siRNA drug development against hepatitis B virus infection

Introduction: Hepatitis B virus (HBV) infection is the worldwide leading cause of liver cirrhosis and hepatocellular carcinoma. Currently available medication can suppress viral replication in the majority of patients, but clearance of the viral antigens can be achieved in only about 10%.

Areas covered: RNA interference is a very attractive therapeutic option since a well-designed compound could possibly inhibit all HBV mRNA and thus synthesis of all its antigens, which could combine antiviral and immunomodulatory modes of action. The aim of the article is to provide current knowledge on possible use of small interfering RNA (siRNA) molecules in the treatment of chronic HBV infection.

Expert opinion: Based on the current status of clinical trials, we should expect that within the coming five years at least one siRNA molecule will be registered for clinical use. However, most important at this stage of development will be the safety profile, improving the route of administration, selection of the optimal combination with other anti-HBV drugs (nucleoside analogues, interferons) and finally selection of the optimal system introducing siRNA molecules into infected cells. Current therapeutic options for HBV, the siRNA mechanism of action, as well as preclinical and clinical studies with siRNA molecules are presented in this article.     

Venous thromboembolism in patients with liver diseases

Essentials

• Emerging evidence shows that patients with liver disease are not protected from thrombotic events.
• We assessed the risk of venous thromboembolism (VTE) in patients with liver disease.
• The presence of VTE resulted in an increase in mortality for patients with liver disease.
• Hospitalized patients with moderate‐severe liver disease had low risk of VTE during admission.

Summary

Background and Aims

Patients with liver disease were traditionally believed to be protected against development of blood clots, but some studies have shown a potential increased risk of venous thrombotic complications. We assessed the risk of venous thromboembolism (VTE) in patients with liver disease.

Methods

Data in discharge reports of patients with liver disease and control patients without liver disease were analyzed from the national inpatient sample. Incidence of VTE was compared in patients with mild, moderate‐severe or no liver disease, and the impact on in‐hospital mortality and length of stay was calculated.

Results

The overall incidence of VTE for patients with no liver disease, mild liver disease and moderate‐severe liver disease was 2.7, 2.4 and 0.9 per 100 patient discharges, respectively. In the presence of VTE, in‐hospital mortality was 10.8%, 5.8%, and 21.7% for the no liver disease, mild disease and moderate‐severe liver disease, respectively. The presence of VTE resulted in an increase in mortality for patients with no liver disease (OR, 1.16; 95% CI, 1.14–1.18) and moderate‐severe liver disease (OR, 1.63; CI 95%, 1.42–1.88).

Conclusions

Patients with moderate‐severe liver disease have a lower risk of VTE than those without liver disease. Development of thrombosis during admission increased the risk of in‐hospital mortality.

     

HIV Primary Care Curriculum Improves HIV Knowledge,Confidence and Attitudes

To meet the goals of the National HIV/AIDS Strategy and the need for a human immunodeficiency virus (HIV)-competent primary care workforce, education and training of nurse practitioners are critical. The University of California, San Francisco School of Nursing developed and implemented an HIV primary care curriculum and evaluated this curriculum for a graduating cohort of 55 students. Results show gains in students’ HIV knowledge and confidence in providing basic HIV care and improvements in attitudes toward people living with HIV. We have been able to show that HIV content can be successfully integrated into a nurse practitioner generalist curriculum.     

Radiologic Imaging Content in Family Nurse Practitioner Programs: A Needs Assessment

Our purpose was to assess radiologic imaging content in family nurse practitioner (FNP) curricula and FNP perspectives concerning practice needs. Anonymous, 5-item, Web-based surveys were distributed to FNP program directors (n = 21) That included items concerned FNP radiologic imaging needs in primary care. Anonymous 13-item Web-based surveys were distributed to practicing FNPs (n = 289 responses). Items assessed FNP confidence regarding radiologic imaging practice guidelines. Program directors reported radiologic imaging curricular content as critical for practice. FNPs reported radiologic imaging education was insufficient; 25% reported receiving none. Addressing FNP practice needs by enhancing FNP radiologic imaging curricula will facilitate FNP confidence and competence.     

内镜治疗急性胆源性胰腺炎的临床疗效

目的探讨内镜治疗急性胆源性胰腺炎(ABP)的临床应用价值。方法整理经内镜治疗的48例及内科保守治疗的37例ABP患者的临床资料,分析内镜治疗对ABP的临床疗效和对ABP重症化的影响。结果内镜治疗ABP可明显缩短患者病程,加速患者恢复,降低患者住院费用并能减少ABP的重症化转化。结论内镜治疗ABP可加速患者恢复,缩短住院时间,同时可抑制ABP重症化转换并降低并发症发生率,是治疗ABP的一种安全、有效的方法。     

Mnemonic to Assist in Management of Liver Cirrhosis

Cirrhosis is a challenge for nurse practitioners in terms of providing effective management. The goals of this article are to provide readers with a general view of the pathophysiological complications of cirrhosis and to describe a mnemonic to assist in its management. Using mnemonics has been shown to reduce clinical errors and improve adherence to best practices. Mnemonics provide immediate access to relevant knowledge of complex concepts. The use of a mnemonics strategy in cirrhosis acts as an aid for translating pathophysiological and pharmaco-therapeutic concepts into meaningful interventions.     

‘The team for both sides?’ A qualitative study of change in heart failure services at three acute NHS Trusts

Heart failure (HF) is an increasingly prevalent long‐term condition that affects around 900,000 people in the United Kingdom (National Institute for Health and Clinical Excellence). The study examined how HF services in the English National Health Service (NHS) were changing, focusing particularly on the primary/secondary care interface. The maintenance of continuity in care in the face of increasing demand and financial pressures on health and social care was a key concern. Semi‐structured interviews were conducted with 22 members of staff working in HF services in three NHS acute Trusts in the West Midlands of England. Interviews were conducted between April and December 2011 with purposively selected participants and data were analysed using the Framework Method. Four main themes emerged from the analysis: service context, capacity, the primary/secondary interface and communication across boundaries. Barriers to, and facilitators of, continuity of care for patients with HF were identified within these themes. The findings provide insights into the structure, management and work of HF services in the acute and community settings. They highlight how local systems for the management of HF patients are developing in ways which are not necessarily consistent with national policy.     

Development and Validation of the Primary Care Team Dynamics Survey

ObjectiveTo develop and validate a survey instrument designed to measure team dynamics in primary care.ConclusionsIt is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes).     

中药正肝汤对乙型肝炎肝硬化患者血清瘦素、脂联素水平以及胰岛素抵抗影响的分析

目的 观察中药制剂正肝汤治疗乙型肝炎(乙肝)肝硬化患者对其血清瘦素(LEP)、脂联素(ADP)水平及胰岛素抵抗(IR)的影响。方法 将入选的66例乙肝肝硬化患者随机分为对照组(31例)和治疗组(35例), 其中对照组选用肌苷片和维生素C口服治疗, 治疗组在此基础上, 应用正肝汤治疗, 疗程为3个月, 测定治疗前后患者血清LEP、ADP水平及IR指数。结果 对照组血清LEP、ADP水平和IR指数与治疗前比较, 差异无统计学意义(P>0.05);治疗组血清LEP、ADP水平和IR指数较治疗前明显下降, 差异有统计学意义(P<0.05), 治疗组血清LEP和ADP水平与对照组比较, 差异有统计学意义(P<0.05)。结论 正肝汤治疗乙肝肝硬化患者具有降低血清LEP、ADP水平, 并有改善IR的作用。