molecular docking emerges as a relevant tool for the quantitative screening of a large number of these substances. This review comprehensively examines the pharmacological potential of diterpenes in modulating the immune system. It highlights the existing experimental evidence supporting the efficacy and safety of these compounds as potential treatment for immune dysfunctions. Ultimately, this review aims to contribute to the development of new therapeutic strategies in this field.

Research progress on the molecular mechanisms of Saikosaponin D in various diseases (Review)

Bupleurum, a Traditional Chinese Medicine (TCM) herb, is widely used in China and other Asian countries to manage chronic liver inflammation and viral hepatitis. Saikosaponin D (SSD), a triterpenoid saponin extracted from Bupleurum, exhibits extensive pharmacological properties, including anti‑inflammatory, antioxidant, anti‑apoptotic, anti‑fibrotic and anti‑cancer effects, making it a therapeutic candidate for numerous diseases. Clarifying the targets and molecular mechanisms underlying TCM compounds is essential for scientifically validating TCM's therapeutic roles in disease prevention and treatment, as well as for identifying novel therapeutic targets and lead compounds. This analysis comprehensively examines SSD's mechanisms across various conditions, such as myocardial injury, pulmonary diseases, hepatic disorders, renal pathologies, neurological disorders, diabetes and cancer. In addition, challenges and potential solutions encountered in SSD research are addressed. SSD is posited as a promising monomer for multifaceted therapeutic applications and this article aims to enhance researchers' understanding of the current landscape of SSD studies, offering strategic insights to guide future investigations.

Peripheral Blood CD4+/CD8+ T Cell Ratio Predicts HBsAg Clearance in Inactive HBsAg Carriers Treated with Peginterferon Alpha

Background and Aims

T lymphocytes play a pivotal role in resolving hepatitis B virus infection. This study aimed to investigate the dynamics of peripheral blood T lymphocyte subsets during peginterferon alpha (peg-IFN-α) therapy and their association with hepatitis B surface antigen (HBsAg) clearance in inactive HBsAg carriers (IHCs).

Methods

This prospective observational study enrolled 197 IHCs treated with peg-IFNα-2a/2b for 48 weeks and followed for 24 weeks (treatment group), and 221 IHCs who were regularly monitored for 72 weeks without treatment (IHC control group). Peripheral blood T lymphocyte subsets were evaluated using flow cytometry at baseline, and at 12, 24, 48, and 72 weeks in both groups. At 72 weeks, IHCs in the treatment group were categorized into an HBsAg clearance group and an HBsAg persistence group. Differences in T lymphocyte subsets among these groups were compared, and correlations between T lymphocyte subsets and HBsAg clearance were analyzed.

Results

At 72 weeks, intention-to-treat analysis showed significantly higher HBsAg clearance (46.7%) and seroconversion rates (34.5%) in the treatment group compared to the IHC control group (HBsAg clearance rate of 1.4%, seroconversion rate of 0.9%; both p < 0.001). The median absolute counts of CD3+, CD4+, and CD8+ cells significantly decreased at 12, 24, and 48 weeks in both the HBsAg clearance and persistence groups, returning to baseline at 72 weeks (all p < 0.001). IHCs with HBsAg clearance had higher median percentages of CD3+ CD8+ cells and lower median percentages of CD3+ CD4+ cells and CD4+/CD8+ ratios at 12, 24, and 48 weeks compared to the HBsAg persistence and IHC control groups (all p < 0.001). Baseline HBsAg levels (below 2.0 log10 IU/mL) and hepatitis B virus DNA levels (below 20 IU/mL), alanine aminotransferase elevation at 12 weeks (greater than 2×upper limit of normal), and CD4+/CD8+ ratios (less than 1.5 at 12 weeks and below 1.4 at 24 weeks) were predictive of HBsAg clearance.

Conclusions

Peripheral blood CD4+/CD8+ ratios at 12 and 24 weeks may serve as predictive markers for HBsAg clearance in IHCs treated with peg-IFN-α.

Shared interactions of six neurotropic viruses with 38 human proteins: a computational and literature-based exploration of viral interactions and hijacking of human proteins in neuropsychiatric disorders

INTRODUCTION

Viral infections may disrupt the structural and functional integrity of the nervous system, leading to acute conditions such as encephalitis, and neuropsychiatric conditions as mood disorders, schizophrenia, and neurodegenerative diseases. Investigating viral interactions of human proteins may reveal mechanisms underlying these effects and offer insights for therapeutic interventions. This study explores molecular interactions of virus and human proteins that may be related to neuropsychiatric disorders.

METHODS

Herpes Simplex Virus-1 (HSV-1), Cytomegalovirus (CMV), Epstein-Barr Virus (EBV), Influenza A virus (IAV) (H1N1, H5N1), and Human Immunodeficiency Virus (HIV1&2) were selected as key viruses. Protein structures for each virus were accessed from the Protein Data Bank and analyzed using the HMI-Pred web server to detect interface mimicry between viral and human proteins. The PANTHER classification system was used to categorize viral-human protein interactions based on function and cellular localization.

RESULTS

Energetically favorable viral-human protein interactions were identified for HSV-1 (467), CMV (514), EBV (495), H1N1 (3331), H5N1 (3533), and HIV 1&2 (62425). Besides immune and apoptosis-related pathways, key neurodegenerative pathways, including those associated with Parkinson's and Huntington's diseases, were frequently interacted. A total of 38 human proteins, including calmodulin 2, Ras-related botulinum toxin substrate 1 (Rac1), PDGF-β, and vimentin, were found to interact with all six viruses.

CONCLUSION

The study indicates a substantial number of energetically favorable interactions between human proteins and selected viral proteins, underscoring the complexity and breadth of viral strategies to hijack host cellular mechanisms. Further in vivo and in vitro validation is required to understand the implications of these interactions.

Global burden of colorectal cancer attributable to metabolic risks from 1990 to 2021, with projections of mortality to 2035

BACKGROUND

The global burden of colorectal cancer (CRC) attributable to metabolic risk factors is increasing. It is crucial to analyze the global epidemiological patterns of CRC attributable to metabolic risk factors and predict future trends.

METHODS

Detailed data on CRC mortality and disability-adjusted life years (DALYs) attributable to metabolic risk factors were extracted for this study using data from the Global Burden of Diseases (GBD) 2021 study to assess the burden of CRC from 1990 to 2021 by global, regional, national, and sociodemographic index (SDI) regions and quantify the time trend using the estimated annual percentage change (EAPC). Bayesian age-period-cohort (BAPC) models projected the global mortality from 2022 to 2035.

RESULTS

The global number of CRC deaths due to metabolic risk factors increased from 70,916 in 1990 to 172,993 in 2021, a 2.4-fold increase. CRC mortality and DALYs attributable to high body mass index (BMI) and fasting plasma glucose (FPG) increased significantly at the global level from 1990 to 2021. In 2021, the GBD regions with the highest CRC age-standardized mortality rate (ASMR) due to high BMI and high FPG were in Central Europe. The ASMR of CRC attributable to high BMI and high FPG among males is expected to increase from 2022 to 2035.

CONCLUSION

CRC mortality and DALYs attributable to metabolic factors are increasing. Reducing the burden of CRC due to high BMI and FPG levels is critically needed.

First Report of Hand, Foot, and Mouth Disease (HFMD) Outbreak in the West Bank, Palestine: Molecular Characterization of Coxsackievirus A16 (CV-A16)

Introduction: Hand, foot, and mouth disease (HFMD) is a mild self-limited childhood infectious disease caused by a variety of enteroviruses (EVs). Aim: To investigate the molecular epidemiology of EVs associated with HFMD and their clinical presentation during the HFMD outbreak that occurred in the Jenin district, Palestine, from May to August 2024. Materials and Methods: Forty-four (44) throat and vesicular swabs were tested for enteroviral infections using two RT-PCR assays targeting both the 5'NTR and the VP1-2A regions of the enteroviral genome for the diagnosis and genotyping. Patients' demographic data and clinical history were used to create an epidemiological curve. EpiInfo free software was used to draw a cluster mapping. MEGA-X was used to construct a maximum likelihood (ML) tree. PopArt 1.7 software was used to construct neighbor-joining network. Results: The mean age of the study sample was 2.08 (0.25-12 years) with 95% (42/44) under five years old. The male/female ratio was 0.9. All cases presented with typical HFMD signs and symptoms with variable sites of signs. Of the 44 samples, 36 yield positive RT-PCR targeting the 5'NTR. Seven randomly selected positive RT-PCR-5'NTR samples were sequenced using Sanger sequencing for genotyping. It was shown that all were CV-A16 sub-genogroup B1c. Phylogenetic analysis of VP1-2A region sequences showed that all Palestinian CV-A16 isolates form a pure haplogroup of CV-A16 sub-genotype B1c. Furthermore, although haplotype network analysis showed high variation between the viral sequences, the haplotype analysis supported the ML phylogenetic tree in having them all in one haplogroup. Conclusion: CV-A16, sub-genotype B1c was the virus responsible for the HFMD outbreak in the Jenin district of Palestine in the summer of 2024. Phylogenetic and haplotype analysis showed that CV-A16 strains cluster closely with each other and very close to an Indian isolate (OR437338.1), indicating the monomorphic nature of this strain with low genetic variation and the probability of virus importation.

Potential therapeutic substances for hand-foot-and-mouth disease in the interplay of enteroviruses and type I interferon

OBJECTIVES

Hand-foot-and-mouth disease (HFMD) is widespread in the world. Severe HFMD can lead to complications like pneumonia, encephalitis, myocarditis, transverse myelitis and even death. Since HFMD is caused by at least 20 types of enteroviruses, there is an urgent need for broad-spectrum antiviral drugs to help control the spread of HFMD outbreaks.

METHODS

Type I interferon (IFN), as an indispensable part of the immune response, plays a key role in the inhibition of the enterovirus replication cycle without species specificity, and regulation of the innate immune system by inducing the activation of the IFN-stimulated genes.

CONCLUSIONS

Here, the interplay of enteroviruses and type I IFN was systematically summarized, including pathways for the activation and evasion of type I IFN. Besides, we proposed promising anti-enterovirus agents with therapeutic potential.

Association between maternal smoking during pregnancy and developmental disabilities in US children and adolescents: A cross-sectional study from NHANES

INTRODUCTION

Maternal smoking during pregnancy is associated with placental DNA methylation and RNA expression, offspring DNA methylation, and affects the decline of mature neurons and the prenatal human brain development trajectory.

METHODS

This study is a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) spanning 2003 to 2008, comprising 10111 children and adolescents. Inclusion criteria required participants to have complete questionnaire responses regarding maternal smoking during pregnancy and receipt of special education or early intervention services. The risk of developmental disabilities was assessed using a multifactor logistic regression model.

RESULTS

In the cohort of 10111 children and adolescents, 727 (7.2%) received special education or early intervention services. Of these participants, 1504 (14.9%) were exposed to maternal smoking during pregnancy. The prevalence of maternal smoking was higher (12.3%) in the group receiving special education or early intervention compared to those who did not (6.3%). After adjusting for other relevant factors in a multifactorial logistic regression model, maternal smoking during pregnancy was significantly associated with an increased likelihood of requiring special education or early intervention services (adjusted odds ratio, AOR=1.51; 95% CI: 1.24-1.83, p<0.001).

CONCLUSIONS

This cross-sectional analysis found an association between maternal smoking during pregnancy and the need for special education or early intervention services among US children and adolescents, after adjusting for confounding variables. Our findings suggest that maternal smoking during pregnancy may increase the odds of developmental disabilities.

Role of aspirin in cancer prevention

Aspirin [1], also known as acetylsalicylic acid, is a common non-steroidal anti-inflammatory drug (NSAID). The available evidence shows that aspirin can effectively prevent and treat diseases such as rectal, gastric, ovarian, prostate, and lung cancer. Aspirin has been extensively studied for the prevention and treatment of colorectal cancer. In recent years, studies have found that the potential mechanism of aspirin in the prevention and treatment of cancer may lie in immune regulation, the role of DNA repair pathways, the regulation of cell metabolism, anti-inflammatory effects and antiplatelet effects.

Analysis of longitudinal social media for monitoring symptoms during a pandemic

OBJECTIVE

Current studies leveraging social media data for disease monitoring face challenges like noisy colloquial language and insufficient tracking of user disease progression in longitudinal data settings. This study aims to develop a pipeline for collecting, cleaning, and analyzing large-scale longitudinal social media data for disease monitoring, with a focus on COVID-19 pandemic.

MATERIALS AND METHODS

This pipeline initiates by screening COVID-19 cases from tweets spanning February 1, 2020, to April 30, 2022. Longitudinal data is collected for each patient, two months before and three months after self-reporting. Symptoms are extracted using Name Entity Recognition (NER), followed by denoising with a combination of Graph Convolutional Network (GCN) and Bidirectional Encoder Representations from Transformers (BERT) model to retain only User-experienced Symptom Mentions (USM). Subsequently, symptoms are mapped to standardized medical concepts using the Unified Medical Language System (UMLS). Finally, this study conducts symptom pattern analysis and visualization to illustrate temporal changes in symptom prevalence and co-occurrence.

RESULTS

This study identified 191,096 self-reported COVID-19-positive cases from COVID-19-related tweets and retrospectively collected 811,398,280 historical tweets, of which 2,120,964 contained symptoms information. After denoising, 39 % (832,287) of symptom-sharing tweets reflected user-experienced mentions. The trained USM model achieved an average F1 score of 0.927. Further analysis revealed a higher prevalence of upper respiratory tract symptoms during the Omicron period compared to the Delta and Wild-type periods. Additionally, there was a pronounced co-occurrence of lower respiratory tract and nervous system symptoms in the Wild-type strain and Delta variant.

CONCLUSION

This study established a robust framework for analyzing longitudinal social media data to monitor symptoms during a pandemic. By integrating denoising of user-experienced symptom mentions, our findings reveal the duration of different symptoms over time and by variant within a cohort of nearly 200,000 patients, providing critical insights into symptom trends that are often difficult to capture through traditional data source.

PegIFN alpha-2a reduces relapse in HBeAg-negative patients after nucleo(s)tide analogue cessation: A randomized-controlled trial

BACKGROUND & AIMS

Nucleo(s)tide analogue (NUC) cessation can lead to hepatitis B surface antigen (HBsAg) clearance but also a high rate of virological relapse. However, the effect of pegylated interferon alpha-2a (PegIFN-α-2a) on virological relapse after NUC cessation is unknown. Therefore, this study aimed to evaluate the effect of switching from NUC to PegIFN-α-2a treatment for 48 weeks on virological relapse up to week 96.

METHODS

In this multicenter randomized-controlled clinical trial, 180 non-cirrhotic patients with HBeAg-negative chronic hepatitis B on continuous NUC therapy for ≥2.5 years, with HBV DNA levels <60 IU/ml, were randomized to discontinue NUC therapy (n = 90) or receive 48 weeks of PegIFN-α-2a treatment (n = 90). Patients were followed up for up to 96 weeks. The primary endpoint was the virological relapse rate up to week 96.

RESULTS

Intention-to-treat analysis revealed patients in the interferon monotherapy group had significantly lower cumulative virological relapse rates than the NUC cessation group until week 96 (20.8% vs. 53.6%, p <0.0001). Consistently, a significantly lower proportion of patients in the interferon monotherapy group had virological relapse than those in the NUC cessation group at 48 weeks off treatment (17.8% vs. 36.7%, p = 0.007). The virological relapse rate positively correlated with HBsAg levels in the NUC cessation group. The interferon monotherapy group had a lower cumulative clinical relapse rate (7.8% vs. 20.9%, p = 0.008) and a higher HBsAg loss rate (21.5% vs. 9.0%, p = 0.03) than the NUC cessation group.

CONCLUSIONS

Switching from NUC to PegIFN-α-2a treatment for 48 weeks significantly reduces virological relapse rates and leads to higher HBsAg loss rates than NUC treatment cessation alone in patients with HBeAg-negative chronic hepatitis B.

IMPACT AND IMPLICATIONS

Nucleo(s)tide analogue (NUC) cessation can lead to HBsAg clearance but also a high rate of virological relapse, but an optimized scheme to reduce the virological relapse rate after NUC withdrawal is yet to be reported. This randomized-controlled trial investigated the effect of switching from NUC to PegIFN-α-2a treatment for 48 weeks on virological relapse up to week 96 in patients with HBeAg-negative chronic hepatitis B. The interferon monotherapy group had a significantly lower cumulative virological relapse rate (20.8% vs. 53.6%, p <0.0001) and higher HBsAg loss rate (21.5% vs. 9.0%, p = 0.03) than the NUC cessation group up to week 96. This provides an optimized strategy for NUC cessation in HBeAg-negative patients.

TRIAL REGISTRATION NUMBER

NCT02594293.

Update on the treatment navigation for functional cure of chronic hepatitis B: Expert consensus 2.0

As new evidence emerges, treatment strategies toward the functional cure of chronic hepatitis B are evolving. In 2019, a panel of national hepatologists published a Consensus Statement on the functional cure of chronic hepatitis B. Currently, an international group of hepatologists has been assembled to evaluate research since the publication of the original consensus, and to collaboratively develop the updated statements. The 2.0 Consensus was aimed to update the original consensus with the latest available studies, and provide a comprehensive overview of the current relevant scientific literatures regarding functional cure of hepatitis B, with a particular focus on issues that are not yet fully clarified. These cover the definition of functional cure of hepatitis B, its mechanisms and barriers, the effective strategies and treatment roadmap to achieve this endpoint, in particular new surrogate biomarkers used to measure efficacy or to predict response, and the appropriate approach to pursuing a functional cure in special populations, the development of emerging antivirals and immunomodulators with potential for curing hepatitis B. The statements are primarily intended to offer international guidance for clinicians in their practice to enhance the functional cure rate of chronic hepatitis B.

Global climate change and seasonal variation of cellulitis in hospitalized children: a 30 year retrospective study

Cellulitis, a common subcutaneous infection, is influenced by host, pathogen, and environmental factors. Previous studies have shown seasonal patterns in adult cellulitis, suggesting temperature as a risk factor. This study investigated seasonal patterns in paediatric cellulitis in Jerusalem's semi-arid climate. A single-center retrospective cohort study reviewed medical records of 2,219 hospitalized children under 18 with cellulitis between 1990 and 2020. Demographic, clinical, temperature, and humidity data were collected. Results revealed a significant sinusoidal pattern for limb cellulitis (LC) but for other body sites, with summer peaks and winter nadirs (P < 0.01). August showed the highest incidence, tripling that of February. Age groups 1-6 and 6-12 demonstrated the largest seasonal differences (P = 0.004, P = 0.008). Over three decades, paediatric hospitalized LC cases increased by 71% (P < 0.001), correlating with rising temperatures. Elevated ambient temperature seven days prior to diagnosis was a risk factor for LC development (OR = 1.02, P = 0.03). This study highlights the cyclic seasonal pattern of paediatric LC, peaking in summer. The significant increase in cases over time, coupled with rising temperatures, suggests climate change as a contributing factor. These findings could inform public health strategies for cellulitis prevention and management in children.

Single-cell differential detergent fractionation for detection of cytokeratin 8 proteoforms

Simultaneous profiling of proteoforms and nucleic acids at the single-cell level, i.e., multi omics, directly links the central dogma. However, current single-cell approaches are limited in their ability to identify proteoforms while preserving the nucleus for further analysis. This limitation is especially pronounced in proteins where their proteoforms present diverse biological functions such as cytokeratin 8 (CK8), which, while commonly known for its structural role, is also involved in several diseases. Here, we present a single-cell western blot (scWB) integrated with differential detergent fractionation (DDF) to selectively solubilize and separate CK8 proteoforms while preserving nuclear integrity for subsequent nucleus-based assays. We report on assay development, including screening a panel of lysis buffers based on nonionic detergents and electrophoresis conditions to achieve a separation resolution between two proteoforms of up to 0.94 with an electric field of 30 V/cm, while preserving an intact nucleus. The cytoplasm-specific lysis approach (DDF buffer) demonstrated comparable solubilization efficiency to whole-cell solubilization (RIPA buffer), achieving proteoform solubilization in 14.3% and 10.3% of solubilized cells using DDF and RIPA buffers, respectively, while keeping the nucleus intact. To understand the broad applicability of the assay conditions, we scrutinized electrophoresis performance for resolving CK8 proteoforms across a panel of widely used breast cancer cell lines (MCF7, SKBR3, and MDA-MB-231), showing presence of proteoforms only in MCF7. Our approach allows for tailored solubilization, achieving reliable proteoform detection and nuclear retention across different cell types. Proteoform profiling at the single-cell level forms a basis for the exploration of the role of specific CK8 molecular forms in cellular processes.

1990-2041 Global burden of Burkitt lymphoma with 20 years forecast: A systematic analysis using the global burden disease of study of 2021

Background

To investigate the trends in Burkitt lymphoma incidence, mortality, and disability-adjusted life-years, considering sex and age, from 1990 to 2021, with a 20-year forecast.

Method

Data regarding Burkitt lymphoma were extracted from the Global Burden of Disease study for the year 2021.

Results

Globally, there were 19,072 incident cases of Burkitt lymphoma in 2021. Cases of Burkitt lymphoma experienced a 207% increase from 1990 to 2021. Over three decades, Burkitt lymphoma-associated deaths rose from 3843 to 6525. The global incidence rate of Burkitt lymphoma increased from 0.127 in 1990 to 0.236 in 2021 per 100,000 population. High body-mass indexes contribution to Burkitt lymphoma is evident in the disability-adjusted life-years, with the United States and the United Kingdom recording 0.06 and 0.05, respectively. Conversely, China and India demonstrated substantially lower contributions, at 0.02 and 0.005, respectively. The groups aged 0-14 and 50-74 years surpassed other age groups in both Burkitt lymphoma-associated incidence and death numbers. Moreover, males consistently had higher Burkitt lymphoma-associated mortality rates and numbers than females in all age groups. Furthermore, the estimated annual percentage changes of incidence with Burkitt lymphoma were positively correlated with sociodemographic index (Pearson r = 0.606; p = 0.003). The Bayesian age-period-cohort model predicts a significant increase in the age-standardized incidence rates of Burkitt lymphoma over the next 20 years. Interestingly, the age-standardized rates of death did not change dramatically from 1990 to 2021; and the trend is expected to remain relatively stable in the future 20 years.

Conclusion

The burden of Burkitt lymphoma varies according to different regions and genders, and children of 0-14 years, adults of 50-74 years with Burkitt lymphoma disease as well as male patients need special attention. High body-mass index contributes significantly to Burkitt lymphoma burden in the United States and United Kingdom, but less so in China and India. Hopefully, this study will help optimize the prevention, diagnosis, treatment, and management of Burkitt lymphoma to reduce the disease burden.

TOM40 as a prognostic oncogene for oral squamous cell carcinoma prognosis

BACKGROUND

To investigate the role of the translocase of the outer mitochondrial membrane 40 (TOM40) in oral squamous cell carcinoma (OSCC) with the aim of identifying new biomarkers or potential therapeutic targets.

METHODS

TOM40 expression level in OSCC was evaluated using datasets downloaded from The Cancer Genome Atlas (TCGA), as well as clinical data. The correlation between TOM40 expression level and the clinicopathological parameters and survival were analyzed in TCGA. The signaling pathways associated with TOM40 were identified through gene set enrichment analysis. A network of genes co-expressed with TOM40 was constructed and functionally annotated by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. The immune infiltration pattern in OSCC was analyzed in the TCGA-OSCC cohort using the CIBERSORT algorithm. Clinically significant factors of OSCC were screened through the expression levels of TOM40 and a clinically relevant nomogram was constructed. The TCGA-OSCC cohort was divided into the TOM40high and TOM40low groups and the correlation between TOM40 expression level and the sensitivity to frequently used chemotherapeutic drugs was evaluated. CCK-8 and colony formation assays were applied to determine the cell growth.

RESULTS

TOM40 was highly expressed in OSCC tissues and correlated negatively with the overall survival (P < 0.05). Patients with high TOM40 expression level showed worse prognosis. Furthermore, GO and KEGG enrichment analyses of the differentially expressed genes related to TOM40 showed that these genes are mainly associated with immunity and tumorigenesis. Immunological infiltration analysis has found that the expression levels of TOM40 are correlated with the proportions of several immune cells. Moreover, we found that TOM40 knockdown inhibited cell growth in OSCC cell lines.

CONCLUSIONS

Our results uncovered that TOM40 is a reliable prognostic marker and therapeutic target in OSCC.

Exploring using HBsAg to predict interferon treatment course to achieve clinical cure in chronic hepatitis B patients: a clinical study

Objective

Although pegylated interferon α-2b (PEG-IFN α-2b) therapy for chronic hepatitis B has received increasing attention, determining the optimal treatment course remains challenging. This research aimed to develop an efficient model for predicting interferon (IFN) treatment course.

Methods

Patients with chronic hepatitis B, undergoing PEG-IFN α-2b monotherapy or combined with NAs (Nucleoside Analogs), were recruited from January 2018 to December 2023 at Tianjin Third Central Hospital. All patients achieved hepatitis B surface antigen (HBsAg) clearance post-treatment.

Result

The study enrolled 176 patients with chronic hepatitis B, with the median IFN treatment course of 35.23 ± 25.22 weeks. They were randomly divided into two cohorts in a ratio of 7:3. And there were 123 patients in the training cohort and 53 patients in the validation cohort. Univariable and multivariable analyses demonstrated that baseline HBsAg, 12 weeks HBsAg and the presence of cirrhosis significantly influenced IFN treatment course, and both are risk factors (β=7.27,4.27,10.91; p<0.05). After adjusting for confounding factors, HBsAg remained a significant predictor (β=6.99, 95%CI: 3.59,10.40; p<0.05), which was finally included to establish the model. The actual and predicted values in the validation cohort were highly matched, meanwhile the mean absolute percentage error (MAPE), root mean square error (RMSE) and accuracy (ACC) of the validation cohort were calculated. External validation also suggests that the model can be used as a tool for initial assessment.

Conclusion

Baseline HBsAg in chronic hepatitis B patients were a risk factor for prolonged IFN treatment course with a positive correlation. Ultimately, a personalized model based on baseline HBsAg levels can be established to roughly estimate the duration of interferon therapy prior to treatment initiation, thereby guiding clinical decision-making.

Predictive factors for clinical cure in the treatment of HBeAg(-) chronic hepatitis B or compensated cirrhosis: a prospective observational study

Background

Sequential or combined treatment with nucleos(t)ide analogs (NAs) and pegylated interferon alpha-2b (Peg-IFN-α-2b) can improve the clinical cure rate. However, its clinical application is limited due to the adverse reactions associated with IFN.

Methods

A multi-center prospective observational study was conducted involving 59 NAs-treated chronic hepatitis B (CHB) patients who were treated with a combination therapy of NAs and Peg-IFN-α-2b for 48 weeks. Another 327 NAs-treated patients received NAs monotherapy for 48 weeks. At the end of the treatment, patients were classified into either the clinically cured group or the non-clinically cured group based on clinical efficacy. The study aimed to analyze the clinical cure rate and the predictive factors.

Results

After propensity score matching (PSM), a total of 104 patients were included in the exposure and the control groups. After 48 weeks of treatment, 13 patients in the exposed group achieved clinical cure, with a cure rate of 25%. In contrast, in the control group was 1.92%. The clinical cure rate was greater in the population with CHB or compensated cirrhosis treated with sequential or combined Peg-IFN-α-2b and NAs than in the control group (p < 0.001). Patients treated with Peg-IFN-α-2b were divided into a clinical cure group and a non-clinical cure group for single-factor regression and multi-factor binary logistic regression. The results showed that baseline qHBsAg [relative ratio (RR) = 0.997, 95%CI: [0.995, 0.999], p = 0.031] and △TBiL (RR = 0.698, 95%CI: [0.555, 0.879], p = 0.002) were independent influencing factors for achieving clinical cure in patients with CHB or compensated cirrhosis.

Conclusion

A lower baseline qHBsAg and decrease in TBiL at 24 weeks of treatment are independent influencing factors for achieving clinical cure. The lower the baseline qHBsAg and the higher the △TBiL levels after 24 weeks of treatment, the higher the probability of patients achieving clinical cure.

Predictors of HBsAg seroclearance in HBeAg-negative chronic hepatitis B patients treated with nucleotide analogs plus polyethylene glycol interferon

Introduction

The minority of the chronic hepatitis B (CHB) patients received polyethylene glycol interferon (PEG-IFN) combined with nucleotide analogs (NAs) can obtain hepatitis B surface antigen (HBsAg) clearance.

Methods

In order to find out the advantaged population, we retrospectively collected 122 CHB patients treated with NAs alone or NAs plus PEG-IFN for 48 weeks, who were admitted to Sun Yat-sen Memorial Hospital from 2019 to 2024.

Results

We found HBsAg clearance rate in NAs plus PEG-IFN group was 40.98%, which was significantly higher than that in the NAs group. Thus, NAs plus PEG-IFN therapy served as a relatively ideal regimen and the patients received combined treatment were then incorporated for further analysis for searching efficacy predictors. Through using univariate and multivariate analysis, we confirmed the predictive value of HBsAg, alanine aminotransferase (ALT) at week 24, and ALT change values from baseline to week 24. The area under the receiver operating characteristic (ROC) curve of each indicators ranged from 0.663 to 0.982.

Discussion

In conclusion, our study verified the clinical value of NAs plus PEG-IFN for treating CHB patients. Moreover, for the first time, we found ALT change values from baseline to week 24 (dALT2) could act as a novel independent clinical efficacy predictors in the forementioned population.

Effects of different antiplatelet therapy drugs on platelet activation and platelet-leukocyte aggregate formation in early septic ARDS

BACKGROUND

In patients with sepsis, platelets are activated and adhere to neutrophils, forming platelet-leukocyte aggregates (PLAs) that lead to the development of MODS. ARDS is one of the main manifestations of septic MODS. We designed this study to explore the effects of different anti-plate therapy drugs on platelet activation and platelet-leukocyte aggregate (PLA) formation in the early stage of septic ARDS.

METHODS

Sixty adult male SD rats were randomly divided into: Control group; ARDS group, ARDS + aspirin group, ARDS + clopidogrel group and ARDS + tirofiban group. ARDS was performed via instill lipopolysaccharide (LPS) intratracheally at a dose of 5 mg/kg. Aspirin or clopidogrel were given by gavage immediately after modeling. Tirofiban were given by intraperitoneal injection immediately after modeling. Rats in every group were euthanized by rapid decapitation 6 h after modeling. Platelet activation and PLA were assessed using flow cytometry and immunofluorescence staining. Histology of lung was performed by hematoxylin and eosin staining.

RESULTS

Aspirin, clopidogrel and tirofiban decreased CRP, IL-1 and TNF-α significantly in septic ARDS (P < 0.05). Aspirin, clopidogrel and tirofiban decreased platelet function and ratio of wet/dry significantly in septic ARDS (P < 0.05). Aspirin, clopidogrel and tirofiban increased PaO2 significantly in septic ARDS (P < 0.05). Platelet activation and PLA in the ARDS + aspirin group, ARDS + clopidogrel group and ARDS + tirofiban group decreased significantly compared to the ARDS group (P < 0.05). At 6 h after ARDS operation, obvious histological damage was observed in the lungs. All of these histological changes were quantitatively evaluated using injury scores. Aspirin, clopidogrel and tirofiban reduced the histological damages in ARDS group (P < 0.05).

CONCLUSIONS

Aspirin, clopidogrel and tirofiban alleviated the inflammatory response and pulmonary edema, reduced platelet function, and alleviated hypoxemia in early septic ARDS. Aspirin, clopidogrel and tirofiban reduced platelet activation and PLA formation in early septic ARDS. Aspirin, clopidogrel and tirofiban ultimately alleviated lung injury in early septic ARDS.

Association between composite dietary antioxidant index and Epstein-Barr virus infection in children aged 6-19 years in the United States: from the national health and nutrition examination survey 2007-2010

Objective

Epstein-Barr virus (EBV) is a globally prevalent herpes virus associated with multiple diseases. Oxidative stress is closely related to EBV infection, latency, reactivation, and transformation. Antioxidant diet protects against EBV infection. Composite Dietary Antioxidant Index (CDAI), serving as a key measure of antioxidant intake, is a summary score of six dietary antioxidants, including vitamins A, C, and E, carotenoid, selenium, and zinc. Despite this, the association between CDAI and EBV infection remains uncertain.

Methods

The aim of the study was to evaluate the association between CDAI and EBV infection using cross-sectional data from 3,318 children aged 6-19 years who participated in the American National Health and Nutrition Examination Survey between 2007 and 2010. Data on EBV results, CDAI, and several other essential variables were analyzed.

Results

Compared with that of individuals in Q3 (-1.627--0.2727) in the multivariate weighted logistic regression model with full adjustment for confounding variables, the adjusted odds ratio (OR) for CDAI and EBV infection in those in Q1 (-6.613 - -2.9157), Q2 (-2.9158--1.626), Q4 (-0.2728-1.7601), and Q5 (1.7602-21.419) was 1.41 (95% CI: 1.01-1.96, p = 0.043), 1.10 (95% CI: 0.84-1.45, p = 0.447), 1.14 (95% CI: 0.86-1.51, p = 0.343), and 1.41 (95% CI: 1.01-1.98, p = 0.044), respectively. The association between CDAI and EBV infection showed a U-shaped curve (non-linear; p = 0.002). The OR of reducing EBV infection was 0.882 (95% CI: 0.792-0.982, p = 0.025) in participants with a CDAI of ≤ - 0.81. The OR of developing EBV infection was 1.055 (95% CI: 1.000-1.114, p = 0.050) in participants with a CDAI of > - 0.81.

Conclusion

Our results indicated that the association between CDAI and EBV infection in U.S. adolescents follows a U-shaped curve, with an inflection point around -0.81.This suggests that an antioxidant-rich diet in some amount could help reduce the risk of EBV infection. Future prospective and experimental studies are needed to confirm causality and clarify the exact mechanism concerning antioxidant diets with EBV infection.

Machine learning models to further identify advantaged populations that can achieve functional cure of chronic hepatitis B virus infection after receiving Peg-IFN alpha treatment

OBJECTIVE

Functional cure is currently the highest goal of hepatitis B virus(HBV) treatment.Pegylated interferon(Peg-IFN) alpha is an important drug for this purpose,but even in the hepatitis B e antigen(HBeAg)-negative population,there is still a portion of the population respond poorly to it.Therefore,it is important to explore the influencing factors affecting the response rate of Peg-IFN alpha and establish a prediction model to further identify advantaged populations.

METHODS

We retrospectively analyzed 382 patients.297 patients were in the training set and 85 patients from another hospital were in the test set.The intersect features were extracted from all variables using the recursive feature elimination(RFE) algorithm, Boruta algorithm, and least absolute shrinkage and selection operator(LASSO) regression algorithm in the training dataset.Then,we employed six machine learning(ML) algorithms-Logistic Regression(LR),Random Forest(RF),Support Vector Machines(SVM),K Nearest Neighbors(KNN),Light Gradient Boosting Machine(LightGBM) and Extreme Gradient Boosting(XGBoost)-to develop the model.Internal 10-fold cross-validation helped determine the best-performing model,which was then tested externally.Model performance was assessed using metrics such as area under the curve(AUC) and other metrics.SHapley Additive exPlanations(SHAP) plots were used to interpret variable significance.

RESULTS

138/382(36.13 %) patients achieved functional cure.HBsAg at baseline,HBsAg decline at week12,non-alcoholic fatty liver disease(NAFLD) and age were identified as significant variables.RF performed the best,with AUC value of 0.988,and maintained good performance in test set.The SHapley Additive exPlanations(SHAP) plot highlighted HBsAg at baseline and HBsAg decline at week 12 are the top two predictors.The web-calculator was designed to predict functional cure more conveniently(https://www.xsmartanalysis.com/model/list/predict/model/html?mid = 17054&symbol = 317ad245Hx628ko3uW51).

CONCLUSION

We developed a prediction model,which can be used to not only accurately identifies advantageous populations with Peg-IFN alpha,but also determines whether to continue subsequent Peg-IFN alpha.

Achieving chronic hepatitis B functional cure: Factors and potential mechanisms

Chronic hepatitis B (CHB) is a significant global health issue affecting approximately 254 million individuals worldwide. Achieving the loss of hepatitis B surface antigen (HBsAg), either with or without seroconversion to hepatitis B surface antibody (HBsAb), is regarded as a functional cure and the optimal goal for addressing CHB, and can be achieved through various approaches, including induction with nucleos(t)ide analogues (NAs), induction with pegylated interferon alpha (PegIFNα), and spontaneous clearance of HBsAg. Spontaneous clearance of HBsAg is rare, while NAs can directly inhibit HBV DNA, they are unable to act on covalently closed circular DNA (cccDNA), hence inhibiting HBsAg production or clearing HBsAg is extremely challenging. On the other hand, functional cure based on PegIFNα shows good long-term durability, but over 10 % of patients still experience relapse, mostly within 48 weeks after functional cure. Factors related to CHB functional cure with antiviral therapy are complex, including host factors, viral factors, environmental factors, etc. The integration of HBV DNA into liver cells, persistence of HBV cccDNA, insufficient B cell responses and compromised T cell function pose significant barriers to HBV clearance. Therefore, this study systematically reviewed the relevant factors and potential mechanisms influencing functional cure CHB, which can provide a basis for personalized treatment, help predict treatment outcomes and assess prognosis, and provide theoretical support for the advancement of novel treatment strategies and medications.

A predictive model for functional cure in chronic HBV patients treated with pegylated interferon alpha: a comparative study of multiple algorithms based on clinical data

BACKGROUND

A multivariate predictive model was constructed using baseline and 12-week clinical data to evaluate the rate of clearance of hepatitis B surface antigen (HBsAg) at the 48-week mark in patients diagnosed with chronic hepatitis B who are receiving treatment with pegylated interferon α (PEG-INFα).

METHODS

The study cohort comprised CHB patients who received pegylated interferon treatment at Mengchao Hepatobiliary Hospital, Fujian Medical University, between January 2019 and April 2024. Predictor variables were identified (LASSO), followed by multivariate analysis and logistic regression analysis. Subsequently, predictive models were developed via logistic regression, random forest (RF), gradient boosting decision tree (GBDT), extreme gradient boosting (XGBoost), and support vector machine (SVM) algorithms. The efficacy of these models was assessed through various performance metrics, including the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and F1 score.

RESULTS

This study included a total of 224 individuals diagnosed with chronic hepatitis B. The variables baseline log2(HBsAg), gender, age, neutrophil count at week 12, HBsAg decline rate at week 12, and HBcAb at week 12 were closely associated with functional cure and were included in the predictive model. In the validation term, the logistic regression model had an AUC of 0.858, which was better than that of the other machine learning models (AUC = 0.858,F1 = 0.753). Consequently, this model was selected for the development of the predictive tool.

CONCLUSIONS

The combined use of the baseline log2(HBsAg) value, HBsAg decline rate at week 12, gender, neutrophil count at week 12, and age can serve as a foundational predicting model for anticipating the clearance of HBsAg in individuals with chronic hepatitis B who are receiving PEG-INFα therapy.

Mood instability and risk of gastrointestinal diseases - a univariable and multivariable mendelian randomization study

BACKGROUND

Mood instability, characterized by sudden and unpredictable mood shifts, is prevalent in psychiatric disorders and as a personality trait. Its association with gastrointestinal diseases has been recognized but remains poorly understood in terms of causality.

METHODS

This study aims to investigate the causal relationship between mood instability and a spectrum of gastrointestinal diseases by univariable and multivariable mendelian randomization analysis. The exposure and outcome data were retrieved from the IEU open GWAS database, the UK biobank and the FinnGen study. Instrumental variables were selected to meet relevance, independence, and exclusion restriction criteria. GWAS datasets for mood instability and 28 gastrointestinal diseases were utilized, incorporating diverse populations and genders. Univariable and multivariable Mendelian randomization analyses were conducted using R software. MR statistics from different datasets for the same disease were meta-analyzed to maximize the study population.

RESULTS

In univariable MR analysis, genetic predisposition to mood instability showed significant associations with increased risk for several gastrointestinal diseases, including: gastroesophageal reflux disease, gastric ulcer, acute gastritis, irritable bowel syndrome, internal hemorrhoids, cirrhosis, cholecystitis, cholelithiasis, acute pancreatitis, chronic pancreatitis. In multivariable MR analysis, after adjusting for major depression, bipolar disorder, anxiety disorder, and schizophrenia, associations with the following gastrointestinal diseases remained statistically significant: internal hemorrhoids, cirrhosis, acute pancreatitis, chronic pancreatitis.

CONCLUSION

This study provides compelling evidence for a potential causal relationship between mood instability and certain gastrointestinal diseases underscoring the importance of considering mood instability as a potential risk factor for gastrointestinal diseases as well as the positive role of maintaining mood stability in the prevention of gastrointestinal disorders.

Predictive model for HBsAg clearance rate in chronic hepatitis B patients treated with pegylated interferon α-2b for 48 weeks

BACKGROUND AND AIMS

Chronic hepatitis B (CHB) is a major global health concern. This study aims to investigate the factors influencing hepatitis B surface antigen (HBsAg) clearance in CHB patients treated with pegylated interferon α-2b (Peg-IFNα-2b) for 48 weeks and to establish a predictive model.

METHODS

This analysis is based on the "OASIS" project, a prospective real-world multicenter study in China. We included CHB patients who completed 48 weeks of Peg-IFNα-2b treatment. Patients were randomly assigned to a training set and a validation set in a ratio of approximately 4:1 by spss 26.0, and were divided into clearance and non-clearance groups based on HBsAg status at 48 weeks. Clinical data were analyzed using SPSS 26.0, employing chi-square tests for categorical data and Mann-Whitney U tests for continuous variables. Significant factors (p < 0.05) were incorporated into a binary logistic regression model to identify independent predictors of HBsAg clearance. The predictive model's performance was evaluated using ROC curve analysis.

RESULTS

We included 868 subjects, divided into the clearance group (187 cases) and the non-clearance group (681 cases). They were randomly assigned to a training set (702 cases) and a validation set (166 cases). Key predictors included female gender (OR = 1.879), lower baseline HBsAg levels (OR = 0.371), and cirrhosis (OR = 0.438). The final predictive model was: Logit(P) = 0.92 + Gender (Female) * 0.66 - HBsAg (log) * 0.96 - Cirrhosis * 0.88. ROC analysis showed an AUC of 0.80 for the training set and 0.82 for the validation set, indicating good predictive performance.

CONCLUSION

Gender, baseline HBsAg levels, and cirrhosis are significant predictors of HBsAg clearance in CHB patients after 48 weeks of Peg-IFNα-2b therapy. The developed predictive model demonstrates high accuracy and potential clinical utility.

Comparison of Apixaban and Aspirin in Preventing Portal Vein Thrombosis after Laparoscopic Splenectomy for Cirrhotic Hypersplenism

BACKGROUND

 Portal vein system thrombosis (PVST) is a frequent and possibly fatal concurrent disorder following splenectomy. The optimal anticoagulant to prevent PVST following splenectomy remains unclear.

OBJECTIVES

 The purpose of this study was to compare the safety and efficacy of apixaban versus aspirin in preventing PVST after laparoscopic splenectomy (LS) for cirrhotic hypersplenism.

METHODS

 In this single-center randomized controlled trial, 80 patients with liver cirrhosis who received LS were randomly allocated to two treatment arms that were treated with apixaban or aspirin for 6 months. The primary effectiveness outcome was PVST formation after LS.

RESULTS

 We excluded four patients who withdrew from the study. The dynamic incidence of PVST, main and intrahepatic branches of PVST, and splenic vein thrombosis in the 6 postoperative months were all significantly lower in the apixaban treatment arm compared to the aspirin treatment arm (all P <0.001). Significantly lower incidences of PVST, main and intrahepatic branches of PVST, and splenic vein thrombosis in apixaban treatment arm started from postoperative day 7, month 1, and day 7 compared to the aspirin treatment arm respectively (all P <0.05). Multiple logistic regression analysis revealed that apixaban was an independent protective factor for PVST at postoperative month 3, as compared with aspirin (relative risk, 0.057; 95% confidence interval, 0.013-0.248; P <0.001).

CONCLUSION

 Compared with aspirin, apixaban could earlier and more effectively prevent PVST following LS for cirrhotic hypersplenism. Apixaban can be chosen as a priority treatment option versus aspirin, contributing to a lower risk of PVST.

Safety and efficacy of 48-week pegylated interferon-α-2b therapy in patients with hepatitis B virus-related compensated liver cirrhosis: a pilot observational study

Background

Pegylated interferon-α (PEG-IFN-α) therapy could decrease hepatitis B surface antigen (HBsAg) and improve long-term prognosis of hepatitis B virus (HBV) infection. However, studies on safety and efficacy of PEG-IFN-α for patients with HBV-related cirrhosis are limited.

Methods

This was a single-center study. Fifty-four patients with HBV-related compensated cirrhosis were enrolled. All patients received subcutaneous injection of PEG-IFN-α-2b 180 μg per week for 48 weeks. The monotherapy of PEG-IFN-α-2b was used for treatment-naïve patients, while addition of PEG-IFN-α-2b to on-going nucleos(t)ide analogs (NAs) was used for NAs-experienced patients. Clinical symptoms, laboratory tests, examination indicators, and adverse events were collected at each observational time point.

Results

Forty-two patients achieved undetectable serum HBV DNA at 48 weeks post-therapy. HBsAg level was significantly reduced at 48 weeks post-therapy (227.2 IU/mL vs. 1,668 IU/mL; p < 0.001), especially in NAs-experienced patients (161.0 IU/mL vs. 1,207 IU/mL; p = 0.005). Three patients achieved HBsAg loss, and two of them obtained HBsAg seroconversion. There were no significant differences in liver stiffness measurement, thickness and length of spleen, or diameter of portal vein between baseline and 48 weeks post-therapy (p > 0.05). The aminotransferase levels were increased, while white blood cells, neutrophils, and platelets counts were decreased during PEG-IFN-α-2b therapy (p < 0.05), especially in treatment-naïve patients. Three patients discontinued PEG-IFN-α-2b therapy due to severe adverse events. No patients suffered with virological breakthrough or progressed to end-stage liver diseases during observational period.

Conclusion

A finite course of PEG-IFN-α-2b therapy was well-tolerated, and reduced HBsAg level without accelerating disease progression in patients with HBV-related compensated cirrhosis.

Clinical trial registration

This trial is a part of ZhuFeng Project (ClinicalTrials.gov, identifier NCT04035837).

Molecular Mechanisms of Fibrosis in Cholestatic Liver Diseases and Regenerative Medicine-Based Therapies

The aim of this review is to explore the potential of new regenerative medicine approaches in the treatment of cholestatic liver fibrosis. Cholestatic liver diseases, such as primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and biliary atresia (BA), due to the accumulation of bile, often progress to liver fibrosis, cirrhosis, and liver failure. When the disease becomes severe enough to require liver transplantation. Deeply understanding the disease's progression and fibrosis formation is crucial for better diagnosis and treatment. Current liver fibrosis treatments mainly target the root causes and no direct treatment method in fibrosis itself. Recent advances in regenerative medicine offer a potential approach that may help find the ways to target fibrosis directly, offering hope for improved outcomes. We also summarize, analyze, and discuss the current state and benefits of regenerative medicine therapies such as mesenchymal stem cell (MSC) therapy, induced pluripotent stem cells (iPSCs), and organoid technology, which may help the treatment of cholestatic liver diseases. Focusing on the latest research may reveal new targets and enhance therapeutic efficacy, potentially leading to more effective management and even curative strategies for cholestatic liver diseases.

Caffeic acid phenethyl ester restores mitochondrial homeostasis against peritoneal fibrosis induced by peritoneal dialysis through the AMPK/SIRT1 pathway

Increasing evidence suggests that peritoneal fibrosis induced by peritoneal dialysis (PD) is linked to oxidative stress. However, there are currently no effective interventions for peritoneal fibrosis. In the present study, we explored whether adding caffeic acid phenethyl ester (CAPE) to peritoneal dialysis fluid (PDF) improved peritoneal fibrosis caused by PD and explored the molecular mechanism. We established a peritoneal fibrosis model in Sprague-Dawley rats through intraperitoneal injection of PDF and lipopolysaccharide (LPS). Rats in the PD group showed increased peritoneal thickness, submesothelial collagen deposition, and the expression of TGFβ1 and α-SMA. Adding CAPE to PDF significantly inhibited PD-induced submesothelial thickening, reduced TGFβ1 and α-SMA expression, alleviated peritoneal fibrosis, and improved the peritoneal ultrafiltration function. In vitro, peritoneal mesothelial cells (PMCs) treated with PDF showed inhibition of the AMPK/SIRT1 pathway, mitochondrial membrane potential depolarization, overproduction of mitochondrial reactive oxygen species (ROS), decreased ATP synthesis, and induction of mesothelial-mesenchymal transition (MMT). CAPE activated the AMPK/SIRT1 pathway, thereby inhibiting mitochondrial membrane potential depolarization, reducing mitochondrial ROS generation, and maintaining ATP synthesis. However, the beneficial effects of CAPE were counteracted by an AMPK inhibitor and siSIRT1. Our results suggest that CAPE maintains mitochondrial homeostasis by upregulating the AMPK/SIRT1 pathway, which alleviates oxidative stress and MMT, thereby mitigating the damage to the peritoneal structure and function caused by PD. These findings suggest that adding CAPE to PDF may prevent and treat peritoneal fibrosis.

VIR-2218 (elebsiran) plus pegylated interferon-alfa-2a in participants with chronic hepatitis B virus infection: a phase 2 study

BACKGROUND

Chronic hepatitis B virus (HBV) remains a global concern, with current treatments achieving low rates of HBsAg seroclearance. VIR-2218 (elebsiran), a small interfering RNA agent against HBV transcripts, reduces HBsAg concentrations. We aimed to evaluate the safety and antiviral activity of VIR-2218 with and without pegylated interferon-alpha-2a treatment in participants with chronic HBV.

METHODS

This open-label, phase 2 study was conducted at 23 sites in six countries (New Zealand, Australia, Hong Kong, Thailand, South Korea, and Malaysia). Adults (aged 18-65 years) with chronic HBV infection without cirrhosis and with HBsAg more than 50 IU/mL and HBV DNA less than 90 IU/mL who were on continued nucleoside or nucleotide reverse transcriptase inhibitor (NRTI) therapy for 2 months or longer were eligible. Participants were enrolled into one of six cohorts to receive VIR-2218 200 mg subcutaneously every 4 weeks, with or without 180 μg subcutaneous pegylated interferon-alfa-2a once per week. Cohort 1 received six doses of VIR-2218 (total 20 weeks); cohort 2 received six doses of VIR-2218 starting at day 1, plus 12 doses of pegylated interferon-alfa-2a starting at week 12 (total 24 weeks); cohort 3 received six doses of VIR-2218 and 24 doses of pegylated interferon-alfa-2a (total 24 weeks); cohort 4 received six doses of VIR-2218 and up to 48 doses of pegylated interferon-alfa-2a (total 48 weeks); cohort 5 received up to 13 doses of VIR-2218 and up to 44 doses of pegylated interferon-alfa-2a (total 48 weeks); and cohort 6 received three doses of VIR-2218 and 12 doses of pegylated interferon-alfa-2a (total 12 weeks). The primary endpoints were the incidence of adverse events and clinical assessments (including results of laboratory tests). Secondary endpoints were the mean maximum reduction of serum HBsAg at any timepoint; the proportion of participants with serum HBsAg seroclearance at any timepoint and for more than 6 months after the end of treatment; and the proportion of participants with anti-HBs seroconversion at any timepoint. For patients who were HBeAg-positive, we also assessed the proportion with HBeAg seroclearance or anti-HBe seroconversion at any timepoint. This study is registered with ClinicalTrials.gov, NCT03672188, and is ongoing.

FINDINGS

Between July 2, 2020, and Nov 2, 2021, 124 individuals were screened for eligibility, 84 of whom were enrolled (15 in cohort 1, 15 in cohort 2, 18 in cohort 3, 18 in cohort 4, 13 in cohort 5, and five in cohort 6). Participants were predominantly HBeAg-negative, Asian, and male (66 [79%] participants were male and 18 [21%] were female). Most treatment emergent adverse events were grades 1-2. Three (20%) participants in cohort 1, four (27%) in cohort 2, eight (44%) in cohort 3, seven (39%) in cohort 4, six (46%) in cohort 5, and two (40%) in cohort 6 reported treatment-emergent adverse events related to VIR-2218. 12 (80%) participants in cohort 2, 12 (67%) in cohort 3, 14 (78%) in cohort 4, 13 (100%) in cohort 5, and three (60%) in cohort 6 reported treatment-emergent adverse events related to pegylated interferon-alfa-2a. Two (13%) participants in cohort 1 had elevations in alanine aminotransferase, compared with 13 (87%) participants in cohort 2, 15 (83%) in cohort 3, 17 (94%) in cohort 4, 11 (85%) in cohort 5, and three (60%) in cohort 6. The mean maximum change from baseline at any timepoint in HBsAg concentration was -2·0 log10 IU/mL (95% CI -2·1 to -1·8) in cohort 1, -2·2 log10 IU/mL (-2·5 to -1·8) in cohort 2, -2·5 log10 IU/mL (-2·8 to -2·1) in cohort 3, -2·4 log10 IU/mL (-3·1 to -1·8) in cohort 4, -3·0 log10 IU/mL (-3·7 to -2·3) in cohort 5, and -1·7 log10 IU/mL (-2·1 to -1·4) in cohort 6. 11 participants (one in cohort 2, one in cohort 3, five in cohort 4, and four in cohort 5) receiving VIR-2218 plus pegylated interferon-alfa-2a had HBsAg seroclearance at any timepoint. Of these, ten (91%; one in cohort 2, five in cohort 4, and four in cohort 5) had anti-HBs seropositivity. Six participants (one in cohort 2, three in cohort 4, and two in cohort 5) had sustained HBsAg seroclearance through to 24 weeks after the end of treatment. No participants receiving VIR-2218 monotherapy (cohort 1) or VIR-2218 plus pegylated interferon-alfa-2a 12-week regimen (cohort 6) had HBsAg seroclearance. 12 (42%) of 26 participants (one of four in cohort 1, two of six in cohort 2, four of seven in cohort 3, four of six in cohort 4, and one of three in cohort 5) who were HBeAg positive at baseline had HBeAg seroclearance or anti-HBe seroconversion.

INTERPRETATION

The results of this phase 2 study support further development of VIR-2218 as a potential therapy for patients with chronic HBV infection. Additional clinical trials of VIR-2218 with and without pegylated interferon-alfa-2a in combination with an HBsAg-targeting monoclonal antibody are ongoing.

FUNDING

Vir Biotechnology.

Association of hepatitis B core antibody level and hepatitis B surface antigen clearance in HBeAg-negative patients with chronic hepatitis B

Predicting hepatitis B surface antigen (HBsAg) clearance is important for chronic hepatitis B (CHB) patients receiving pegylated interferon-alfa (Peg-IFN) therapy. We aimed to determine the predictive value of serum hepatitis B core antibody (anti-HBc) for HBsAg clearance. A total of 189 HBeAg-negative CHB patients who received Peg-IFN based therapy were retrospectively included and classified into two groups: nucleos(t)ide analogues (NAs) add-on Peg-IFN group (add-on group, n = 94) and Peg-IFN combined with NAs or Peg-IFN monotherapy group (combination or monotherapy group, n = 95). After 48 weeks of treatment, 27.5% (52/189) and 15.9% (30/189) of patients achieved HBsAg clearance and seroconversion, respectively. Patients in the combination or monotherapy group tended to achieve relatively higher HBsAg clearance (31.6% vs. 23.4%, p = 0.208) and seroconversion (21.1% vs. 10.6%, p = 0.050) rates than those in the add-on group. In combination or monotherapy group, anti-HBc levels at week 12 were lower in patients with HBsAg clearance (9.0 S/CO vs. 9.9 S/CO, p < 0.001) and seroconversion (8.8 S/CO vs. 9.8 S/CO, p < 0.001) than those without. Anti-HBc level at week 12 was an independent predictor of HBsAg clearance and seroconversion. Patients with lower anti-HBc levels at week 12 showed a more significant decline in HBsAg levels during treatment. Combination of anti-HBc at week 12 and baseline HBsAg could identify over 70% of patients who achieved HBsAg clearance after 48 weeks of treatment. In addition to HBsAg, anti-HBc level could be used as a promising marker for selecting HBeAg-negative CHB patients who are more likely to respond to Peg-IFN-based therapy.

Prolonged use of pentoxifylline increases the life expectancy of patients with compensated cirrhosis: A 20‑year retrospective study

Liver cirrhosis is a pathology of varied etiology with a high prevalence and mortality, resulting in >1 million mortalities per year. Patients with liver cirrhosis typically have a survival time of 12 years following diagnosis. The treatment for this disease is directed at the complications of cirrhosis; however, to the best of our knowledge, the long-term management of patients with cirrhosis has been scarcely studied. Pentoxifylline (PTX) is a non-selective phosphodiesterase inhibitor with rheological activity and antioxidant, anti-inflammatory and antifibrotic properties. PTX has been used in the treatment of peripheral arterial disease, inflammatory liver diseases and hepatocellular carcinoma with encouraging results. The aim of the present study was to evaluate the effect of PTX use on the survival of patients with compensated cirrhosis. For this purpose, a cross-sectional study was performed at the Gastroenterology and Hepatitis C Department of Dr. Valentín Gómez Farias Hospital (Institute for Security and Social Services for State Workers, Zapopan, Mexico) from June, 1996 to December, 2019. The follow-up time for these patients was 22.6 years (up to the end of the study period). In the present study, 326 patient files were analyzed and 118 patients with the disease were identified, 81 of whom (68.64%) died within 12 years after diagnosis. Of the included patients, 26 received PTX combined with PEG IFN-α-2a plus ribavirin, and 11 received PTX plus propranolol, with a median treatment duration of 20.6±0.8 years. Furthermore, 16 patients (43%) did not develop co-morbidities within this time, and the transition to decompensated cirrhosis was 16.6 years, with a survival time of 20 years. Therefore, the results of the present study suggest that PTX may improve the long-term survival of patients with compensated cirrhosis, rendering PTX a candidate for repurposing in the treatment of hepatic cirrhosis.

Caffeic acid phenethyl ester ameliorates colistin-induced nephrotoxicity in rats via modulation of FOXO1/Nrf2/Sirt1 axis

BACKGROUND

Colistin (Cst) is one of the antimicrobial peptides and is reserved for use against multi-drug-resistant Gram-negative bacteria. However, the clinical value of Cst is limited by its nephrotoxic adverse effects. Caffeic acid phenethyl ester (CAPE) is a honeybee propolis flavonoid recognised for its diverse pharmacological potential. It has demonstrated d antioxidant and anti-inflammatory properties, as well as protective effects against chemically induced toxicity in variuos biological systems. This study aimed to investigate the impact of CAPE on nephrotoxicity induced in rats by Cst.

METHODS

Animals were randomly divided into five groups. Group 1 served as control, group 2 received CAPE (10 mg/kg) orally, group 3 received Cst IP, group 4 received Cst + CAPE (5 mg/kg) and group 5 received Cst + CAPE (10 mg/kg). All treatments were given daily for 10 consecutive days.

RESULTS

CAPE notably attenuated Cst-inducednephrotoxicity as shown by reducing urea serum levels, creatinine, cystatin C, urinary protein contents and urinary N-acetyl-β-D-glucosaminidase (NAG). This was confirmed by histological investigations that indicated amelioration of histopathological changes in the kidney architecture as well as the deposition of collagen in renal tissues. CAPE exhibited antioxidant effects supported by the prevention of rise in Cst-induced lipid peroxidation and depletion of superoxide dismutase and catalase enzymatic activities. In addition, CAPE inhibited the expression of the inflammatory markers including tumour necrosis factor-α, nuclear factor kappa B and interleukin-6. These actions were associated with modulation of messenger ribonucleic acid (mRNA) expression of Bax and Bcl-2 in favour of anti-apoptosis. CAPE inhibited Cst-induced rise in forkhead box O1 (FOXO1) expression and downregulation of nuclear factor erythroid 2-related factor 2 (Nrf2) and Sirtuin 1 (Sirt1) immune-expression.

CONCLUSION

CAPE protects against nephrotoxicity induced by Cst in ratsprimarily through its antioxidant, antiinflammatory and antiapoptotic activities. These pritective effects are mediated via modulation of FOXO1/Nrf2/Sirt1 axis.

Breastfeeding Beyond Six Months: Evidence of Child Health Benefits

Breastfeeding is globally recognized as the optimal method of infant nutrition, offering health benefits for both the child and the mother, making it a public health priority. However, the potential advantages of breastfeeding extend well beyond initial months. Breast milk adapts to the evolving needs of the growing infant, and its immunological, microbiological, and biochemical properties have been associated with enhanced protection against infections and chronic diseases, improved growth and development, and lower rates of hospitalization and mortality. This review explores the evidence supporting the continuation of breastfeeding beyond six months. More meticulous studies employing consistent methodologies and addressing confounders are essential. This will enable a more accurate determination of the extent and mechanisms of the positive impact of prolonged breastfeeding and allow for the implementation of effective public health strategies.

Sustainable Nanomedicine: Enhancement of Asplatin's Cytotoxicity In Vitro and In Vivo Using Green-Synthesized Zinc Oxide Nanoparticles Formed via Microwave-Assisted and Gambogic Acid-Mediated Processes

Chemoresistance encountered using conventional chemotherapy demands novel treatment approaches. Asplatin (Asp), a novel platinum (IV) prodrug designed to release cisplatin and aspirin in a reductive environment, has demonstrated high cytotoxicity at reduced drug resistance. Herein, we investigated the ability of green-synthesized nanocarriers to enhance Asp's efficacy. Zinc oxide nanoparticles (ZnO-NPs) were synthesized using a green microwave-assisted method with the reducing and capping agent gambogic acid (GA). These nanoparticles were then loaded with Asp, yielding Asp@ZnO-NPs. Transmission electron microscopy was utilized to study the morphological features of ZnO-NPs. Cell viability studies conducted on MDA-MB-231 breast cancer cells demonstrated the ability of the Asp@ZnO-NPs treatment to significantly decrease Asp's half-maximal inhibitory concentration (IC50) (5 ± 1 µg/mL). This was further demonstrated using flow cytometric analysis that revealed the capacity of Asp@ZnO-NPs treatment to significantly increase late apoptotic fractions. Furthermore, in vivo studies carried out using solid Ehrlich carcinoma-bearing mice showed significant tumor volume reduction with the Asp@ZnO-NPs treatment (156.3 ± 7.6 mm3), compared to Asp alone (202.3 ± 8.4 mm3) and untreated controls (342.6 ± 10.3 mm3). The histopathological analysis further demonstrated the increased necrosis in Asp@ZnO-NPs-treated group. This study revealed that Asp@ZnO-NPs, synthesized using an eco-friendly approach, significantly enhanced Asp's anticancer activity, offering a sustainable solution for potent anticancer formulations.

Global, regional, and national burden and trends analysis of malignant neoplasm of bone and articular cartilage from 1990 to 2021: A systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Malignant neoplasm of bone and articular cartilage (MNBAC) is one of the causes of cancer-related deaths worldwide. To date, there is a lack of detailed studies on the disease burden of MNBAC.

METHODS

Data on the incidence, mortality, and disability-adjusted life years (DALYs) of MNBAC from 1990 to 2021 were obtained from the Global Burden of Disease study. We estimated the trends in the burden of MNBAC by calculating the estimated annual percentage change (EAPC) in age-standardized rates by region, country, and social development index.

RESULTS

Globally, the cases of incidence and deaths of MNBAC showed a significant upward trend. In 2021, the global incidence cases of MNBAC were 91,375.1 (73,780.4-102,469.7), and the number of deaths was 66,114.3 (53,305.4-74,466.9). The age-standardized incidence, mortality, and DALYs rates were all on the rise, with EAPCs of 0.59 (0.51 to 0.68), 0.11 (0.02 to 0.21), and 0.08 (0 to 0.17), respectively. In 2021, China had the highest number of incidence cases and deaths. Two peaks in incidence cases and deaths were observed in the 15-19 and 65-69 age groups, with incidence rates and death rates generally increasing with age, and higher in males than females. The region with the highest incidence cases, deaths, and age-standardized incidence rate was East Asia, while Eastern Sub-Saharan Africa had the highest age-standardized mortality, and DALYs rates.

CONCLUSION

From 1990 to 2021, the global burden of MNBAC has continued to increase, particularly in East Asia, which faces the highest number of incidence cases and deaths, while Eastern Sub-Saharan Africa faces the highest ASMR and ASDR. To mitigate this burden, different regions should develop cancer control actions based on their respective epidemiological characteristics, with a focus on the elderly and adolescents, and control of risk factors.