Recurrence of hepatitis C virus(HCV)infection following liver transplantation(LT)is almost universal and can accelerate graft cirrhosis in up to 30%of patients.The development of effective strategies to treat or preve...Recurrence of hepatitis C virus(HCV)infection following liver transplantation(LT)is almost universal and can accelerate graft cirrhosis in up to 30%of patients.The development of effective strategies to treat or prevent HCV recurrence after LT remains a major challenge,considering the shortage of donor organs and the accelerated progression of HCV in LT recipients.Standard antiviral therapy with pegylated-interferon plus ribavirin is the current treatment of choice for HCV LT recipients,even though the combination is not as effective as it is in immunocompetent patients.A sustained virological response in the setting of LT improves patient and graft survival,but this is only achieved in 30%-45%of patients and the treatment is poorly tolerated.To improve the efficacy of pre-and post-transplant antiviral therapy,a new class of potent direct-acting antiviral agents (DAAs)has been developed.The aim of this review is to summarize the use of DAAs in LT HCV patients.PubMed,Cochrane Library,MEDLINE,EMBASE,Web of Science and clinical trial databases were searched for this purpose.To date,only three clinical studies on the topic have been published and most of the available data are in abstract form.Although a moderately successful early virological response has been reported,DAA treatment regimens were associated with severe toxicity mitigating their potential usefulness.Moreover,the ongoing nature of data,the lack of randomized studies,the small number of enrolled patients and the heterogeneity of these studies make the results largely anecdotal and questionable.In conclusion,large welldesigned clinical studies on DAAs in HCV LT patients are required before these drugs can be recommended after transplantation.展开更多
AIM:To evaluate the safety of adding ketoprofen to pegylated-interferon(PEG-IFN)with or without ribavirin and the effect on viral kinetics,STAT1 activity and expression of 2'-5'-oligoadenylate synthetase (2...AIM:To evaluate the safety of adding ketoprofen to pegylated-interferon(PEG-IFN)with or without ribavirin and the effect on viral kinetics,STAT1 activity and expression of 2'-5'-oligoadenylate synthetase (2'-5'OAS)in genotype 1 chronic hepatitis C in a phaseⅡstudy. METHODS:Forty-five patients were studied:fifteen were randomized to PEG-IFN plus ribavirin(PR),16 to PEGIFN plus ketoprofen and 14 to PR and ketoprofen.Themolecular study of IFN-dependent signal transduction was conducted in 9 patients from each group. RESULTS:The combination of ketoprofen and PEG- IFN with or without ribavirin was safe and well tolerated.An early activation of STAT1 was observed in ke-toprofen-treated patients,but this activation was less sustained over time.Conversely,ketoprofen plus PEG- IFN and ribavirin induced an early and sustained increase of 2'-5'OAS transcription starting 24 h after the first dose until the 36th wk.These data are consistent with the clinical results,showing a better sustained virological response and a lower relapse rate in patients receiving ketoprofen plus PEG-IFN and ribavirin. CONCLUSION:The addition of ketoprofen to the standard therapy of chronic hepatitis C should be explored in larger randomized clinical studies.展开更多
Introduction and Aim: Vitamin K acupuncture point injection is an effective and safe menstrual pain treatment derived from Traditional Chinese Medicine, commonly used in some Chinese hospitals. This case series invest...Introduction and Aim: Vitamin K acupuncture point injection is an effective and safe menstrual pain treatment derived from Traditional Chinese Medicine, commonly used in some Chinese hospitals. This case series investigated the effectiveness and safety of vitamin K acupuncture point injection on menstrual pain in patients with severe primary dysmenorrhea at a regional public health clinic at Bologna, Italy. Methods: From September 2006 to July 2010, 24 women were enrolled and treated during their first day of menstrual pain with an injection of 1 ml of solution containing 5 mg of vitamin K1 in an acupuncture point San Yin Jiao/Spleen 6 (SP6) bilaterally on the inside of each lower leg above the ankle. Results: Treatment was well tolerated and no major adverse events were reported. Pain relief was observed starting from 2 minutes after treatment and within 30 minutes. All treated women but one (96%) reported a substantial pain reduction (p 0.001). During the six post-treatment follow-up cycles, a trend toward a reduction of menstrual distress evaluated by the Cox Pain Intensity and Duration Scales was documented. Women reported fewer daily life restrictions and consumption of fewer analgesic tablets when compared to what they reported at the pre-treatment cycle. Conclusions: The results of this case series indicate that in primary dysmenorrhea a single vitamin K1 injection in the SP6 acupuncture point has an immediate pain-relieving effect and may ameliorate menstrual pain intensity and duration in post-treatment follow-up cycles.展开更多
文摘Recurrence of hepatitis C virus(HCV)infection following liver transplantation(LT)is almost universal and can accelerate graft cirrhosis in up to 30%of patients.The development of effective strategies to treat or prevent HCV recurrence after LT remains a major challenge,considering the shortage of donor organs and the accelerated progression of HCV in LT recipients.Standard antiviral therapy with pegylated-interferon plus ribavirin is the current treatment of choice for HCV LT recipients,even though the combination is not as effective as it is in immunocompetent patients.A sustained virological response in the setting of LT improves patient and graft survival,but this is only achieved in 30%-45%of patients and the treatment is poorly tolerated.To improve the efficacy of pre-and post-transplant antiviral therapy,a new class of potent direct-acting antiviral agents (DAAs)has been developed.The aim of this review is to summarize the use of DAAs in LT HCV patients.PubMed,Cochrane Library,MEDLINE,EMBASE,Web of Science and clinical trial databases were searched for this purpose.To date,only three clinical studies on the topic have been published and most of the available data are in abstract form.Although a moderately successful early virological response has been reported,DAA treatment regimens were associated with severe toxicity mitigating their potential usefulness.Moreover,the ongoing nature of data,the lack of randomized studies,the small number of enrolled patients and the heterogeneity of these studies make the results largely anecdotal and questionable.In conclusion,large welldesigned clinical studies on DAAs in HCV LT patients are required before these drugs can be recommended after transplantation.
文摘AIM:To evaluate the safety of adding ketoprofen to pegylated-interferon(PEG-IFN)with or without ribavirin and the effect on viral kinetics,STAT1 activity and expression of 2'-5'-oligoadenylate synthetase (2'-5'OAS)in genotype 1 chronic hepatitis C in a phaseⅡstudy. METHODS:Forty-five patients were studied:fifteen were randomized to PEG-IFN plus ribavirin(PR),16 to PEGIFN plus ketoprofen and 14 to PR and ketoprofen.Themolecular study of IFN-dependent signal transduction was conducted in 9 patients from each group. RESULTS:The combination of ketoprofen and PEG- IFN with or without ribavirin was safe and well tolerated.An early activation of STAT1 was observed in ke-toprofen-treated patients,but this activation was less sustained over time.Conversely,ketoprofen plus PEG- IFN and ribavirin induced an early and sustained increase of 2'-5'OAS transcription starting 24 h after the first dose until the 36th wk.These data are consistent with the clinical results,showing a better sustained virological response and a lower relapse rate in patients receiving ketoprofen plus PEG-IFN and ribavirin. CONCLUSION:The addition of ketoprofen to the standard therapy of chronic hepatitis C should be explored in larger randomized clinical studies.
文摘Introduction and Aim: Vitamin K acupuncture point injection is an effective and safe menstrual pain treatment derived from Traditional Chinese Medicine, commonly used in some Chinese hospitals. This case series investigated the effectiveness and safety of vitamin K acupuncture point injection on menstrual pain in patients with severe primary dysmenorrhea at a regional public health clinic at Bologna, Italy. Methods: From September 2006 to July 2010, 24 women were enrolled and treated during their first day of menstrual pain with an injection of 1 ml of solution containing 5 mg of vitamin K1 in an acupuncture point San Yin Jiao/Spleen 6 (SP6) bilaterally on the inside of each lower leg above the ankle. Results: Treatment was well tolerated and no major adverse events were reported. Pain relief was observed starting from 2 minutes after treatment and within 30 minutes. All treated women but one (96%) reported a substantial pain reduction (p 0.001). During the six post-treatment follow-up cycles, a trend toward a reduction of menstrual distress evaluated by the Cox Pain Intensity and Duration Scales was documented. Women reported fewer daily life restrictions and consumption of fewer analgesic tablets when compared to what they reported at the pre-treatment cycle. Conclusions: The results of this case series indicate that in primary dysmenorrhea a single vitamin K1 injection in the SP6 acupuncture point has an immediate pain-relieving effect and may ameliorate menstrual pain intensity and duration in post-treatment follow-up cycles.
