Chronic liver disease rarely follows acute hepatitis B in non-immunocompromised adults

Summary The risk of developing a chronic carriage state after acute hepatitis B infection in adults was evaluated. Two hundred and eighty-nine HBV-susceptible heterosexual partners of acute hepatitis B patients were used to investigate the effectiveness of post-exposure immunoprophylaxis; 75 of them received hepatitis B vaccine, 72 hepatitis B hyperimmune globulin (HBIG), 71 vaccine plus HBIG and 71 placebo. Participants were interviewed, clinically examined and serum specimens were taken at 1, 3, 6 and 9 months after their first intervention. Serum samples were tested for ALT and HBV markers (HBsAg, anti-HBc and anti-HBs) using radio immunoassays. Forty-six (15.9%) of the heterosexual partners examined were infected; the incidence of HBV infections was higher among placebo (18.3%, 13/71) and HBIG (18.1%, 13/72) recipients compared to vaccine (16.0%, 12/75) and HBIG plus vaccine (11.3%, 8/71) recipients, but the differences were not statistically significant. Infections were significantly more often subclinical after immunoprophylaxis (p=0.03). HBsAg was detected in all eight clinical and in 13 of the 38 subclinical cases. In the remaining 25 subclinical cases HBV infections were diagnosed by the development of anti-HBc and anti-HBs during the follow-up period. Finally, all 46 cases studied cleared the HBsAg.

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Bei Erwachsenen ohne Abwehrstörung geht die B-Hepatitis nur selten in eine chronische Lebererkrankung über

Zusammenfassung Die Entwicklung eines chronischen Trägerstatus wurde bei 289 für eine HBV-Infektion empfänglichen heterosexuellen Partnern von Patienten mit akuter Hepatitis B verfolgt, bei denen die Wirksamkeit einer postexpositionellen Immunprophylaxe geprüft wurde. Bei 75 Personen wurde Hepatitis B-Vakzine eingesetzt, bei 72 Hyperimmunglobulin (HBIG), bei 71 Vakzine plus HBIG und bei 71 Placebo. Anamnestische Befragung und Nachuntersuchungen erfolgten jeweils 1, 3, 6 und 9 Monate nach der ersten Intervention. Serumspiegel von ALT und HBV-Markern (HBsAg, anti-HBc und anti-HBs) wurden mittels Radioimmunoassay bestimmt. Insgesamt hatten 46 der heterosexuellen Partner die HBV-Infektion erworben (15,9%). Nach Placebogabe waren 13/71 (18,3%) mit HBV infiziert, nach HBIG 13/72 (18,1%). Die Infektionraten waren nach Vakzine (12/75; 16%) sowie nach HBIG plus Vakzine (8/71; 11,3%) neidriger, jedoch war der Unterschied nicht statistisch signifikant. Nach Immunprophylaxe verliefen die Infektionen signifikant häufiger subklinisch als nach Placebogabe (p=0,03). HBsAg war in allen acht Fällen einer klinischen und in 13 von 38 Fällen einer subklinischen HBV-Infektion nachzuweisen. In den übrigen 25 subklinischen Fällen wurde die HBV- Infektion durch das Auftreten von anti-HBc und anti-HBs im Verlauf der Beobachtungszeit diagnostiziert. In allen 46 Fällen wurde HBsAg schließlich eliminiert.

     

Double versus single cervical cerclage for the prevention of preterm births

Objective: To evaluate the effectiveness double cervical cerclage in reducing antenatal complications and improve perinatal outcomes.

Methods: We searched Medline, Scopus, Clinicaltrials.org, The Cochrane Central Register of Controlled Trials and Google Scholar search engines.

Results: Six studies were included that involved 880 women. Double cerclage was significantly superior to single cerclage in reducing preterm births <34?weeks (734 cases, OR 0.59, 95% CI 0.40, 0.86) and preterm births <28?weeks (645 cases, OR 0.43, 95% CI 0.26–0.73). It also significantly increased the gestational age (380 cases, MD 2.63, 95% CI 0.87, 4.39). However, as a technique, it failed to improve the rates of preterm births <37?weeks (740 cases, OR 0.98, 95% CI 0.72, 1.34) the incidence of chorioamnionitis (740 cases, OR 0.83, 95% CI 0.51, 1.36) and the occurrence of preterm premature rupture of the membranes (796 cases, OR 1.32, 95% CI 0.95, 1.82).

Conclusions: It seems that double cerclage effectively increases the gestational age at delivery and decreases the rates of extremely premature births. However, as a procedure, it does not reduce the incidence of antenatal morbidity or the neonatal death rates. Further research is needed in the field as our meta-analysis is limited by the small number of enrolled studies.     

Stochastic resonance stimulation improves balance in children with cerebral palsy: a case control study

Background

Stochastic Resonance (SR) Stimulation has been used to enhance balance in populations with sensory deficits by improving the detection and transmission of afferent information. Despite the potential promise of SR in improving postural control, its use in individuals with cerebral palsy (CP) is novel. The objective of this study was to investigate the immediate effects of electrical SR stimulation when applied in the ankle muscles and ligaments on postural stability in children with CP and their typically developing (TD) peers.

Methods

Ten children with spastic diplegia (GMFCS level I- III) and ten age-matched TD children participated in this study. For each participant the SR sensory threshold was determined. Then, five different SR intensity levels (no stimulation, 25, 50, 75, and 90% of sensory threshold) were used to identify the optimal SR intensity for each subject. The optimal SR and no stimulation condition were tested while children stood on top of 2 force plates with their eyes open and closed. To assess balance, the center of pressure velocity (COPV) in anteroposterior (A/P) and medial-lateral (M/L) direction, 95% COP confidence ellipse area (COPA), and A/P and M/L root mean square (RMS) measures were computed and compared.

Results

For the CP group, SR significantly decreased COPV in A/P direction, and COPA measures compared to the no stimulation condition for the eyes open condition. In the eyes closed condition, SR significantly decreased COPV only in M/L direction. Children with CP demonstrated greater reduction in all the COP measures but the RMS in M/L direction during the eyes open condition compared to their TD peers. The only significant difference between groups in the eyes closed condition was in the COPV in M/L direction.

Conclusions

SR electrical stimulation may be an effective stimulation approach for decreasing postural sway and has the potential to be used as a therapeutic tool to improve balance. Applying subject-specific SR stimulation intensities is recommended to maximize balance improvements. Overall, balance rehabilitation interventions in CP might be more effective if sensory facilitation methods, like SR, are utilized by the clinicians.

Trial registration

ClinicalTrials.gov identifier NCT02456376; 28 May 2015 (Retrospectively registered); https://clinicaltrials.gov/ct2/show/NCT02456376.

     

Hydrophobicity of Lipid-Conjugated siRNAs Predicts Productive Loading to Small Extracellular Vesicles

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Optimized Cholesterol-siRNA Chemistry Improves Productive Loading onto Extracellular Vesicles

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Biology‐Driven Gene‐Gene Interaction Analysis of Age‐Related Cataract in the eMERGE Network

Bioinformatics approaches to examine gene‐gene models provide a means to discover interactions between multiple genes that underlie complex disease. Extensive computational demands and adjusting for multiple testing make uncovering genetic interactions a challenge. Here, we address these issues using our knowledge‐driven filtering method, Biofilter, to identify putative single nucleotide polymorphism (SNP) interaction models for cataract susceptibility, thereby reducing the number of models for analysis. Models were evaluated in 3,377 European Americans (1,185 controls, 2,192 cases) from the Marshfield Clinic, a study site of the Electronic Medical Records and Genomics (eMERGE) Network, using logistic regression. All statistically significant models from the Marshfield Clinic were then evaluated in an independent dataset of 4,311 individuals (742 controls, 3,569 cases), using independent samples from additional study sites in the eMERGE Network: Mayo Clinic, Group Health/University of Washington, Vanderbilt University Medical Center, and Geisinger Health System. Eighty‐three SNP‐SNP models replicated in the independent dataset at likelihood ratio test P < 0.05. Among the most significant replicating models was rs12597188 (intron of CDH1)–rs11564445 (intron of CTNNB1). These genes are known to be involved in processes that include: cell‐to‐cell adhesion signaling, cell‐cell junction organization, and cell‐cell communication. Further Biofilter analysis of all replicating models revealed a number of common functions among the genes harboring the 83 replicating SNP‐SNP models, which included signal transduction and PI3K‐Akt signaling pathway. These findings demonstrate the utility of Biofilter as a biology‐driven method, applicable for any genome‐wide association study dataset.     

Fluid resuscitation in pre-hospital management of septic shock

Background

Septic shock is associated with hypovolemia resulting in organs failure and poor prognosis. The first step in hemodynamic resuscitation relies on early fluid expansion. In this study, we describe qualitative and quantitative fluid resuscitation of septic shock initially managed in a pre-hospital setting by a mobile intensive care unit.