A comparison of antibiotic point prevalence survey data from four Irish regional/general hospitals

Introduction  

Point prevalence surveys (PPS) are increasingly used to examining and compare hospital antibiotic consumption. The aim of this study was to identify the (1) point prevalence of antibiotic use in one regional hospital and (2) compare PPS data from similar regional/general hospitals.     

Spectrum of Childhood Tuberculosis in BCG Vaccinated and Unvaccinated Children

Background

Childhood tuberculosis remains a major public health problem in India. We evaluated the impact of BCG vaccination on childhood tuberculosis and the underlying risk factors.

Methods

100 consecutive children below 12 years diagnosed to have tuberculosis based on the WHO and IAP consensus statement were included in the study.

Result

Majority(42%) of children with tuberculosis were below four years of age. History of contact with a case of tuberculosis was present in 41 cases. BCG scar was present in 77 cases indicating a poor coverage/uptake of BCG vaccination. Pulmonary form of tuberculosis was seen in 52 and extra pulmonary form in 41 cases. Tubercular lymphadenitis was seen in seven cases, of which more than 70 % were in BCG vaccinated group. There was no statistically significant difference in the type of tuberculosis (pulmonary or extra pulmonary) and BCG vaccination. In the extra pulmonary form, 13 children had neuro-tuberculosis, of which 66% were in BCG unvaccinated group, which was statistically significant (p=0.011). The underlying risk factors were poor socioeconomic status (62%), malnutrition (61%) and poor immunization coverage.

Conclusion

Higher incidence of pulmonary tuberculosis in BCG vaccinated group was not statistically significant. However, high incidence of neuro-tuberculosis in BCG unvaccinated group was statistically significant. The underlying risk factors were poor socio-economic status, malnutrition and poor immunization coverage and should be taken into consideration in order to prevent morbidity and mortality due to tuberculosis in children.Key Words: Bacille Calmette Guerin vaccine, Tuberculosis     

Bloodborne virus infections among drug users in Ireland: a retrospective cross-sectional survey of screening,prevalence, incidence and hepatitis B immunisation uptake

Background  

Injecting drug users are at high-risk of bloodborne virus infections including hepatitis C (HCV), hepatitis B (HBV) and HIV.     

Therapeutic Effect of Chang'an Ⅰ Recipe (肠安Ⅰ 号方) on Irritable Bowel Syndrome with Diarrhea: A Multicenter Randomized Double-Blind Placebo-Controlled Clinical Trial

Objective: To evaluate the efficacy and safety of Chinese medicine (CM) decoction Chang''an Ⅰ Recipe (肠安Ⅰ 号方) in the treatment of irritable bowel syndrome with diarrhea (IBS-D). Method: A multicenter, randomized, double-blind, placebo-controlled clinical trial was designed. Based on the order of inclusion, the IBS-D patients were randomly assigned to the treatment group or the placebo control group, administrated with Chang''an Ⅰ Recipe or placebo, 150 mL/bag, 3 times daily, for 8 weeks. The primary indices of efficacy included the effective rates of IBS symptom severity score (IBS-SSS) and the differences in adequate relief(AR) responder; the secondary indexes of efficacy included the changes in scores of the IBS Quality of Life (IBS-QOL) and Hospital Anxiety and Depression (HAD) scales. The safety indices included adverse events and related laboratory tests. Results: A total of 216 patients were included, with 109 in the treatment group and 107 in the control group, and finally 206 were included in the full analysis set (FAS), 191 were included in the per protocol set (PPS). In FAS, the total effective rate was 67.6% and 40.2% for the treatment and control groups, respectively, with 95% confidence interval (CI) for difference in the effective rates between the two groups of 14.4%–40.2%; while in PPS, the total effective rate was 71.3% and 41.2% for the treatment and control groups, respectively (95% CI 16.6%–43.4%). The consistent conclusions of FAS and PPS showed a better efficacy in the treatment group. Both FAS and PPS showed higher AR responder in the treatment group (FAS: 59.6% vs. 35.5%; PPS: 62.8% vs. 38.1%). As for IBS-QOL, the total score and scores in various dimensions of IBS-QOL were not significantly different between the two groups (P>0.05). Both anxiety and depression scales of HAD were not significantly different between the two groups (P>0.05). No adverse events or laboratory abnormalities were found to be obviously related to the tested drugs or clinically significant. Conclusion: Chang''an Ⅰ Recipe was more effective than placebo in the treatment of IBS-D, with no obvious adverse reactions. (No.ChiCTR-TRC-09000328)     

Effects of BCG Vaccination on Evolution of Leprosy

Background

BCG vaccine is considered to have immunoprophylactic potential in leprosy. However controversy exists about the extent of prophylaxis it provides. In view of this, a study was undertaken to see the evolution of disease in established cases of leprosy who were already vaccinated with BCG and to compare it with the cases of leprosy who were not vaccinated with BCG.

Methods

114 newly diagnosed cases of leprosy were studied. Patients were divided into two groups-BCG vaccinated and non-vaccinated. Clinical diagnosis of leprosy was confirmed by bacteriological and histopathological studies in each case. All patients were given standard anti leprosy treatment and were evaluated monthly for a minimum period of one year.

Results

All the cases were males in the age group of 20 to 50 years. 25.4% of cases had received BCG vaccine and 74.6% were not vaccinated for the same. No significant difference was observed in the incidence of different types of leprosy in vaccinated and non-vaccinated groups. 25.9% cases in non-vaccinated group developed lepra reaction as compared to 13.8% in vaccinated group. The incidence of deformities and disabilities in vaccinated group was only 10.3% as against 18.8% in non-vaccinated group. The rate of bacillary clearance appeared faster in vaccinated group.

Conclusions

Although there is no significant difference in the pattern of different types of leprosy in BCG vaccinated and non-vaccinated cases, there is reduction in the incidence of reactions as well as deformities and disabilities in BCG vaccinated cases as compared to non-vaccinated cases.Key Words: BCG Vaccine, Leprosy     

补肺益肾颗粒联合穴位按压对稳定期慢阻肺患者生活质量的改善作用

Objective: To evaluate the efficacy of Bufei Yishen Granule (补肺益肾颗粒,BFYSG) combined with Shufei Tie (舒肺贴) acupoint sticking therapy on quality of life of patients with stable chronic obstructive pulmonary disease (COPD). Methods: A multi-center, double-blinded, double-dummy and randomized controlled method was adopted in this trial. A total of 244 patients were randomly assigned to a trial group and a control group according to the random number, each with 122 patients; treatment allocation occurred when the participants met the inclusion criteria and signed the informed consent form. In the trial group, patients were treated with BFYSG combined with "Shufei Tie" acupoint sticking therapy and sustained-release theophylline dummy, and in the control group patients were treated with oral sustained-release theophylline and BFYSG dummy combined with "Shufei Tie" acupoint sticking therapy dummy. The therapeutic course for two groups was 4 months and the follow-up was 6 months. The frequency and duration of acute exacerbation calculated by adding up each frequency and duration of acute exacerbation in treatment and follow-up time respectively, the quality of life measured by the World Health Organization Quality of Life (WHOQOL)-BREF scale and adult COPD quality of life (COPD-QOL) scale were observed. Results: Among the 244 enrolled patients, 234 were screened for full analysis set (FAS); 221 were screened for per-protocol analysis set (PPS). After 4-month treatment and 6-month follow-up there were differences between the trial group and the control group in frequency of acute exacerbation (FAS: P=0.013; PPS: P=0.046); duration of acute exacerbation (FAS: P=0.005; PPS: P=0.006); scores of physiological, psychological and environment aspects of the WHOQOL-BREF questionnaire (FAS: P=0.002, P=0.006, P=0.000; PPS: P=0.00, P=0.001, P=0.000); scores of daily living ability, social activity, depression symptoms aspects of the COPD-QOL questionnaire (FAS: P=0.000, P=0.000, P=0.006; PPS: P=0.002, P=0.001, P=0.001). Conclusions: BFYSG combined with acupoint sticking therapy could improve the quality of life of patients with stable COPD.     

卡介苗感染人B细胞诱导细胞凋亡

目的 探究卡介苗(BCG)是否能感染人B细胞及观察感染后对细胞的影响。方法 人B细胞系Raji细胞与BCG共培养, 4、12和24h后分别用共聚焦及透射电镜观察Raji细胞对BCG的结合和摄取情况,用CCK-8法检测细胞毒性,流式Annexin Ⅴ-PI双标法检测细胞凋亡和坏死情况。结果 培养4、12和24h后,感染了BCG的细胞比例分别为12.4%±2.0%, 23.8%±5.1%, 25.2%±4.8%。 BCG感染可引起细胞毒性,4h后Raji细胞存活率为75.5%±8.8%,12h后细胞存活率降至51.0%±5.3%,24h后细胞存活率仅为21.6%±4.2%,而感染灭活BCG的细胞存活率均在95%以上。进一步用流式检测凋亡坏死发现,与未感染细胞相比,Raji细胞感染BCG后凋亡,坏死均有所增加,以凋亡增加为主。结论 BCG可以感染人B细胞并诱导细胞凋亡。     

Effects of andrographolide on the activation of mitogen activated protein kinases and nuclear factor-κB in mouse peritoneal macrophage-derived foam cells

Objective:To observe the effect of andrographolide on the activation of mitogen-activated protein kinases(MAPKs) and expression of nuclear factor-κB(NF-k B) in macrophage foam cells.Methods:The mouse peritoneal macrophages were cultured in the media in the presence of oxidized low-density lipoprotein (ox-LDL),ox-LDL+andrographolide,or neither(control).The phosphorylation of MAPK molecules(p38MAPK, JNK,ERK1/2) and the expressions of NK-κB p65 were examined by Western blot.Results:As compared with cells in the control group,the expressions of phospho-p38 and NF-κB p65 were increased in the cells cultured with either ox-LDL or ox-LDL+andrographolide(P<0.01),but attenuated significantly in the presence of ox-LDL+ andrographolide when compared with ox-LDL(P<0.05).The phospho-JNK increased in the presence of either ox-LDL or ox-LDL+andrographolide when compared with control cells(P<0.01),but no significant difference existed between ox-LDL and ox-LDL+andrographolide(P>0.05).The expression of phospho-ERK1/2 was increased in the presence of ox-LDL compared with the control cells(P<0.01),but no significant differences existed between the cells cultured in the presence of ox-LDL+andrographolide and the control medium(P>0.05). Conclusions:Andrographolide could inhibit the activation of ERK1/2,p38MAPK and NK-k B induced by ox-LDL in macrophage foam cells,which might be one of its mechanisms in preventing atherosclerosis.     

Clinical characteristics and needle aspiration management of Bacillus Calmette-Guérin lymphadenitis in children

Objectives:

To describe characteristics of children developing Bacillus Calmette-Guérin (BCG) lymphadenitis, and to evaluate needle aspiration treatment.

Methods:

Children developing BCG lymphadenitis following BCG vaccination in Al-Rass General Hospital, Al-Rass, Saudi Arabia were prospectively studied from October 2008 to September 2013. Non-suppurative BCG lymphadenitis was conservatively managed, while suppurative lymphadenitis was treated by needle aspiration.

Results:

The mean (SD) age of children (n=23) was 4.1 (1.4) months, and symptoms duration was 2.08 (1.38) months. Fifteen (65.2%) children had suppurative, whereas 8 (34.8%) had non-suppurative lymphadenitis. Age, gender, birth weight, and duration of symptoms were not significantly different between children with suppurative and non-suppurative lymphadenitis (p>0.05). Children with suppurative adenitis had higher weight, and larger size of the involved lymph nodes compared with those with non-suppurative nodes (p=0.001). Most (91.3%) had axillary lesions; with a mean lymph node size of 3.2 cm. Abscesses were detected by ultrasound in 8 (80%). Non-suppurative lymphadenitis was conservatively managed, while suppurative was aspirated. The mean duration for resolution was 3.25 months. Lymph nodes aspirate were positive for acid and alcohol fast bacilli in 10 patients (66.6%), and 3 of them grew Staphylococcus aureus.

Conclusion:

Bacillus Calmette-Guérin adenitis occurs in young children, mainly as unilocular suppurative left axillary group with a mean size of 3.2 cm. Needle aspiration is safe in treatment of suppurative lymphadenitis. Mycobacteria stained positive in most of the suppurative lesions. Excision is not needed.The Bacillus Calmette-Guérin (BCG) vaccine was derived by in vitro attenuation of Mycobacterium bovis strains in 1906, and the World Health Organization (WHO) incorporated the vaccine in the Expanded Program of Immunization (EPI) in 1974.1 It is estimated that 89% of the targeted children received BCG vaccination in the year 2012.2 The efficacy of the BCG vaccine for tuberculosis protection is controversial; however, it is known to be effective against disseminated tuberculosis (TB) and tuberculous meningitis.3 The most common complication of BCG vaccination is regional lymphadenitis. In Saudi children, the incidence was reported as 1.96 per 1000.4,5 Different methods of management are recommended; however, their beneficial effects remain controversial.6 Non-suppurated lymphadenitis resolves without treatment in 4-6 months.7 In a Saudi setting, the mean age of developing BCG-related complications in lymph nodes was 4.8 months. Suppurative adenitis was treated with total excision or incision and drainage.8 Needle aspiration is infrequently studied as a mode of treatment of suppurative BCG lymphadenitis. This study aimed to describe the clinical characteristics of children developing BCG lymphadenitis and to evaluate the value of needle aspiration in treatment of the suppurative type.     

Clinical pathologic study on effect of Qianggan capsule in treating patients of chronic hepatitis B with liver cirrhosis

Objective  

To explore the clinical therapeutic effect of Qianggan Capsule (QGC) in treating chronic hepatitis B with liver fibrosis from the pathological aspect.     

Antiviral effects of aqueous extract from Spatholobus suberectus Dunn. against coxsackievirus B3 in mice

Objective  

To investigate the antiviral effects of the aqueous extract of Spatholobus suberectus Dunn. (A.E.), a Chinese medicinal herb, against coxsackievirus B3 (CVB3).     

Ursolic Acid Inhibits T-Cell Activation through Modulating Nuclear Factor-κB Signaling

<正>Objective:To investigate the effects of ursolic acid(UA) on T-cell proliferation and activation,as well as to examine its effect on nuclear factor-κB(NF-κB) signaling pathway in T cells.Methods:T-cells isolated from BALB/c mice were incubated with UA at concentrations ranging from 5-30μmol/L in the presence of phorbol 12-myristate 13-acetate(PMA) or PMA plus ionomycin.The proliferation of T cells was measured by the MTT assay.The expressions of CD69,CD25,and CD71 on T-cell surface were analyzed using flow cytometry. The level of interleukin-2(IL-2) in the culture supernatant of activated T cells was quantified by enzyme-linked immunosorbent assay(ELISA).The level of phosphorylated IκB-α(p-lκB-α) in total protein and p65,a subunit of NF-κB,nuclear translocation were measured by Western blot analysis.Results:UA in a dose-dependent manner significantly decreased the proliferation and inhibited the surface expressions of CD69,CD25,and CD71 in murine T lymphocytes upon in vitro activation(P0.01).Significant reduction of IL-2 production was found in activated T cells treated with UA(P0.01).The PMA-induced increase in p-lκB-αprotein was inhibited,and nuclear translocation of p65 from the cytoplasm was blocked by UA.Conclusion:UA is a potent inhibitor for T cell activation and proliferation;these effects are associated with the inhibition of NF-κB signaling pathway.     

Characteristics of lymphocyte nuclear factor-κB signal transduction kinase expression in aging process and regulatory effect of epimedium flavonoids

Objective:To study the characteristics of lymphocyte nuclear factor kappa B(NF-κB) signal transduction kinase-related molecular mRNA differential expressions at various month age segments in aging process and the intervening effect of Epimedium flavonoids(EF) on it.Methods:Sixty SD rats were divided into six groups,according to animals’ age,i.e.,the 3 days(d) group,the 4 months(m) group,the 10 m group,the 18 m group,the 27 m group,and the 27 m+EF group.RNA was extracted from separated splenic lymphocytes. Adopting NF-κB signal path functional genome oligonucleotide gene-chip(128 related genes),the integral characteristics and differences of NF-κB signal transduction kinase-related mRNA expressions were determined, and the intervening effect of EF was examined.Results:The mean level of the NF-κB signal transduction kinase-related mRNA expressions in rats’ splenic lymphocytes lowered with aging;the highest expression was presented at 3 d after birth,and then,it lowered gradually,with the lowest level at 18 m or 27 m.After EF intervention,the expression level was raised to the 10-18 m level in the aged rats.Conclusion:The changing rules of lymphocyte NF-κB-signal-transduction-kinase-related mRNA expressions in various stages of aging are helpful for selecting the well time for preventing and intervening aging,and will also give a hint to the molecular index for assessment of senility retarding researches.     

Effect of puerarin on the release of interleukin-8 in co-culture of human bronchial epithelial cells and neutrophils

Objective:To investigate the effect of puerarin on interleukin(IL)-8 mRNA expression and the protein release in the co-culture of human bronchial epithelial(BEAS-2B) cells and human neutrophils.Methods:BEAS2B cells and neutrophills were cultured separately and co-cultured with puerarin(50,100,and 200μg/mL) for a predetermined time.Cytokines in culture supematant were evaluated by protein array and IL-8 quantified by enzymelinked immunosorbent assay(ELISA).IL-8 mRNA expression was evaluated by real-time quantitative polymerase chain reaction(real-time qPCR).Results:The co-culture of BEAS-2B cells and neutrophils exhibited synergistic effects on IL-8 mRNA expression in BEAS-2B cells,but not in neutrophils after 12 h incubation(P<0.01),as compared with that in BEAS-2B cells or neutrophils alone.IL-8 protein release in the culture supematant was obviously elevated when BEAS-2B cells were co-cultured with human neutrophils as compared with that in the supematant of BEAS-2B cells or neutrophils alone after incubated for 2,6,12,and 18 h(P<0.01).Treatment with puerarin could significantly down-regulate the expression of IL-8 mRNA in BEAS-2B cells and IL-8 release in the supernatant of the co-culture of BEAS-2B cells and neutrophils(P<0.01).Conclusion:Puerarin could exhibit anti-inflammatory activity by suppressing IL-8 production from the co-culture of human bronchial epithelial cells and neutrophils.     

Effects of tanshinone II A on the myocardial hypertrophy signal transduction system protein kinase B in rats

Objective： To study the effect of tanshinone ⅡA on the cell signal transduction system protein kinase B （Akt） in rats with hypertrophy of the myocardium induced by partial constriction of the thoracic aorta. Methods： Rat models of myocardial hypertrophy were established by the thoracic aorta partial constriction method. Forty-eight rats were randomly divided into the sham-operative group, the model group, the valsartan treatment group, and the low-, medium-, and high-dose tanshinone treatment groups. The heart mass index （HMI）, left ventricular mass index （LVMI）, ejection fraction （EF）, left ventricular posterior wall （LVPW）, and interventricular septal thickness （IVS） were detected by high-frequency ultrasonography. The myocardial fiber diameter （MFD） was detected by HE staining, and the contents of p-Akt and p-Gsk3β in the myocardium were detected by Western blot. Results： Compared with the sham-operative group, the levels of HMI, LVMI, LVPW, IVS, and MFD were increased respectively in the other groups （P〈0.05）; the contents of p-Akt and p-Gsk3β were also increased in the other groups. Compared with the model group, the levels of HMI, LVMI, LVPW, IVS, and MFD were decreased respectively in all treatment groups （P〈0.05）; the contents of p-Akt and p-Gsk3β were decreased in all treatment groups as well. There was no significant difference, however, among the low-, medium-, and high-dose tanshinone treatment groups and the valsartan treatment group （P〉0.05）. Conclusion： Tanshinone HE A can prevent myocardial hypertrophy by its action on the protein kinase B （Akt） signaling pathway.     

Relationship of anxiety state with lymphocyte subsets and the effect of chinese medical treatment on anxiety in patients with chronic hepatitis B

Objective:To analyze the relationship of anxiety state with CD4~+ level and CD4~+/CD8~+ ratio and to observe the effect of Chinese medicine(CM) treatment on anxiety in chronic hepatitis B(CHB) patients. Methods:The anxiety state of 120 CHB patients was evaluated based on Hamilton Anxiety Scale(HAMA) scoring.According to the scores,63 patients with scores≥14 were classified to anxiety and 57 patients with scores<14 to non-anxiety.The differences in CD4~+ cells and CD4~+/CD8~+ ratio between patients with anxiety and non-anxiety were analyzed.Moreover,63 patients with anxiety were randomized into two groups:31 in the control group were treated with lamivudine(100 mg per day) alone and 32 in the observation group were given equal dosage lamivudine combined with CM treatment depending on syndrome differentiation,all for 12 weeks. The effects of treatment on anxiety state and T-lymphocyte subsets as well as its impact on some CHB-related indices were observed and compared.Results:The anxiety state of CHB patients was negatively correlated with CD4~+ and CD4~+/CD8~+;the level of CD4~+ in patients with anxiety was significantly lower than that in non-anxiety patients(P<0.01 or P<0.05).After treatment,anxiety state in the observation group was significantly improved, with their HAMA scores significantly lowered(P<0.01),and the levels of CD4~+ and CD4~+/CD8~+ were significantly higher than those in the control group(P<0.05 or P<0.01).Moreover,the alanine transaminase recovery rate and the HBV-DNA-negative conversion rate in the observation group were significantly higher than those in the control group,respectively(P<0.05).Conclusions:The anxiety state of CHB patients was related to CD4~+ and CD4~+/CD8~+ levels.CM treatment could improve the anxiety state and showed certain regulatory effect on the patients’ immune system.     

Clinical outcome after acquisition ofBurkholderia cepacia in patients with cystic fibrosis

Background  

Respiratory disease is the major cause of morbidity and mortality in cystic fibrosis (CF). The significance ofBurkholderia cepacia (B. cepacia) in the pathogenesis of lung disease in CF is debated, but its exact role remains unclear.     

Clinical Observation on the Treatment of Chronic Severe Hepatitis B by Retention Enema with Huchang Jiedu Decoction(护肠解毒汤)

<正>Objective:To observe the efficacy of retention enema with Huchang Jiedu Decoction(护肠解毒汤, HJD)in treating chronic severe hepatitis B(CSHB).Methods:Sixty patients of CSHB were equally randomized into the treated group and the control group.Both groups were treated with conventional integrative medicine, but to patients in the treated group,retention enema with HJD was given in addition,once every day for 3 weeks.The dominant symptoms,physical signs,and related biochemical indices,as well as the incidence of complications in patients before and after treatment,were observed.Results:Good therapeutic effects were shown in the treated group,with a total effective rate better than that in the control group(83.3%versus 60.0%, P0.05),superior in terms of lowering alanine aminotransferase(ALT),aspartate aminotransferase(AST), total bilirubin(TBil),globulin(GIb),and endotoxin(ET)levels and increasing prothrombin activity(PTA),total cholesterol(TC),and calcium(Ca)levels,as well as eliminating ascites and preventing hepatic encephalopathy (P0.05);especially in treating middle/early stage patients with Chinese medicine syndrome differentiated as water-toxin accumulation pattern.Conclusion:Retention enema with HJD is surely effective in treating CSHB, and its primary mechanism may be related to the mitigation of enterogenous endotoxemia.     

Qushi Huayu Decoction (祛湿化瘀方) Inhibits Protein and Gene Expression of Cathepsin B in HepG2 Cells Induced by Free Fatty Acids

Objective: To study the experimental efficacy of Qushi Huayu Decoction (祛湿化瘀方,QHD) on protein and gene expression of cathepsin B (ctsb) in HepG2 cells induced by free fatty acids (FFAs).Methods: The model of HepG2 steatosis and tumor necrosis factor-α (TNF-α) secretion was induced by long-chain FFAs.HepG2 cells were divided into 4 groups: control group (group C),model group (group M),low-dose QHD group (group L) and high-dose QHD group (group H ).Long-chain FFAs were added to groups M,L and H.The 10% blank-control serum was added to group C and M,while 5% and 10% QHD-containing sera were added to group L and H,respectively.The levels of serum TNF-α and cellular triglyceride (TG) were detected.Cellular p-IκB and ctsb expression were detected using Western blot and PCR.The expression and distribution of ctsb were observed by immunofluorescence.Results: After incubating with FFA for 24 h,TG deposition in HepG2,TNF-α content in cell supernatant,the protein expression of cellular ctsb and P-IκB,as well as mRNA expression of ctsb increased markedly in group M compared with group C (P0.05,P0.01).Compared with group M,TG deposition,the expression of cellular ctsb,P-IκB and ctsb mRNA in groups L and H,as well as TNF-α content in group H,decreased significantly (P0.05).Cell immunochemical fluorescence studies showed that ctsb was released from lysosomes and distributed in the cytoplasm extensively and diffusedly after being stimulated with FFA.In this study,these above-mentioned changes were inhibited markedly in groups L and H.Conclusion: QHD might have a direct inhibitory effect on the ctsb target in the FFA-ctsb-TNFα pathway of hepatic lipotoxicity.