Donor genetic variants as risk factors for thrombosis after liver transplantation: A genome-wide association study

Thrombosis after liver transplantation substantially impairs graft- and patient survival. Inevitably, heritable disorders of coagulation originating in the donor liver are transmitted by transplantation. We hypothesized that genetic variants in donor thrombophilia genes are associated with increased risk of posttransplant thrombosis. We genotyped 775 donors for adult recipients and 310 donors for pediatric recipients transplanted between 1993 and 2018. We determined the association between known donor thrombophilia gene variants and recipient posttransplant thrombosis. In addition, we performed a genome-wide association study (GWAS) and meta-analyzed 1085 liver transplantations. In our donor cohort, known thrombosis risk loci were not associated with posttransplant thrombosis, suggesting that it is unnecessary to exclude liver donors based on thrombosis-susceptible polymorphisms. By performing a meta-GWAS from children and adults, we identified 280 variants in 55 loci at suggestive genetic significance threshold. Downstream prioritization strategies identified biologically plausible candidate genes, among which were AK4 (rs11208611-T, p = 4.22 × 10⁻⁰⁵) which encodes a protein that regulates cellular ATP levels and concurrent activation of AMPK and mTOR, and RGS5 (rs10917696-C, p = 2.62 × 10⁻⁰⁵) which is involved in vascular development. We provide evidence that common genetic variants in the donor, but not previously known thrombophilia-related variants, are associated with increased risk of thrombosis after liver transplantation.     

A framework for considering the risk‐benefit trade‐off in designing noninferiority trials using composite outcome approaches

When a new treatment regimen is expected to have comparable or slightly worse efficacy to that of the control regimen but has benefits in other domains such as safety and tolerability, a noninferiority (NI) trial may be appropriate but is fraught with difficulty in justifying an acceptable NI margin that is based on both clinical and statistical input. To overcome this, we propose to utilize composite risk‐benefit outcomes that combine elements from domains of importance (eg, efficacy, safety, and tolerability). The composite outcome itself may be analyzed using a superiority framework, or it can be used as a tool at the design stage of a NI trial for selecting an NI margin for efficacy that balances changes in risks and benefits. In the latter case, the choice of NI margin may be based on a novel quantity called the maximum allowable decrease in efficacy (MADE), defined as the marginal difference in efficacy between arms that would yield a null treatment effect for the composite outcome given an assumed distribution for the composite outcome. We observe that MADE: (1) is larger when the safety improvement for the experimental arm is larger, (2) depends on the association between the efficacy and safety outcomes, and (3) depends on the control arm efficacy rate. We use a numerical example for power comparisons between a superiority test for the composite outcome vs a noninferiority test for efficacy using the MADE as the NI margin, and apply the methods to a TB treatment trial.     

Development of a composite indicator to prioritize districts for implementation of human immunodeficiency virus programmes in Maharashtra,India

A key recommendation of the National AIDS Control Programme‐IV of India was to develop new strategies for geo‐prioritization of the human immunodeficiency virus (HIV) epidemic. We conducted this study to categorize the districts in Maharashtra (India) based on a multidimensional framework for geo‐prioritization of services. Programmatic data on trends of HIV prevalence, coverage of marginalized populations and vulnerability factors were included. A composite indicator based on these was developed, and the cumulative score was calculated for each district. HIV prevalence among general population has declined steadily from 0.60% in 2007 to 0.33% in 2017. The programme coverage was stable but inadequate for men who have sex with men (MSM). The coverage for female sex workers (FSWs) was inadequate and reduced over time. Nine districts were categorized as high priority, 13 as moderate priority and 11 were classified as low‐priority districts based on burden and vulnerability for HIV. The high‐priority districts were Pune, Solapur and Yavatmal for FSW interventions and Pune, Thane and Latur for MSM interventions. This multidimensional indicator is based on existing programmatic data, dynamic and can be made state‐specific. It is useful to categorize and prioritize districts for allocation of resources and geo‐prioritization of services in resource limited settings.     

阿奇霉素-离子交换树脂复合物的制备及其掩味与调控释药作用

为掩盖阿奇霉素(azithromycin,AZI)苦味和个性化调控药物释放速度以减少胃肠道刺激,分别以羟丙基纤维素(hydroxypropyl cellulose,HPC)和尤特奇RS100修饰制备速释型AZI-Amberlite^TM IRP64/HPC和缓释型AZI-Amberlite^TM IRP69/RS100进而组合以实现控制释放。对AZI-离子交换树脂复合物的载药量、药物利用率进行测定,通过差示扫描量热分析和X射线衍射对AZI-离子交换树脂复合物进行结构表征,测定其润湿度、掩味效果、体外溶出和释放行为。结果显示,形成的AZI-离子交换树脂复合物改变了药物原有的结晶状态,2.5%HPC修饰的AZI-Amberlite^TM IRP64/HPC和0.5%RS100修饰的AZI-Amberlite^TM IRP69/RS100掩味效果良好,两者以对应AZI含量为13∶67的比例组合可以实现AZI在前10 min的快速释放和后期的6 h内平稳释药。结果表明,经表面修饰制得的AZI-离子交换树脂复合物及其...     

山楂中总黄酮几种提取分离方法的考察及含量测定

目的 考察几种提取方法对山楂果中总黄酮含量的影响。方法 采用不同的提取方法获得山楂浸膏,经大孔吸附树脂分离提取有效成分。结果 以甲醇为溶剂,用索氏提取器提取经大孔吸附树脂分离,提取效率最高（2.00%）;以60％乙醇为溶剂,超声提取经大孔吸附树脂分离,提取效率较高（1.96%）。结论 以60％乙醇为溶剂,超声提取,经大孔吸附树脂分离,提取效率较高,且方法简便易行,适于大规模生产。     

甲基酚烯酸酯树脂的热裂解机理

研究了以甲基丙烯酸酯端基不饱和取酯树脂为主链,用甲基丙烯酸甲酯取代苯乙烯作为交联剂制成的甲基丙烯酸酯树脂（ＭＡＥＲ）与通用型不饱和聚酯树脂（ＧＵＰＲ）的热裂解机理、燃烧现象。结果表明：ＭＡＥＲ的裂角产物中苯环化合物含量（１４．９％）少于ＧＵＰＲ（７４．５％）。ＭＡＥＲ燃烧时的发烟量和毒性也远低于ＧＵＰＲ。在ＭＡＥＲ中加入三水合氧化铝（ＡＴＨ）后,裂解产物中有毒物质的各类和数量更少,在燃烧时只有少量     

电化法研究壳聚糖树脂与游离酸的相互作用

利用电化学实验技术跟踪交联壳聚糖树脂吸附低浓度游离酸的行为,讨论了不同盐酸浓度和不同甲醇浓度两种因素对吸附的影响,并利用固液相互作用方程,求取吸附剂－吸附质相互作用能。实验结果表明,交联壳聚糖树脂吸附低浓度游离酸的过程是遵循单分子 机制进行的。     

曲马多药树脂速释混悬剂的研制

为掩盖盐酸曲马多的苦味 ,并达到迅速镇痛的目的 ,利用盐酸曲马多与离子交换树脂结合制成药物树脂的制备方法 ,进行了曲马多药树脂速释混悬剂的研制实验。实验结果表明 ,该制备方法简单 ,研制出的曲马多药树脂速释混悬剂稳定、口味好、释放迅速     

Measuring quality of life from the point of view of HIV-positive subjects: the HIV-QL31

Assessment of the quality of life (QoL) of human immunodeficiency virus (HIV)-infected subjects is often based on questionnaires in which the items or questions are not seen to be relevant by patients, nor by the users of the data obtained. It therefore seemed appropriate to return to the issue. The methodological and bibliographical research as well as the consultations we conducted convinced us that the elaboration of a new questionnaire was both necessary and possible. In order to do so, we adopted methodological principles based on the Sickness Impact Profile development methodology. First a bibliographical research was conducted in order to study instruments already used for HIV infection. Then, experts concerned with HIV infection and members of patients' associations were interviewed to assess how opportune the development of a new instrument could be. Following this, a methodology was established for the design and construction of the new instrument. One hundred and eighteen candidate questions were generated from an analysis of the content of 20 patients' interviews, which were subsequently submitted to 102 patients, to obtain finally a set of 31 questions from the interpretation of the results obtained from classic psychometric analysis and also from non-classic methods (item response theory and Rasch model). The concept being measured is the impact of illness being experienced by HIV-infected subjects from their own perspective. The range of health states covered by this questionnaire relates to fairly mild conditions. Rasch analysis of this set of 31 questions (HIV-QL31) shows that it corresponds to one unidimensional construct. A single score can be calculated by simple summation of dichotomous response options. This score is highly reliable (Cronbach's coefficient = 0.93) and is also discriminant regarding the severity of clinical status.