Clinical Predictors of Functional Cure in Children 1–6 Years-old with Chronic Hepatitis B

Background and AimsHepatitis B surface antigen (HBsAg) clearance is significantly more common in children with chronic hepatitis B (CHB) than in adults; however, the possible influencing factors related to HBsAg loss have yet to be found. This study aimed to explore the efficacy of long-term interferon (IFN)α therapy in treating children with CHB and analyzed the factors influencing functional cure after treatment.MethodsA total of 236 children aged 1–6 years and diagnosed with CHB via liver biopsy were included in the study, all receiving IFNα treatment (IFNα-2b monotherapy, IFNα-2b followed by lamivudine [LAM] or IFNα-2b combined with LAM) and followed up for 144 weeks. A comprehensive analysis was conducted on clinical data, including biochemical items, serum markers of hepatitis B virus (HBV) and immunological indexes, and logistic regression analysis was used to screen the influencing factors related to HBsAg loss.ResultsThe cumulative loss rates of HBsAg were 79.5%, 62.1% and 42.1% at 144 weeks after the start of treatment in the 1–3 years-old group, 3–5 years-old group and 5–7 years-old group, respectively (p<0.05). IFNα-2b combined with LAM treatment displayed the highest HBsAg loss rates compared with monotherapy and sequential treatment (p=0.011). Younger baseline age and lower HBsAg levels were independent factors for the prediction of HBsAg loss (p<0.05). The baseline PreS1 and hepatitis B core antibody levels in the HBsAg loss group were lower than those in the HBsAg non-loss group. In addition, the PreS1 level was positively corelated with the level of HBsAg, HBV DNA and liver inflammation.ConclusionsLong-term treatment with IFNα was effective in achieving HBsAg loss in CHB children aged 1–6 years-old. Age less than 3 years-old and lower HBsAg levels are independent predictors of functional cure in children with CHB.     

Preprocedure patient values regarding sedation for colonoscopy

BACKGROUND: Adherence rates for screening colonoscopy remain low. There are little data describing pre-colonoscopy patient concepts, values, and preferences for sedation during colonoscopy. In this study, we sought to investigate preprocedure patient values regarding sedation use for colonoscopy. METHODS: Questionnaires were administered to 210 consecutive outpatients presenting for colonoscopy. An unscaled visual analog scale was used to value each of eight statements relating to sedation. RESULTS: The statement receiving the highest valuation was "I don't want to feel any pain" (mean score, 82 +/- 21), followed by "I want to go to sleep and not wake up until the procedure is over" (mean score, 71 +/- 31), and "I want to be alert as soon as possible after the procedure" (mean score, 65 +/- 30). The statement receiving the lowest value was "I'd like to watch as much of the procedure as I can" (22 +/- 29). Patients who preferred to undergo colonoscopy without sedation were more likely to be men (P = 0.001) and more likely to have graduate or professional educational degrees (P < 0.001). CONCLUSIONS: Our data suggest that, on average, American patients place the highest valuation on experiencing no pain during colonoscopy, waking up promptly after the procedure, and for going to sleep and not waking up until the procedure is over. However, unsedated colonoscopy does appeal to a small minority of patients, primarily men with graduate educations.     

Ethanol-induced alterations in fatty acid-related lipids in serum and tissues in mice

Background: Chronic alcohol consumption is a major factor for several human diseases, and alcoholism is associated with a host of societal problems. One of the major alcohol‐induced metabolic changes is the increased NADH levels, which reduces glucose synthesis and increases fatty acid (FA) synthesis. Probably more important is the induction of FA synthesizing enzymes under the control of sterol regulatory element binding proteins (SREBP), plus increased malonyl‐CoA, which blocks FA entry to the mitochondria for oxidation. The changes in FA‐related lipids, particularly lysophospholipids and ceramides (Cers), in different tissues in ethanol‐fed mice have not been reported. Methods: We systematically determined the levels of FA‐related lipids, including FAs, phosphatidylcholines, phosphatidylethanolamines, lysophosphatidic acid, lysophosphatidylcholine, lysophosphatidylethanolamine, lysophosphatidylinositol, sphingomyelins, and ceramides (Cers), in the serum and different tissues by high‐performance liquid chromatography–electrospray ionization–tandem mass spectrometry (HPLC–ESI–MS/MS). The study was performed in C57BL/6J mice fed with Lieber‐DeCarli diet, in which ethanol was added to account for 27.5% of total calories. The serum and tissues were collected from these mice at the time of killing, and the results were compared to pair‐fed controls. Results: The important observation was that ethanol‐induced tissue‐specific changes, which were related to different FA chains. Several 22:6 FA, 18:0 FA, 18:0 to 18:3 FA‐containing lipids were significantly increased in the serum, liver, and skeletal muscle, respectively. In the kidney, all 22:6 FA‐containing lipids detected were increased. In addition, alterations in other lipids in tissues, except adipose tissue, were also observed. Conclusions: We found tissue‐specific alterations in the levels of FA‐related lipids after ethanol administration. The implications of these findings pertinent to human physiology/pathology warrant further investigation. More studies are needed to explore the mechanisms on the different effects of ethanol on certain lipids in different tissues.