Longterm Outcome of Therapeutic Vaccination with a Third Generation Pre-S/S HBV Vaccine (PreHevbrioR) of Chronically HBV Infected Patients

Several antiviral treatment regimens for chronic hepatitis B (CHB) virus infection have been shown to be effective in suppressing viral load and reducing the risk of hepatocellular injury and its complications. It has been hypothesized that high levels of circulating HBV surface antigen(s) may lead to immune tolerance against HBV and contribute to chronic carriership. Conversely, low-level HBsAg may create a window for the reconstitution of an HBV-specific immune response through vaccination and control of infection. Previous studies in non-responders to yeast-derived HBV vaccines, using a third-generation pre-S/S vaccine, have led to up to 95% anti-HBs seroconversion. This report evaluates the long-term outcome after experimental vaccination with a pre-S/S HBV vaccine intended as a therapeutic intervention in chronic HBV carriers. Four low-level HBsAg carriers (<500 IU/mL) were vaccinated three to seven times with 20 μg PreHevbrioR. Three out of four carriers eliminated HBsAg completely and seroconverted to anti-HBs. One patient seroconverted to anti-HBs but remained with a borderline HBsAg titer (10 IU/mL). Serum anti-HBs levels following repeated vaccination varied between 27 and >1000 IU/L, respectively. Long-term observation (>6 years) showed that after discontinuing NUC treatment for at least two years, HBsAg and HBV DNA remained negative with anti-HBs positive titers ranging between 80 and >1000 IU/L. Based on our preliminary observations, there is a rationale to further evaluate the role of this vaccine as a therapeutic agent.

Long-term follow-up of cats in complete remission after treatment of feline infectious peritonitis with oral GS-441524

OBJECTIVES

Feline infectious peritonitis (FIP), a common disease in cats caused by feline coronavirus (FCoV), is usually fatal once clinical signs appear. Successful treatment of FIP with oral GS-441524 for 84 days was demonstrated recently by this research group. The aim of this study was to evaluate the long-term outcome in these cats.

METHODS

A total of 18 successfully treated cats were followed for up to 1 year after treatment initiation (9 months after completion of the antiviral treatment). Follow-up examinations were performed at 12-week intervals, including physical examination, haematology, serum biochemistry, abdominal and thoracic ultrasound, FCoV ribonucleic acid (RNA) loads in blood and faeces by reverse transciptase-quantitative PCR and anti-FCoV antibody titres by indirect immunofluorescence assay.

RESULTS

Follow-up data were available from 18 cats in week 24, from 15 cats in week 36 and from 14 cats in week 48 (after the start of treatment), respectively. Laboratory parameters remained stable after the end of the treatment, with undetectable blood viral loads (in all but one cat on one occasion). Recurrence of faecal FCoV shedding was detected in five cats. In four cats, an intermediate short-term rise in anti-FCoV antibody titres was detected. In total, 12 cats showed abdominal lymphadenomegaly during the follow-up period; four of them continuously during the treatment and follow-up period. Two cats developed mild neurological signs, compatible with feline hyperaesthesia syndrome, in weeks 36 and 48, respectively; however, FCoV RNA remained undetectable in blood and faeces, and no increase in anti-FCoV antibody titres was observed in these two cats, and the signs resolved.

CONCLUSIONS AND RELEVANCE

Treatment with GS-441524 proved to be effective against FIP in both the short term as well as the long term, with no confirmed relapse during the 1-year follow-up period. Whether delayed neurological signs could be a long-term adverse effect of the treatment or associated with a 'long FIP syndrome' needs to be further evaluated.

How longitudinal observational studies can guide screening strategy for rare diseases

Newborn screening (NBS) is an important secondary prevention program, aiming to shift the paradigm of medicine to the pre-clinical stage of a disease. Starting more than 50 years ago, technical advances, such as tandem mass spectrometry (MS/MS), paved the way to a continuous extension of NBS programs. However, formal evidence of the long-term clinical benefits in large cohorts and cost-effectiveness of extended NBS programs is still scarce. Although published studies confirmed important benefits of NBS programs, it also unraveled a significant number of limitations. These include an incompletely understood natural history and phenotypic diversity of some screened diseases, unreliable early and precise prediction of individual disease severity, uncertainty about case definition, risk stratification, and indication to treat, resulting in a diagnostic and treatment dilemma in individuals with ambiguous screening and confirmatory test results. Interoperable patient registries are multi-purpose tools that could help to close the current knowledge gaps and to inform further optimization of NBS strategy. Standing at the edge of introducing high throughput genetic technologies to NBS programs with the opportunity to massively extend NBS programs and with the risk of aggravating current limitations of NBS programs, it seems overdue to include mandatory long-term follow-up of NBS cohorts into the list of screening principles and to build an international collaborative framework that enables data collection and exchange in a protected environment, integrating the perspectives of patients, families, and the society.

Long-Term Observation of Locomotion of Drosophila Larvae Facilitates Feasibility of Food-Choice Assays

Animal behavior is reflected by locomotor patterns. To decipher the underlying neural circuitry locomotion has to be monitored over often longer time periods. Here a simple adaptation is described to constrain movement of third instar Drosophila larvae to a defined area and use Frustrated total internal reflection based imaging method (FIM) imaging to monitor larval movements up to 1 h. It is demonstrated that the combination of FIM imaging and long analysis periods facilitates the conduction of food choice assays and provides the means to easily quantify food preferences.

Physiological and Psychological Assessments for the Establishment of Evidence-Based Forest Healing Programs

This study aimed to establish a health and medical foundation for forest healing programs and provide a basis for developing an evaluation system for such programs. While the number of visitors to forests and interest in forest healing effects are increasing, few studies have examined the various indicators of the persistent changes in forest healing effects. Therefore, this study conducted pre-, post-, and follow-up experiments on 87 health and clinical indicators in a sample of 88 adolescent participants. The relationships between pre-, post-, and follow-up experiment results for each indicator were analyzed. Of the 87 indicators, 46 showed significant changes, including systolic blood pressure, diastolic blood pressure, cholesterol, serotonin, vitamin D, CD16+CD56 count, interferon-γ, resilience, and self-esteem. The findings are significant for studying diverse participants and indicators and lay the foundation for developing forest healing programs by clarifying aspects such as the indicators suitable for short-term observation versus the indicators requiring long-term observation. Based on these analyses, the results of this study are expected to be useful when conducting research to establish an evidence-based forest healing program in the future.

Siberian plants shift their phenology in response to climate change

Siberia has undergone dramatic climatic changes due to global warming in recent decades. Yet, the ecological responses to these climatic changes are still poorly understood due to a lack of data. Here, we use a unique data set from the Russian 'Chronicles of Nature' network to analyse the long-term (1976-2018) phenological shifts in leaf out, flowering, fruiting and senescence of 67 common Siberian plant species. We find that Siberian boreal forest plants advanced their early season (leaf out and flowering) and mid-season (fruiting) phenology by -2.2, -0.7 and -1.6 days/decade, and delayed the onset of senescence by 1.6 days/decade during this period. These mean values, however, are subject to substantial intraspecific variability, which is partly explained by the plants' growth forms. Trees and shrubs advanced leaf out and flowering (-3.1 and -3.3. days/decade) faster than herbs (-1 day/decade), presumably due to the more direct exposure of leaf and flower buds to ambient air for the woody vegetation. For senescence, we detected a reverse pattern: stronger delays in herbs (2.1 days/decade) than in woody plants (1.0-1.2 days/decade), presumably due to the stronger effects of autumn frosts on the leaves of herbs. Interestingly, the timing of fruiting in all four growth forms advanced at similar paces, from 1.4 days/decade in shrubs to 1.7 days/decade in trees and herbs. Our findings point to a strong, yet heterogeneous, response of Siberian plant phenology to recent global warming. Furthermore, the results highlight that species- and growth form-specific differences among study species could be used to identify plants particularly at risk of decline due to their low adaptive capacity or a loss of synchronization with important interaction partners.

The performance of heparin modified poly(ε-caprolactone) small diameter tissue engineering vascular graft in canine-A long-term pilot experiment in vivo

Long-term in vivo observation in large animal model is critical for evaluating the potential of small diameter tissue engineering vascular graft (SDTEVG) in clinical application, but is rarely reported. In this study, a SDTEVG is fabricated by the electrospinning of poly(ε-caprolactone) and subsequent heparin modification. SDTEVG is implanted into canine's abdominal aorta for 511 days in order to investigate its clinical feasibility. An active and robust remodeling process was characterized by a confluent endothelium, macrophage infiltrate, extracellular matrix deposition and remodeling on the explanted graft. The immunohistochemical and immunofluorescence analysis further exhibit the regeneration of endothelium and smooth muscle layer on tunica intima and tunica media, respectively. Thus, long-term follow-up reveals viable neovessel formation beyond graft degradation. Furthermore, the von Kossa staining exhibits no occurrence of calcification. However, although no TEVG failure or rupture happens during the follow-up, the aneurysm is found by both Doppler ultrasonic and gross observation. Consequently, as-prepared TEVG shows promising potential in vascular tissue engineering if it can be appropriately strengthened to prevent the occurrence of aneurysm.

Long-term safety and efficacy of emicizumab for up to 5.8 years and patients' perceptions of symptoms and daily life: A phase 1/2 study in patients with severe haemophilia A

Introduction

Safety and efficacy results of the phase 1 study and phase 1/2 extension study of the bispecific antibody emicizumab in patients with severe haemophilia A with or without factor VIII inhibitors for up to 2.8 years were reported previously.

Aim

To evaluate further longer‐term data including patients’ perceptions at study completion.

Methods

Emicizumab was administered subcutaneously once weekly at maintenance doses of 0.3, 1 or 3 mg/kg with potential up‐titration. All patients were later switched to the approved maintenance dose of 1.5 mg/kg.

Results

Eighteen patients received emicizumab for up to 5.8 years. Most adverse events were mild and unrelated to emicizumab. Annualized bleeding rates (ABRs) for bleeds treated with coagulation factors decreased from pre‐emicizumab rates or remained zero in all patients. The median ABRs were low at 1.25, 0.83 and 0.22 during the 0.3, 1 and 3 mg/kg dosing periods, respectively. Of 8 patients who decreased their doses from 3 to 1.5 mg/kg, ABRs decreased in 4, remained at zero in 2, and increased in 2. Total time spent with symptoms associated with treated bleeds decreased in all patients except 2. All patients answered ‘improved’ for bleeding severity and time until bleeding stops, except 1 answering ‘slightly improved’. Most patients answered ‘improved’ or ‘slightly improved’’ for daily life and feelings; in particular, all patients except 1 answered ‘improved’ or ‘slightly improved’ for anxiety.

Conclusions

Long‐term emicizumab prophylaxis for up to 5.8 years was safe and efficacious, and may improve patients’ daily lives and feelings, regardless of inhibitor status.

Severe multiple rabid dog bite injuries in a child in central China: Continuous 10-year observation and analysis on this case

Dog bites are common in rural areas of underdeveloped countries or regions, affecting persons of different ages. Suspected rabid dog bites will lead to more severe outcomes, especially in children because injuries often occur on their heads and faces that are highly innervated parts of the body. In such circumstances, immediate and complete post-exposure prophylaxis (PEP) will be essential, though vaccine hesitancy is a problem. Herein, we report a 4-y-old girl who was seriously bitten by a confirmed rabid dog in rural China. Multiple lacerations and punctures distributed on her head, neck, face, extremities, and back after being bitten. It was in question that surgery or PEP should be performed in priority when the dog was not confirmed rabid at first, but considering the risks of rabies, immediate PEP was provided to her, along with immunogenicity tests to ensure an adequate protective immune response. Because of the severity of her injuries, medical practitioners suggested her parents to bring her to take immunogenicity tests in 1-, 5-, and 10-y intervals to ensure adequate rabies virus-neutralizing antibodies (RVNA) titers. Her parents had a good preference for medical advices, and in the 10-y interval, it was found that her RVNA titer was below protection level, so a booster vaccination was given to her, and 14 d after that, according to immunogenicity test, RVNA titer arose quickly above the protection level.

100 yr of primary succession highlights stochasticity and competition driving community establishment and stability

The study of community succession is one of the oldest pursuits in ecology. Challenges remain in terms of evaluating the predictability of succession and the reliability of the chronosequence methods typically used to study community development. The research of William S. Cooper in Glacier Bay National Park is an early and well-known example of successional ecology that provides a long-term observational data set to test hypotheses derived from space-for-time substitutions. It also provides a unique opportunity to explore the importance of historical contingencies and as an example of a revitalized historical study system. We test the textbook successional trajectory in Glacier Bay and evaluate long-term plant community development via primary succession through extensive fieldwork, remote sensing, dendrochronological methods, and newly discovered data that fills in data gaps (1940s to late 1980s) in continuous measurement over 100+ years. To date, Cooper's quadrats do not support the classic facilitation model of succession in which a sequence of species interacts to form predictable successional trajectories. Rather, stochastic early community assembly and subsequent inhibition have dominated; most species arrived shortly after deglaciation and have remained stable for 50+ years. Chronosequence studies assuming prior composition are thus questionable, as no predictable species sequence or timeline was observed. This underscores the significance of assumptions about early conditions in chronosequences and the need to defend such assumptions. Furthermore, this work brings a classic study system in ecology up to date via a plot size expansion, new baseline biogeochemical data, and spatial mapping for future researchers for its second century of observation.

Efficacy of long-term treatment with efinaconazole 10% solution in patients with onychomycosis, including severe cases: A multicenter, single-arm study

We evaluated the efficacy of efinaconazole 10% topical solution in long‐term use, for up to 72 weeks, for onychomycosis, including severe cases. Among 605 participants, 219 patients diagnosed as having onychomycosis were evaluated for the efficacy of efinaconazole. The treatment success rate (<10% clinical involvement of the target toenail) at the final assessment time point was 56.6%, the complete cure rate was 31.1% and the mycological cure rate was 61.6%, all of which increased over time, demonstrating that continuous application contributed to the improvement of cure rate. Even in severe cases, reduction of the affected nail area was observed, showing the potential efficacy of the treatment. Responses to a quality of life questionnaire among patients with onychomycosis, OnyCOE‐t, suggested that efinaconazole treatment improved the patients’ quality of life. The incidence of adverse drug reaction in the patients eligible for the assessment was 6.3%, and this developed only in the administration site in all cases. No systemic adverse event was observed. In addition, no increase in the incidence of adverse drug reaction due to long‐term use was found. Efinaconazole therapy was proved to exhibit excellent balance between efficacy and safety, and thus may serve as a useful treatment option for onychomycosis.

Spontaneous closure of traumatic tympanic membrane perforation following long-term observation

BACKGROUND

Traumatic tympanic membrane perforation (TTMP) is usually managed conservatively because most close spontaneously within a few months. Nevertheless, spontaneous closure of TTMP during long-term observation has not been well described in the literature.

OBJECTIVES

The present study investigated factors associated with spontaneous closure of TTMP, and the characteristics of cases exhibiting spontaneous closure following long-term observation.

MATERIALS AND METHODS

The medical records of 40 patients with TTMP who visited the authors' hospital were retrospectively reviewed.

RESULTS

Spontaneous closure was observed in 27 (67.5%) patients. The healing period was <2 weeks in 6 cases, <4 weeks in 9, <3 months in 5, <6 months in 3, and ≥6 months in 4. All four cases in which spontaneous closure took ≥6 months exhibited a sign of spontaneous closure at 6 months following injury. Perforation in contact with the malleus was associated with a lower frequency of spontaneous closure.

CONCLUSIONS AND SIGNIFICANCE

In TTMP, surgery should be considered in patients who exhibit perforation in contact with the malleus. However, it has also been suggested that long-term observation may be a viable treatment option when a sign of spontaneous closure is observed within 6 months following injury.

[Social adaptation of patients with organic mental disorders in childhood: the results of the long-term study]

AIM

To analyze the clinical and social outcomes of organic mental disorders (OMD), diagnosed in children and teens; establish the factors that are relevant for the formation of the clinical picture of OMD in different sexes; the circumstances that determine the dynamics of remote OMD and the level of social adaptation of patients in adulthood.

MATERIAL AND METHODS

Four hundred and ninety-eight children with organic mental disorders were followed-up in one of neuropsychiatric outpatient clinics of Moscow, until they reached 23-25 years of age. The total duration of observation was from 7.5 to 22 years (M±σ: 17.3±3.5 years). Clinical-psychopathological and follow-up methods were used. To assess social functioning of patients, a form for recording social skills of adolescents and a questionnaire for assessment of social functioning and quality of life were used.

RESULTS AND CONCLUSION

In 82% of patients, OMD reduced by the time of adulthood. Disorders with severe intellectual impairment, paroxysmal disorders, psychopathic syndrome, mixed forms of the disease were the causes of a lifelong disability in 3.6% of cases.

Long-term outcome of chronic hepatitis C virus infection in a real-world setting: The German LOTOS study

BACKGROUND & AIMS

There are few large-scale, prospective studies comparing liver-associated events in treated and untreated patients with CHC managed in routine clinical practice.

METHODS

Patients with CHC were prospectively enrolled in a non-interventional study. Data from patients with available documentation who had either achieved a sustained virological response, or were non-responders, relapsers, or had virological breakthrough following treatment with peginterferon alfa-2a±ribavirin, or who had been diagnosed but never treated at least 3 years previously, and who remained under medical observation were analyzed. Primary endpoint was liver-associated events (composite of decompensation/liver failure, ascites, hepatocellular carcinoma, or liver transplant/placement on a transplant list).

RESULTS

In all, 1444 eligible patients were identified. Mean follow-up was 4.7 (standard deviation; SD 1.1) years. Patients with sustained virological response had a lower incidence of liver-associated events vs non-responders, relapsers, or virological breakthrough and never treated patients (1.7% vs 4.7% and 4.7% respectively). The proportion of patients with cirrhosis increased from baseline in the non-responders, relapsers, or virological breakthrough (6.8%-10.5%) and never treated group (3.7%-8.4%), with an associated increase in severity, but was unchanged in the sustained virological response group (2.1%). Event-free survival was significantly higher in sustained virological response patients (P=.0082).

CONCLUSIONS

In this "real-world" cohort, the achievement of sustained virological response almost eliminated liver-related morbidity and mortality compared with patients who failed to achieve sustained virological response and those who were untreated. Overall, the LOTOS cohort highlights the importance of timely and effective treatment for patients with CHC.

Spirometry: a predictor of lung cancer among asbestos workers

OBJECTIVE

The significance of lung function as an independent risk factor for lung cancer remains unclear. The objective of the study is to answer the question if spirometry can identify patients at risk for lung cancer among people occupationally exposed to asbestos dust in the past.

METHODS

In order to identify a group of individuals with the highest risk of lung cancer incidence based on lung function levels of FEV₁% predicted value, we examined 6882 subjects enrolled in the health surveillance program for asbestos related diseases over the years 2000-2014. We found a total of 110 cases confirmed as primary lung cancer.

RESULTS

Using Cox's proportional hazards model after adjustment for age, gender, number of cigarettes, duration of smoking and cumulative asbestos exposure, we estimated that compared with the subjects with FEV₁ ≥90% pred, the HR of lung cancer was 1.40 (95%CI: 0.94-2.08) for the subjects with FEV₁ less than 90% and 1.95 (HR = 1.86; 95%CI: 1.12-3.08) for those with FEV₁ less than 70%. In addition, probability of the occurrence of lung cancer for FEV₁ <90% of the predicted value was HR = 2.19 (95%CI: 1.04-4.61) in the subjects whose time since spirometry and cancer diagnosis was three years or less.

CONCLUSIONS

The results strongly support the hypothesis that spirometry can identify patients at a risk of lung cancer development. Regular spirometry should be offered to all patients with a history of asbestos exposure, at least once every three years.

Convergent ecosystem responses to 23-year ambient and manipulated warming link advancing snowmelt and shrub encroachment to transient and long-term climate-soil carbon feedback

Ecosystem responses to climate change can exert positive or negative feedbacks on climate, mediated in part by slow-moving factors such as shifts in vegetation community composition. Long-term experimental manipulations can be used to examine such ecosystem responses, but they also present another opportunity: inferring the extent to which contemporary climate change is responsible for slow changes in ecosystems under ambient conditions. Here, using 23 years of data, we document a shift from nonwoody to woody vegetation and a loss of soil carbon in ambient plots and show that these changes track previously shown similar but faster changes under experimental warming. This allows us to infer that climate change is the cause of the observed shifts in ambient vegetation and soil carbon and that the vegetation responses mediate the observed changes in soil carbon. Our findings demonstrate the realism of an experimental manipulation, allow attribution of a climate cause to observed ambient ecosystem changes, and demonstrate how a combination of long-term study of ambient and experimental responses to warming can identify mechanistic drivers needed for realistic predictions of the conditions under which ecosystems are likely to become carbon sources or sinks over varying timescales.