Baseline High Viral Load and Unfavorable Patterns of Alanine Aminotransferase Change Predict Virological Relapse in Patients With Chronic Hepatitis C Genotype 1 or 2 Obtaining Rapid Virological Response During Antiviral Therapy

Background

Rapid virological response (RVR) strongly predicts sustained virological response (SVR) in patients with chronic hepatitis C (CHC), and abbreviates antiviral therapy in some patients.

Objectives

To identify factors predicting virological relapse (VR) in CHC patients who attained RVR.

Patients and Methods

Medical records of 133 CHC patients with an RVR after completing 24 weeks of antiviral therapy (a combination of pegylated interferon-α and ribavirin) were analyzed. Baseline characteristics and on-treatment responses were compared between the patients with an SVR and those with VR. Patients with normal alanine aminotransferase (ALT) levels at weeks 4 and 12 and at the end-of-treatment (EoT) and patients with elevated, but constantly decreasing, ALT levels were classified as having favorable patterns of ALT change. A trend of increasing ALT levels either between weeks 4 and 12 or between weeks 12 and EoT was classified as unfavorable. A high viral load (HVL) was defined as a baseline HCV RNA ≥ 600000 IU/mL.

Results

In total, 116 (87.2%) patients had a SVR and 14 (10.5%) had VR. The VR rates were comparable between patients with genotype-1 (13.1%) and genotype-2 infection (8.7%) (P = 0.572). Multivariate analysis revealed that HVL (P = 0.015; odds ratio [OR] = 14.754; 95% confidence interval (CI) = 1.671–130.240), and unfavorable ALT patterns (P = 0.039; OR = 4.397; 95% CI = 1.078–17.930) independently predicted VR. In subgroup analysis, low viral load (LVL) patients had a minimal VR rate (1.8%). Among the HVL patients, the VR rate of those using peg-IFN-α-2a was relatively low (9.1%). Patients using peg-IFN-α-2b had a slightly higher VR rate (23.8%; P = 0.128), and patients with favorable patterns of ALT changes had a lower VR rate (10.3%) compared to the 53.8% in patients with unfavorable ALT patterns (P = 0.005).

Conclusions

In southern Taiwan, 24 weeks of antiviral therapy achieved a high SVR rate in patients with CHC attaining RVR, except in the subgroup of patients treated with peg-IFN-α-2b with HVL and on-treatment unfavorable ALT patterns.     

The experiences of adult ventilator‐dependent patients: A meta‐synthesis review

Studies exploring the perceptions of patients whose lives are maintained by mechanical ventilation highlight the stressful nature of this type of experience. The objective of this meta‐synthesis study was to describe the nature of the experience of adult ventilator‐dependent patients. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1970 and 2012. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A total of 1004 papers were identified from various database and hand searches. Nineteen papers were critically appraised and 16 met inclusion criteria. Five meta‐synthesis themes emerged from the analysis: (1) the feelings of fear due to being dependent on a ventilator and the loss of control of life; (2) disconnection with reality; (3) impaired embodiment; (4) construction of coping patterns; (5) trust and caring relationship. Suggested implications for practice include enhancing the trust relationship with health professionals, as well as nursing actions throughout the suction procedure relating to release of patient's psychological distress and empowering their resilience factors.     

The Role of Zn Substitution in Improving the Electrical Properties of CuI Thin Films and Optoelectronic Performance of CuI MSM Photodetectors

Pure CuI and Zn-substituted CuI (CuI:Zn) semiconductor thin films, and metal-semiconductor-metal (MSM) photodetectors were fabricated on glass substrates by a low-temperature solution process. The influence of Zn substitution concentration (0–12 at%) on the microstructural, optical, and electrical characteristics of CuI thin films and its role in improving the optoelectronic performance of CuI MSM photodetectors were investigated in this study. Incorporation of Zn cation dopant into CuI thin films improved the crystallinity and increased the average crystalline size. XPS analysis revealed that the oxidation state of Cu ions in all the CuI-based thin films was +1, and the estimated values of [Cu]/[I] for the CuI:Zn thin films were lower than 0.9. It was found that the native p-type conductivity of polycrystalline CuI thin film was converted to n-type conductivity after the incorporation of Zn ions into CuI nanocrystals, and the electrical resistivity decreased with increases in Zn concentration. A time-resolved photocurrent study indicated that the improvements in the optoelectronic performance of CuI MSM photodetectors were obtained through the substitution of Zn ions, which provided operational stability to the two-terminal optoelectronic device. The 8 at% Zn-substituted CuI photodetectors exhibited the highest response current, responsivity, and EQE, as well as moderate specific detectivity.     

西沙必利片剂和胶囊剂人体药代动力学及相对生物利用度研究

目的研究西沙必利片剂及胶囊剂在健康人体内的药代动力学及相对生物利用度。方法采用反相高效液相色谱法测定12名健康自愿者单剂量口服三种制剂各15mg后,血浆中西沙必利浓度变化情况,用3P97程序按非室模型进行药代动力学分析。结果测得主要药代动力学参数为试验片剂T     

The role of Helicobacter pylori infection in children with acute immune thrombocytopenic purpura

The outcome of immune thrombocytopenic purpura (ITP) is classified as acute or chronic depending on whether platelet count returns to normal. The prevalence of Helicobacter pylori infection increases with age and is independent of gender. We investigated the prevalence of H. pylori infection in Chinese children from Northern Taiwan and analyzed the association between H. pylori infection and acute ITP. Our prospective cohort studies found no statistically significant relation between H. pylori infection and acute ITP. There is therefore no indication to screen children with presumed acute ITP for H. pylori infection.     

Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma.

OBJECTIVE; Morbidity and mortality involved in the resection of hilar cholangiocarcinoma were reviewed retrospectively. The clinicopathologic and laboratory parameters that might influence the patient's survival also were re-evaluated. SUMMARY BACKGROUND DATA: Although much progress has been made in the diagnosis and management of hilar cholangiocarcinoma, long-term outlook for most patients remains poor. Surgical resection is usually prohibited because of its local invasiveness, and most patients can only be managed by palliative drainage. Recently, many surgeons have adopted a more aggressive resection with varying degrees of success. Several prognostic factors in bile duct carcinoma have been proposed; however, no reports have specifically focused on resected hilar cholangiocarcinoma and its prognostic survival factors using multivariate analysis. METHODS: The clinical records and pathologic slides of 49 cases with resected hilar cholangiocarcinoma were reviewed retrospectively. Twenty clinical and laboratory parameters were evaluated for their correlation with postoperative morbidity and mortality, whereas 31 variables were evaluated for their significance with postoperative survival. Variables showing statistical significance in the first univariate analysis were included in the following multivariate analysis using stepwise logistic regression test for factors affecting morbidity and mortality and Cox stepwise proportional hazard model for factors influencing survival. RESULTS: There were 5 in-hospital deaths, and the cumulative 5-year survival rate in 44 patients who survived was 14.9%, with a median survival of 14.0 months. Multivariate analysis disclosed that co-existent hepatolithiasis and lower serum asparate aminotransferase levels (<90 U/L) had a significant low incidence of postoperative morbidity, whereas a serum albumin of less than 3 g/dL was the only significant factor affecting mortality. Regarding survival, univariate analysis identified eight significant factors: 1) total bilirubin > or = 10 mg/dL, 2) curative resection, 3) histologic type, 4) perineural invasion, 5) liver invasion, 6) depth of cancer invasion, 7) positive proximal resected margin, and 8) positive surgical margin. However, multivariate analysis disclosed total bilirubin > or = 10 mg/dL, curative resection, and histologic type as the three most significant independent variables. CONCLUSIONS: Surgical resection provides the best survival for hilar cholangiocarcinoma. An adequate nutritional support to increase serum albumin over 3 g/dL is the most important factor to decrease postoperative mortality. Moreover, preoperative biliary drainage to decrease jaundice and a curative resection with adequate surgical margin are recommended if longer survival is anticipated. Patients with well-differentiated adenocarcinoma seem to survive longer compared to those with moderately or poorly differentiated tumors.     

Effects of kainic acid injections in the striatum on physiologic and behavioral functions in conscious rats

Alterations in both physiologic and behavioral functions were assessed in unanesthetized rats after a unilateral injection of kainic acid (KA) in the striatum. The immediate behavioral effects were dyskinesias, head swaying, circling, tail elevation, hyperpnea and marked salivation. The induced behavioral responses lasted for about 14 to 18 h. Rats with intrastriatal KA injection, although showing no thermoregulatory deficit at both moderate (22 degrees C) and hot (30 degrees C) environmental temperatures, displayed a lower metabolism and a lower rectal temperature than the preinjection controls in the cold (8 degrees C) environment. In addition, the hypothermia induced by intrastriatal administration of apomorphine (dopamine agonist) was greatly antagonized by pretreatment with intrastriatal injection of KA. Furthermore, intrastriatal infusions of KA (1 microgram in 0.5 microliter) also caused a decrease in pain threshold (or in the latency to the hind-paw lick on the hot plate test), hypophagia, polydipsia, and weight loss. The induced alterations in thermoregulation, pain reflex, and ingestive behavior lasted for about 7 days. These data indicate that striatal neurons are involved in the central control of motor activity, thermoregulation, the pain reflex, and ingestive behavior.     

Performance characteristics of DRI, CEDIA, and REMEDi systems for preliminary tests of amphetamines and opiates in human urine

Arrestee urine specimens (930) were tested with DRI, CEDIA, and REMEDi; those that tested positive for amphetamines and opiates (616 and 414, respectively) were then confirmed by gas chromatography-mass spectrometry. The performance characteristics of these three preliminary systems were evaluated using the following commonly used parameters: true positive, true negative, false positive, and false negative. The sensitivity, specificity, and efficiency of these methods were also calculated. Data derived from this study indicated DRI and CEDIA adapted by this study generated acceptable preliminary test results for amphetamine/methamphetamine and morphine/codeine, but not for MDA/MDMA and REMEDi has lower sensitivity than DRI and CEDIA, but with better specificity and efficiency, supporting its use under emergency room settings where drug concentrations in overdose cases are expectedly at high levels.