[Transient elastography technology role assessment during the diagnosis and treatment of patients with chronic hepatitis B virus infection]

Objective: To explore the role of transient elastography technology in the assessment of disease staging and treatment in patients with chronic hepatitis B virus (HBV) infection. Methods: Patients who were clinically diagnosed with chronic HBV infection at Beijing Tsinghua Changgung Hospital from January 2018 to December 2021 was collected. Liver stiffness measurement (LSM) examination was performed more than once by transient elastography. The count data were expressed as cases (%) and the χ (2) test was made. Fisher's exact test was used with theoretical frequency less than 5. The measurement data between two groups was compared by t-test. Multiple groups were compared with an analysis of variance. Results: 1 055 patients were included in this study, including 669 (63.4%) males and 386 (36.6%) females. 757 (71.8%) patients were untreated. Among the untreated patients, the LSM value in the immune clearance (10.2 ± 3.8) kPa (187 cases, 40.4%), and the reactivation stages (9.1 ± 3.4) kPa (114 cases, 24.6%) was significantly higher than that in the immune tolerance (8.7 ± 3.6) kPa (78 cases, 16.8%) and immune control stages (8.4 ± 3.5) KPa (84 cases, 18.1%), and the difference between the four groups was statistically significant (F = 5.31 and P = 0.03). With ALT (male: 30 U/L, female: 19 U/L) as defined the normal value, the LSM value in the immune tolerance and the immune control stages were (5.8 ± 0.9) kPa and (7.1 ± 2.5) kPa, respectively, which were significantly lower than those of patients in the immune tolerance and immune control stages, and the difference was statistically significant (P < 0.01). There were 294 (38.8%) patients with uncertain period, excluding patients with fatty liver. Patients with uncertain periods were divided into four gray zone (GZ) groups: immune tolerance stage: LSM (5.1 ± 1.3) kPa was significantly lower than GZ-A (6.5 ± 2.4) kPa, t = 2.06, P = 0.03, and the difference was statistically significant; immune control stage: LSM was (5.6 ± 1.5) kPa, which was also lower than GZ-C (6.8 ± 1.3) kPa, t = 3.08, P = 0.02, and the difference was statistically significant; immune clearance stage: LSM > 8.0 kPa. LSM values showed a year-by-year reduction in patients with expanded indications who started antiviral treatment and were followed up for three years. Conclusion: The LSM value is significantly lower after the decrease of the defined high-normal ALT value in patients with the immune tolerance and immune control stages of chronic HBV infection. The LSM values of GZ-A and GZ-C in the uncertain periods of chronic HBV infection are higher than those of patients in the immune tolerance and immune control stages.

Association between sleep parameters and longitudinal shortening of telomere length

Background: The relationship between sleep parameters and longitudinal shortening of telomere length is unclear. This study aimed to investigate the relationship between sleep parameters and the shortening of leukocyte telomere length (LTL) over a year.

Methods: Among the participants in the validation cohort of the Korea Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer’s Disease, participants who measured both baseline and follow-up (two years later) of LTL were analyzed. They were dichotomized according to the degree of LTL attrition over two years. Clinical characteristics were compared between the faster and slower LTL shortening groups (cut-off points: −0.710 kbp, n = 119 each). Multivariable logistic regression analyses were performed to determine independent relationships between faster shortening of LTL length and sleep parameters.

Results: A total of 238 participants, aged 55–88 years, were included. Participants with faster LTL shortening had a shorter duration of sleep (P = 0.013) and longer sleep latency (P = 0.007). Among the components of the PSQI, subjective measures of sleep quality, sleep latency, sleep duration, and sleep efficiency were significantly worse in participants with faster LTL shortening. Multivariate logistic regression analysis showed that sleep duration (per hour, OR = 0.831, 95% CI = 0.698–0.989), sleep latency (per minute, OR = 1.013, 95% CI = 1.002–1.024), global PSQI score (OR = 1.134, 95% CI = 1.040–1.236), shortest sleep duration (OR = 5.173, 95% CI = 1.563–17.126), and lowest sleep efficiency (OR = 7.351, 95% CI = 1.943–27.946) were independently associated with faster LTL shortening.

Conclusions: Poor sleep quality, specifically short sleep duration, long sleep latency, and low sleep efficiency were associated with faster longitudinal shortening of LTL.

Serum neurofilament light chain level as a predictor of cognitive stage transition

BACKGROUND

Neurofilament light chain (NFL) level has been suggested as a blood-based biomarker for neurodegeneration in dementia. However, the association between baseline NFL levels and cognitive stage transition or cortical thickness is unclear. This study aimed to investigate whether baseline NFL levels are associated with cognitive stage transition or cortical thickness in mild cognitive impairment (MCI) and cognitively unimpaired (CU) participants.

METHODS

This study analyzed data on participants from the independent validation cohort of the Korea Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's disease (KBASE-V) study. Among the participants of KBASE-V study, 53 MCI and 146 CU participants who were followed up for ≥ 2 years and had data on the serum NFL levels were eligible for inclusion in this study. Participants were classified into three groups according to baseline serum NFL levels of low, middle, or high.

RESULTS

The Kaplan-Meier analysis showed association between the serum NFL tertiles and risk of cognitive stage transition in MCI (P = 0.002) and CU (P = 0.028) participants, analyzed separately. The same is true upon analysis of MCI and CU participants together (P < 0.001). In MCI participants, the highest serum NFL tertile and amyloid-beta positivity were independent predictors for cognitive stage transition after adjusting for covariates. For CU participants, only amyloid-beta positivity was identified to be an independent predictor.

CONCLUSION

The study shows that higher serum NFL tertile levels correlate with increased risk of cognitive stage transition in both MCI and CU participants. Serum NFL levels were negatively correlated with the mean cortical thickness of the whole-brain and specific brain regions.

Increased telomere length in patients with frontotemporal dementia syndrome

BACKGROUND

Telomeres are repetitive DNA sequences of TTAGGG at the ends of chromosomes. Many studies have shown that telomere shortening is associated with aging-related diseases, such as cardiovascular diseases, hypertension, diabetes, cancer, and various neurodegenerative diseases, including Alzheimer's disease, vascular dementia, Parkinson's disease, and dementia with Lewy bodies. However, changes in telomere length (TL) in patients with frontotemporal dementia (FTD) syndrome are unclear. Accordingly, in this study, we assessed TL in blood samples from patients with FTD syndrome.

METHODS

Absolute TL was measured in peripheral blood leukocytes from 53 patients with FTD syndromes (25 with behavioral variant FTD, 19 with semantic variant primary progressive aphasia [PPA], six with nonfluent/agrammatic variant PPA, and three with amyotrophic lateral sclerosis [ALS] plus) and 28 cognitively unimpaired (CU) controls using terminal restriction fragment analysis.

RESULTS

TL was significantly longer in the FTD group than in the CU group. All FTD subtypes had significantly longer TL than controls. There were no significant differences in TL among FTD syndromes. No significant correlations were found between TL and demographic factors in the FTD group.

CONCLUSIONS

Longer telomeres were associated with FTD syndrome, consistent with a recent report demonstrating that longer telomeres are related to ALS. Therefore, our results may support a shared biology between FTD and ALS. More studies with larger sample sizes are needed.

Facility-based and home-based multidomain interventions including cognitive training, exercise, diet, vascular risk management, and motivation for older adults: a randomized controlled feasibility trial

We aimed to evaluate the feasibility of multidomain intervention (MI) tailored to the Korean context. In an outcome assessor-blinded, randomized controlled trial, participants without dementia and with one or more modifiable dementia risk factors, aged 60-79 years, were randomly assigned to the facility-based MI (FMI; n=51), the home-based MI (HMI; n=51), or the control group receiving general health advice (n=50). The 24-week intervention comprised vascular risk management, cognitive training, social activity, physical exercise, nutrition guidance, and motivational enhancement. The FMI participants performed all intervention programs at a facility three times a week. The HMI participants performed some programs at a facility once every 1-2 weeks and performed others at home. The primary outcome was feasibility measured through retention, adherence, and at least no differences from the control group in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). In the FMI and HMI groups, the retention rates were 88.2% and 96.1%, and adherence to the intervention was 94.5% and 96.8%, respectively. The RBANS total scale index score improved significantly in the FMI (5.46 ± 7.50, P = 0.004) and HMI (5.50 ± 8.14, P = 0.004) groups compared to the control group (-0.74 ± 11.51). The FMI and HMI are feasible and there are indicators of efficacy.

The role of CD8 T cells in controlling HIV beyond the antigen-specific face

OBJECTIVES

Understanding the determinants of HIV immune control is important for seeking viable HIV prevention, treatment and curative strategies. The antigen-specific roles of CD8 T cells in controlling primary HIV infection have been well documented, but their abilities to control the latent HIV reservoir is less well studied.

METHODS

The scientific literature on this issue was searched on PubMed.

RESULTS

Recent reports have demonstrated that CD8 T cells are also involved in the control of viral replication in HIV-infected individuals receiving antiretroviral therapy (ART). However, based on accumulating evidence, the antiviral role of CD8 T cells in ART patients may not be achieved via an antigen-specific manner as HIV-specific CD8 T cells can sense, but not effectively eliminate, cells harbouring intact provirus without first being activated. Our recent study indicated that virtual memory CD8 T cells, a semi-differentiated component of CD8 T cells, may be involved in the mechanism restraining the HIV DNA reservoir in ART patients.

CONCLUSIONS

In this review, we summarize recent findings on the role of CD8 T cells in controlling HIV, highlighting differences between conventional antigen-specific and innate-like CD8 T cells. A better understanding of the roles of CD8 T cells during HIV infection should benefit the informed design of immune-based treatment strategies.

Early increment of soluble triggering receptor expressed on myeloid cells 2 in plasma might be a predictor of poor outcome after ischemic stroke

Soluble triggering receptor expressed on myeloid cells 2 (sTREM2) is derived from cleavage of TREM2, which is expressed on the cell surface of microlgia and other tissue-specific macrophages. In the present study, the changes in the sTREM2 levels after ischemic stroke (IS) and their association with clinical outcomes were evaluated. A total of 43 patients diagnosed with non-cardioembolic IS between June 2011 and May 2014 were consecutively included in this study. Patients treated with intravenous thrombolysis or intra-arterial thrombectomy were excluded. Plasma samples were collected three times (days 1, 7, and 90) after ictus. The sTREM2 level was measured in the samples using the highly sensitive solid-phase proximity ligation assay (SP-PLA). Among the 43 subjects, higher initial NIH stroke scale (NIHSS) score (P = 0.005), early increment of sTREM2 (P < 0.001), and late decrement of sTREM2 (P = 0.002), were more common in patients with poor outcome. Based on multivariate analysis, initial NIHSS score (P = 0.015) and early increment of sTREM2 (P = 0.032) were independently associated with poor outcome. The results from the present study indicate that increment of sTREM2 level at the early phase was a predictor of poor outcome. Serial follow-up of sTREM2 may aid prognosis after stroke.

[Uvuplopalatal flap in OSAHS patients with anteriorand posterior pharyngeal plane stenosis]

Objective: Observation of the effect of uvuplopalatal flap for OSAHS patients with anterior and posterior pharyngeal stenosis. Method: Fifty-six patients with OSAHS who were mainly anterior posterior stenosis in the velopharyngeal plane were selected. Patients with suspending uvuplopalatal flap were used as observation group (30 cases). Patients with UPPP were used as control group (26 cases). The investigation and comparison of AHI, SaO₂, scars, throat foreign body sensation, pharynx desiccation, pharynx' s tightness, pharynx discomfort and surgical satisfaction were investigated at 6-8 months after the operation. Restul: At 6-8 months after operation, the AHI and SaO₂ of the two groups were significantly improved compared with those before operation(P<0.01). However, there were significant differences(P<0.01) among the indexes of scar formation, throat foreign body, sensation pharynx desiccation, pharynx' s tightness, pharynx discomfort and surgical satisfaction. Conclusion: In the OSAHS patients with anterior and posterior pharyngeal stenosis, the effect of UPF was better than that of UPPP among the indexes of scar formation, pharyngeal symptoms and surgical satisfaction.

[Comparison of three surgical patterns for cholecysto-choledocholithiasis]

Objective: To investigate the clinical efficiencies of the three surgical patterns in the treatment of cholecysto-choledocholithiasis (CCL). Methods: A total of 157 patients with CCL, during the period from Janury 2012 to Janury 2016 at the Affiliated Hospital of Inner Mongolia Medical University, were divided into three groups according to surgical patterns: LC-LCBDE Group (laparoscopic cholecystectomy+ laparoscopic common bile duct exploration, n=49), ERCP-LC Group (endoscopic retrograde cholangiopancreatography+ laparoscopic cholecystectomy, n=51) and OC-OCBDE Group (open cholecystectomy+ open common bile duct exploration, n=57). Simultaneously, the intraoperative, postoperative and follow-up results of all the patients were compared. Results: There were significantly differences among three groups in intraoperative blood loss[LC-LCBDE Group: (18.16±3.88) ml, ERCP-LC Group: (17.37±3.79) ml, and OC-OCBDE Group: (60.39±8.73) ml, P=0.000], operation time[LC-LCBDE Group: (118.27±8.89) min, ERCP-LC Group: (124.27±9.48) min, and OC-OCBDE Group: (94.25±6.39) min, P=0.000], surgical successful rate (LC-LCBDE Group 89.20%, ERCP-LC Group 86.93%, and OC-OCBDE Group 100%, P=0.02), intestine function recovery[LC-LCBDE Group (42.35±3.44) h, ERCP-LC Group (43.61±3.34) h, and OC-OCBDE Group (53.86±4.76) h, P=0.000], hospitalization cost[LC-LCBDE Group (18 600±1 300) yuan, ERCP-LC Group (33 300±2 000) yuan, and OC-OCBDE Group (13 800±1 900) yuan, P=0.000], serum amylase elevation (LC-LCBDE Group 1 case, ERCP-LC Group 14 cases, and OC-OCBDE Group 2 cases, P<0.01) and postoperative hospital stay (LC-LCBDE Group 5.20±0.77 d, ERCP-LC Group 4.85±0.51 d, and OC-OCBDE Group 8.55±0.71 d, P=0.000). There were no differences among three groups in postoperative biliary leakage (LC-LCBDE Group 2 cases, ERCP-LC Group 0 case, and OC-OCBDE Group 2 cases) and residual bile duct stone rate (LC-LCBDE Group 4.08%, ERCP-LC Group 5.88%, and OC-OCBDE Group 3.50%). Conclusion: All three types of surgical pattern are both efficacious and safe in the treatment of CCL. But no single pattern has absolute advantage over the other two. LC-LCBDE could preserve the function of Oddis sphincter, ERCP-LC could retain the integrity of common bile duct (CBD), and OC-OCBDE could serve as remedial measure for LC-LCBDE and ERCP-LC.

[Association between OR2T3 gene and pulmonary arterial hypertension]

OBJECTIVE

To explore the pathogenic genes of pulmonary arterial hypertension (PAH) and validate the association between OR2T3 gene and PAH.

METHODS

Whole exome sequencing was performed in four patients and one healthy person as control in two pulmonary arterial hypertension pedigree; patient-specific variations were screened by bioinformatics methods and comparison between groups. To further analyze the association between these variations and PAH, Sanger sequencing was used to analyze the genotype of patient-specific variations of 30 patients with idiopathic PAH, 90 healthy people and 30 patients with chronic thromboembolic pulmonary hypertension.

RESULTS

The preliminary findings of whole exome sequencing were 57 variations may be associated with PAH; Among them, there were 6 AG heterozygotes due to OR2T3rs148748995 in the 30 idiopathic PAH patients, while no G allele carrier was found in other healthy people of two pulmonary arterial hypertension pedigree (AⅠ-1, AⅡ-3, BⅡ-1) and 90 normal control, and the difference was statistically significant (P<0.05). The variation also didn't exist in 30 chronic thromboembolic pulmonary hypertension patients.

CONCLUSION

OR2T3 gene may be the pathogenic gene of PAH and OR2T3rs148748995 could have a role in the development of PAH.

βig-h3 CORRELATES WITH RELATED FACTORS OF PERITONEAL METASTASIS OF GASTRIC CANCER

βig-h3 is an extracellular matrix protein induced by transforming growth factor-β1 (TGF-β1) and involved in adhesion between cell and cell, cell and matrix. It has been proved that βig-h3 is highly expressed in human lung cancer and colorectal cancer cells, and thus it is considered to have the same effect on gastric cancer cells. This research applied histochemical staining and RT-PCR to detect the content of βig-h3 in peritoneal mesothelial cells and the content of carcino embryonic antigen (CEA) mRNA in abdominal dropsy or peritoneal washing liquid, in order to explore the relationship between the factors of peritoneal metastasis of gastric cancer and βig-h3. It was found that the positive ratio of βig-h3 in the gastric cancer group was higher than that in the benign disease group, and the positive rate of immunohistochemistry was closely related to the relative factors of peritoneal metastasis such as tumor infiltration depth, serosal types, macroscopic peritoneal metastasis, CEA mRNA, results of pleural lavage cytology (PLC) examination, etc. Research found that βig-h3 expressed distinctly in gastric cancer peritoneal metastasis, therefore, it is useful for monitoring biological behavior of gastric cancer.

Protective effect of DA-9601, an extract ofArtemisiae Herba, against naproxen-induced gastric damage in arthritic rats

Gastrointestinal irritation is the most frequent adverse effect in patients chronically taking nonsteroidal antiinflammatory drugs (NSAIDs) for the treatment of arthritic conditions. Gastroprotective effect of DA-9601, a new antiulcer agent fromArtemisiae Herba extract, against NSAID was evaluated in a rat model of arthritis that is similar in many aspects to human rheumatoid arthritis. Daily oral dosing of naproxen (30 mg/kg), one of the most commonly used NSAID, induced apparent gastric lesions as well as a significant decrease in mucosal prostaglandin E(2) (PGE(2)) and prostaglandin F(1alpha) (PGF(1alpha)) levels. Coadministration of DA-9601 prevents naproxen-induced mucosal injury and depletion, of prostaglandins, in a dose-related manner. DA-9601 did not alter the antiinflammatory or analgesic effect of naproxen. The present results suggest that DA-9601 may be useful as a mucoprotectant against NSAIDs in clinical practice.

Study of flow characteristics in a secondary clarifier by numerical simulation and radioisotope tracer technique

Numerical simulation in a 2-D rectangular coordinate and experimental study have been performed to figure out the flow characteristics and concentration distribution of a large-scale rectangular final clarifier in wastewater treatment facility located in Busan, S. Korea. The purpose of numerical calculation is to verify the experimentally measured data by radioisotope tracer technique and further to understand the important physical feature occurring in a large-scale clarifier, in many cases which is not sufficient by the aid of limited number of experimental data. To this end, a comprehensive computer program is basically made by SIMPLE algorithm by Patankar with the special emphasis on the parametric evaluation of the various phenomenological models. Calculation results are successfully evaluated against experimental data obtained by the method of radioisotope tracer. Detailed comparison is made on the calculated residence time distribution (RTD) curves with measurement inside the clarifier as well as the exhaust. Further the calculation results predict well the well-known characteristics of clarifier flow such as the waterfall phenomenon at the front end of the clarifier, the bottom density current in the settling zone and the upward flow in the withdrawal zone. Thus it is believed that the flow calculation program and the data incorporation technique of radioisotope measurement employed in this study show the high possibility as a complementary tool of experiment in this area.

False-Positive Outcome and Drug Residue in Milk Samples Over Withdrawal Times

This study was conducted to identify false-positive outcomes and drug residues in milk samples over withdrawal times and to determine whether the positive results were caused by drug residues or natural inhibitors. A total of 73 milk samples over withdrawal times after the last intramammary infusion were collected from each treated quarter of cows and tested using the Delvotest SP assay. Reading time was 150, 165, and 180 min, and results of samples were recorded according to the color of the well containing the control milk sample. There were 24, 20, and 12 positive samples at the reading times of 150, 165, and 180 min, respectively. All 24 positive milk samples were heated at 82 degrees C for 5 min and retested to verify that the positive results were caused by drug residues or natural inhibitors. Twenty-one samples that exhibited positive results were negative after heat treatment, and drug residues were not identified by LacTek and Charm tests. However, 3 samples that exhibited positive results from heat treatment of 82 degrees C were positive for drugs. In our study, most positive results (89%) in the milk samples over withdrawal times were false-positive results by natural inhibitors. Moreover, the heat treatment is a fast, simple, and inexpensive method to remove false-positive results and has no effect on positive samples containing drugs. We suggest that heat treatment before screening tests is an effective way to reduce false-positive results in the milk samples.

Difference in Protein Expression in Vero Cells after Antisense-blocking Genes Involved in the Suppression of Non-targeted Mutagenesis

A cDNA fragment (fragment 9) has been isolated by mRNA differential display and antisense technology in this lab, and its relevant gene (fragment 9 related gene, FNR gene) might be involved in the inhibition of non-targeted mutagenesis induced by N -methyl- N ' -nitro-N-nitrosoguanidine(MNNG) in mammalian cells. In order to elucidate the functional mechanism of the FNR gene, the protein expression was compared between MNNG-exposed Vero cells transfected with antisense RNA expression plasmid (Vero-pM-amp(-)-9(-)) and those with vector DNA (Vero-pM-amp(-)), by using two-dimensional gel electrophoresis followed by 2D image software analysis. Our analysis indicated that 12 proteins were specifically expressed only in Vero-pM-amp(-)-9(-), and 2 proteins in Vero-pM-amp(-). In addition,there were 24 proteins expressed in higher level in Vero-pM-amp(-)-9(-) as compared with Vero-pM-amp(-)( P <0.05), among them the expression of 7 proteins were enhanced by greater than 5 folds. These results suggest that antisense blocking the FNR gene expression triggered a series of alteration of other gene expression and the FNR gene might be a regulatory factor. This study will also facilitate the identification and characterization of these proteins and corresponding genes involved in the non-targeted mutagenesis.

Mapping dispersed repetitive loci using semi-specific PCR cloning and somatic cell hybrid mapping

A simple and effective method based upon semi-specific PCR followed by cloning has been developed. Chromosomal mapping of the generated fragment on a somatic cell hybrid panel identifies the chromosomal position, and yields a unique sequence tag for the site. Using this method, the chromosomal location of one porcine endogenous retrovirus (PERV) was determined. The porcine genomic sequences were first amplified by PCR using a PERV-specific primer and a porcine short interspersed nuclear element (SINE)-specific primer. PCR products were cloned, and those sequences that contained PERV plus flanking regions were selected using a second round of PCR and cloning. Sequences flanking the PERV were determined and a PERV-B was physically mapped on porcine chromosome 17 using a somatic hybrid panel. The general utility of the method was subsequently demonstrated by locating PERVs in the genome of PERV infected human 293 cells. This method obviates the need for individual library construction or linker/adaptor ligation, and can be used to quickly locate individual sites of moderately repeated, dispersed DNA sequences in any genome.

Molecular characterization of multidrug-resistant Streptococcus pneumoniae isolates in Korea. The Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study Group

Pulsed-field gel electrophoresis, ribotyping, and fingerprinting analysis of 22 invasive isolates of multidrug-resistant (MDR) pneumococci from Korea showed that 59 to 82% were genetically related. DNA sequencing of the PBP 2B gene showed relatively uniform alterations in nucleotides (5.4 to 7.8%) and amino acids (3.0 to 4. 3%), while Asn-276-->Lys, Arg-285-->Cys and Ser-305-->Phe substitutions were unique to Korean MDR strains, suggesting the spread of a few epidemic clones of resistant pneumococci within Korea.

Analysis of the precore and core promoter DNA sequence in liver tissues from patients with hepatocellular carcinoma

To investigate the role of mutant hepatitis B virus (HBV) in the development of hepatocellular carcinoma (HCC), 20 patients with HCC were studied for precore and core promoter mutations in tumorous and nontumorous tissues. The precore and core promoter region was amplified and analyzed by direct sequencing. Among the 20 tumorous and nontumorous tissues, precore mutant HBV was found in 12 (60%) and 18 (90%), respectively. Of the 12 tumorous tissues with precore mutant, nine tissues had a single mutation (1896) and one tissue had another single mutation (1899). The remaining two tissues had a double mutation (1896 and 1899). A single mutation (1896) and a single mutation (1899) were found in 11 and two of the 18 nontumorous tissues with precore mutant, respectively. Among 20 tumorous and nontumorous tissues, HBV with a C to T mutation at nucleotide (nt) 1846 was detected in six and eight, respectively, and was associated with the virus carrying a mutation (1896 or 1899) except in two tumorous tissues. Mutations at nt 1762 and 1764 in core promoter were observed in 16 (80%) tumorous tissues and 18 (90%) nontumorous tissues. Mutations in the precore and core promoter region were found frequently in nontumorous tissue and in tumorous tissue (18/20 and 12/20 in precore region, 18/20 and 16/20 in core promoter respectively). The high prevalence of precore and core promoter mutations in liver tissue from patients with HCC suggests that these mutations may contribute to the development of HCC.

Safety and tolerability of cyclosporine microemulsion versus cyclosporine: two-year data in primary renal allograft recipients: a report of the Neoral Study Group

BACKGROUND

The new microemulsion formulation of cyclosporine (CsA-ME) is more bioavailable than cyclosporine (CsA) in de novo renal transplant patients. Therefore, it was of interest to compare the safety profile of each formulation in such patients.

METHODS

In a multicenter, double-blind, parallel-group study, 101 renal transplant recipients were randomized after transplantation to receive either CsA (n=50) or CsA-ME (n=51) capsules twice daily for 2 years. Of these patients, 54 (CsA, n=26; CsA-ME, n=28) completed 1 year of the study and entered the second-year, double-blind extension. Initial dose at the time of transplantation was 5 mg/kg b.i.d.; doses were titrated to target trough levels.

METHODS

The mean (+/- SD) doses at the end of 2 years were 4.6 +/- 1.8 and 3.8 +/- 1.1 mg/kg per day for CsA- and CsA-ME-treated patients, respectively. The mean (+/- SD) CsA trough levels at end point were 187 +/- 63 and 210 +/- 95 ng/ml for CsA- and CsA-ME-treated patients, respectively. At least one adverse event was reported by 25/26 (96%) of CsA- and 27/28 (96%) of CsA-ME-treated patients. No patient discontinued the study because of adverse events. No deaths occurred during the study. Renal function, as measured by serum creatinine levels, and blood pressure were comparable over time in both treatment groups.

CONCLUSIONS

There was no significant difference in safety and tolerability between CsA- and CsA-ME-treated kidney recipients for 2 years after transplantation.

The safety and tolerability of cyclosporine emulsion versus cyclosporine in a randomized, double-blind comparison in primary renal allograft recipients. The Neoral Study Group

A 12-week, randomized, double-blind, multicenter pharmacokinetics study was conducted to compare the clinical safety and tolerability of cyclosporine capsules and oral solution for microemulsion and cyclosporine in 101 primary renal transplant recipients Cyclosporine emulsion has more complete absorption and improved bioavailability compared with cyclosporine, and dosing of both cyclosporine formulations was adjusted to achieve comparable whole-blood trough levels. Mean serum creatinine values were higher in the cyclosporine emulsion group at baseline, 8, and 12 weeks (P<0.05). The incidence of acute rejection was similar in both treatment groups although fewer patients required monoclonal antibody therapy in the cyclosporine group (31% vs. 82%, respectively). Despite the increased bioavailability of cyclosporine emulsion, no significant differences in the incidence of adverse events were observed; the safety, tolerability, and efficacy of cyclosporine emulsion and cyclosporine were comparable.

Five-year follow-up of immune response to hepatitis B vaccine in juveniles

The persistence of anti-HBs was investigated in 95 juveniles who received plasma-derived HBV vaccine (vaccine group) and 63 counterparts who got anti-HBs from natural HBV infection (infection group) for a period of five years. The positive rates of anti-HBs from the first to fifth year in the vaccine group are 97.89%, 98.95%, 81.05%, 78.95% and 72.63% respectively with one recipient remaining anti-HBs negative after being immunized with three dosages of 10 micrograms plasma-derived HBV vaccine in 0, 1st, 2nd month and the mean S/N values (GMV) are 30.94, 22.18, 13.61, 12.02 and 9.18 respectively. There are 26 recipients whose anti-HBs turned from positive to negative at the end of the study with a negative rate of 27.37%. The S/N GMVs in the infection group are 36.37, 27.33, 24.08 at the first, third and fifth year of the study, respectively. Both the S/N GMV and negative rate are lower than that of the vaccine group (P < 0.01). No one was found to have positive HBsAg or elevated ALT in both groups. Questions such as immune dosage, immune program and booster immunization in juvenile population are discussed.