Viral hepatitis: Past,present, and future

Each hepatitis virus—Hepatitis A, B, C, D, E, and G—poses a distinct scenario to the patient and clinician alike. Since the discovery of each virus, extensive knowledge regarding epidemiology, virologic properties, and the natural clinical and immunologic history of acute and chronic infections has been generated. Basic discoveries about host immunologic responses to acute and chronic viral infections, combined with virologic data, has led to vaccines to prevent Hepatitis A, B, and E and highly efficacious antivirals for Hepatitis B and C. These therapeutic breakthroughs are transforming the fields of hepatology, transplant medicine in general, and public and global health. Most notably, there is even an ambitious global effort to eliminate chronic viral hepatitis within the next decade. While attainable, there are many barriers to this goal that are being actively investigated in basic and clinical labs on the local, national, and international scales. Herein, we discuss pertinent clinical information and recent organizational guidelines for each of the individual hepatitis viruses while also synthesizing this information with the latest research to focus on exciting future directions for each virus.     

脾脏ARFI弹性联合血小板计数预测乙肝肝硬化食管静脉曲张的价值

目的 本研究应用声辐射力脉冲成像(Acoustic Radiation Force Impulse ARFI)技术对慢性乙型肝炎肝硬化患者进行脾脏弹性检测和分析,探讨和对比脾脏ARFI弹性及脾脏ARFI弹性联合血小板计数(Platelet Count PC)在预测乙肝肝硬化食道静脉曲张的临床应用价值。方法 对232例慢性乙型肝炎肝硬化患者应用ARFI技术检测脾脏实时超声弹性,并测量PC,所有患者均于检测前后一周内行胃镜检查明确食管静脉曲张情况,以胃镜结果为金标准,应用受试者工作特征(receiver operating characteristic, ROC)曲线比较脾脏ARFI弹性、PC、及脾ARFI弹性联合PC诊断肝硬化食管静脉曲张的临床价值。结果 食道静脉曲张组脾脏ARFI弹性和PC分别为3.52(3.16-3.87)m/s 和62(41-88.25),无食道静脉曲张组脾脏ARFI弹性和PC分别为2.91(2.35-3.35)m/s和129.5(87.25-196.25)。脾脏ARFI弹性和PC在两组间比较的差异均具有统计学意义(P＜0.001 )。单独脾脏ARFI弹性及脾脏ARFI弹性联合PC的ROC曲线下面积分别为0.76和0.83,差异具有统计学意义(P = 0.0021)。结论 脾脏ARFI弹性测值联合PC较单纯脾脏ARFI弹性能更准确的无创预测慢性乙型肝炎肝硬化食管静脉曲张的存在,具有良好的临床应用前景。     

2011—2020年平顶山市 乙型病毒性肝炎流行病学特征分析 时空分布特征及与性别、年龄变化情况

[摘要]　目的　分析河南省平顶山市2011—2020年乙型病毒性肝炎（乙肝）流行病学特征，为调整本市的乙肝防控策略和措施提供科学依据。方法?通过中国疾病预防控制信息系统收集网络直报的平顶山市2011—2020年乙肝病例数据，采用描述性流行病学方法进行分析。结果?2011—2020年平顶山市共报告27 078例乙肝病例，年平均发病率为67.47/10万，2016—2020年期间的年平均发病率（36.95/10万）较2011—2015年期间（98.46/10万）明显下降（χ2=5628.949，P=0.000）；急、慢性乙肝发病率分别为8.50/10万和57.88/10万；0～14岁以下儿童年平均发病率最低，为2.89/10万，随着年龄的增长，乙肝报告发病率呈现逐渐增高的趋势（χ2趋势=4644.258，P=0.000）；男性年平均发病率（71.21/10万）高于女性（63.44/10万）（χ2=89.803，P=0.000）；2016—2020年间发病率居前3位的分别为宝丰县（58.40/10万）、舞钢市（57.83/10万）、石龙区（56.50/10万），均为城郊地区。结论?平顶山市2011—2020年乙肝报告发病率呈下降趋势，尤以0～14岁以下儿童发病率较低。建议进一步加强成人乙肝防控工作，并重点加强宝丰县和舞钢市等高风险地区的防控工作。     

The impact of the COVID-19 pandemic on hepatitis B virus vaccination and transmission among men who have sex with men: A mathematical modelling study

BackgroundDuring the COVID-19 pandemic, the number of hepatitis B virus (HBV) vaccinations among men who have sex with men (MSM) has been considerably lower than before the pandemic. Moreover, less frequent HBV testing and a reduction in numbers of sex partners have been reported. We assessed the impact of these COVID-19-related changes on HBV transmission among MSM in the Netherlands.MethodsWe estimated the changes in sexual activity, HBV testing, and HBV vaccination among MSM during the pandemic from Dutch data. We used a deterministic compartmental model and investigated scenarios with small or large declines in sexual activity, testing, and vaccination for the current phase of the pandemic (without available data). We examined the increase in HBV vaccinations needed to prevent further increase in HBV incidence.ResultsWith a decrease in numbers of sex partners of 15–25% during the first lockdown and 5% during the second lockdown, we found a decline of 6.6% in HBV incidence in 2020, despite a >70% reduction in HBV testing and vaccination during the first lockdown. With numbers of sex partners rebounding close to pre-pandemic level in 2021, and a reduction of 15% in testing and 30% in vaccination in 2021, we found an increase of 1.4% in incidence in 2021 and 3.1% in 2026. With these changes, an increase of ≥60% in HBV vaccinations in 2022 would be needed to bring the HBV incidence in 2023 back to the level that it would have had if the COVID-19-related changes had not occurred.ConclusionsDespite reductions in sexual activity during the COVID-19 pandemic, the decrease in HBV vaccinations may result in a small increase in HBV incidence after 2021, which may persist for years. It is important to restore the vaccination level and limit further increase in HBV transmission among MSM.     

Efficacy of an eConsult service to cure hepatitis C in primary care

In 2016, an eConsult service was developed within a safety net health system to expand access to hepatitis C (HCV) treatment in the primary care setting. The eConsult system provides individualized treatment recommendations from specially trained primary care pharmacists and primary care physicians to primary care providers with less experience in the rapidly changing treatment of HCV. Since its launch, this service has had a large impact in expanding care to a largely homeless and low-income urban population within our health system. We now aim to evaluate its efficacy in curing HCV. In this retrospective cohort study, we describe rates of sustained virologic response 12 weeks after treatment completion (SVR12) for those who received primary care-based HCV treatment through the eConsult system with those who were treated in primary care independent of an eConsult from 2017 to 2019. We found there was no significant difference in the proportion of patients who achieved SVR12 between the two groups. Overall, >90% of patients who received treatment achieved SVR12. Approximately 40% of patients treated for HCV received an eConsult, suggesting utility of the eConsult in expanding access and coordinating treatment for patients within our network.     

Organoids in modelling infectious diseases

Approaches based on animal and two-dimensional (2D) cell culture models cannot ensure reliable results in modeling novel pathogens or in drug testing in the short term; therefore, there is rising interest in platforms such as organoids. To develop a toolbox that can be used successfully to overcome current issues in modeling various infections, it is essential to provide a framework of recent achievements in applying organoids. Organoids have been used to study viruses, bacteria, and protists that cause, for example, respiratory, gastrointestinal, and liver diseases. Their future as models of infection will be associated with improvements in system complexity, including abilities to model tissue structure, a dynamic microenvironment, and coinfection.Teaser.Organoids are a flexible tool for modelling viral, bacterial and protist infections. They can provide fast and reliable information on the biology of pathogens and in drug screening, and thus have become essential in combatting emerging infectious diseases.     

扶正化瘀方含药血清对肝星状细胞activinA/smad信号通路活化的影响

目的　探讨扶正化瘀方含药血清对肝星状细胞（HSC）激活素A（activinA）/smad信号通路活化的影响。方法　20只SD大鼠按照随机数字表法分为对照组及扶正化瘀（Fzhy）-低、中、高剂量含药血清组，每组5只，分别以蒸馏水，0.75、1.5、3.0 g/kg扶正化瘀溶液（扶正化瘀胶囊药物粉末与蒸馏水配制）灌胃1次/d，连续3 d，取血制备空白血清（对照组）和含药血清。以大鼠HSC-T6细胞为研究对象，分别用5%、10%、20%体积分数的各组含药血清培养细胞。CCK-8检测细胞存活率，选取细胞存活率在50%左右的体积分数重新分为对照组及Fzhy-低、中、高剂量组。流式细胞术检测细胞周期及凋亡率、线粒体膜电位变化和活性氧（ROS）水平；实时荧光定量聚合酶链反应检测细胞中activinA、smad3、samd7、核因子（NF）-κB的mRNA水平；蛋白质印迹法检测细胞中activinⅡA受体（ActRⅡA）、smad3、NF-κB p65、胱天蛋白酶（caspase）-3的蛋白水平。结果　各扶正化瘀含药血清组的细胞存活率均低于对照组（P＜0.05），选择体积分数为10%的含药血清进行后续实验。对照组和各扶正化瘀方含药血清组细胞周期和凋亡率差异均无统计学意义。对照组及Fzhy-低、中、高剂量组细胞内ROS水平及线粒体膜电位水平降低比例逐次升高（P＜0.05）。与对照组比较，Fzhy-中、高剂量组smad3 mRNA表达水平降低，smad7 mRNA升高，Fzhy-低、中、高剂量组NF-κB、activinA mRNA，smad3、NF-κB p65、ActRⅡA蛋白表达水平降低，Fzhy-低剂量组、中剂量组caspase-3蛋白表达水平升高（P＜0.05）；与Fzhy-低剂量组相比，Fzhy-中、高剂量组smad3 mRNA表达水平降低，Fzhy-中剂量组activinA及smad7 mRNA升高（P＜0.05）。结论　扶正化瘀方含药血清可通过影响HSC-T6细胞增殖、参与细胞的氧化应激以及调节细胞activinA/smad信号转导通路来实现抗纤维化作用。