Around 450 cases of acute severe hepatitis of unknown origin in children have been reported in 21 countries and region globally since April 2022,which has exceeded the past annual incidences of related regions,and has...Around 450 cases of acute severe hepatitis of unknown origin in children have been reported in 21 countries and region globally since April 2022,which has exceeded the past annual incidences of related regions,and has aroused wide concern.Affected patients were predominantly children under 16years of age,presented with symptoms of acute hepatitis with markedly elevated liver enzymes,and had been ruled out of common viral infections such as hepatitis A,B,C,D,and E.Similar cases have not been reported in China yet.However,considering that the severe acute hepatitis has involved worldwide areas,still with unknown origin,and incidences of severity is relatively high,we formulated this recommendation to standardize diagnosis and treatment of acute severe hepatitis of unknown origin in Peking Union Medical College Hospital,to get fully prepared to the possible public health events.展开更多
BACKGROUND The lymphocyte-to-white blood cell ratio(LWR)is a blood marker of the systemic inflammatory response.The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure(...BACKGROUND The lymphocyte-to-white blood cell ratio(LWR)is a blood marker of the systemic inflammatory response.The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)remains unclear.AIM To explore whether LWR could stratify the risk of poor outcomes in HBV-ACLF patients.METHODS This study was conducted by recruiting 330 patients with HBV-ACLF at the Department of Gastroenterology in a large tertiary hospital.Patients were divided into survivor and non-survivor groups according to their 28-d prognosis.The independent risk factors for 28-d mortality were calculated by univariate and multivariate Cox regression analyses.Patients were divided into low-and high-LWR groups according to the cutoff values.Kaplan-Meier analysis was performed according to the level of LWR.RESULTS During the 28-d follow-up time,135 patients died,and the mortality rate was 40.90%.The LWR level in non-surviving patients was significantly decreased compared to that in surviving patients.A lower LWR level was an independent risk factor for poor 28-d outcomes(hazard ratio=0.052,95%confidence interval:0.005-0.535).The LWR level was significantly negatively correlated with the Child-Turcotte-Pugh,model for end-stage liver disease,and Chinese Group on the Study of Severe Hepatitis B-ACLF II scores.In addition,the 28-d mortality was higher for patients with LWR<0.11 than for those with LWR≥0.11.CONCLUSION LWR may serve as a simple and useful tool for stratifying the risk of poor 28-d outcomes in HBVACLF patients.展开更多
Severe alcoholic hepatitis(AH)is a distinct entity in the spectrum of alcoholrelated liver disease,with limited treatment options and high mortality.Supportive medical care with corticosteroids in selected patients is...Severe alcoholic hepatitis(AH)is a distinct entity in the spectrum of alcoholrelated liver disease,with limited treatment options and high mortality.Supportive medical care with corticosteroids in selected patients is the only currently available treatment option,often with poor outcomes.Based on the insights into the pathogenetic mechanisms of AH,which are mostly obtained from animal studies,several new treatment options are being explored.Studies have implicated impaired and deranged liver regeneration processes as one of the culprit mechanisms and a potential therapeutic target.Acknowledging evidence for the beneficial effects of granulocyte colony-stimulating factor(G-CSF)on liver regeneration and immunomodulation in animal models,several human studies investigated its role in the treatment of advanced alcohol-related liver disease and AH.Contrary to the previously published studies suggesting benefits of G-CSF in the outcomes of patients with severe AH,these effects were not confirmed by a recently published multicenter randomized trial,suggesting that other options should rather be pursued.Stem cell transplantation represents another option for improving liver regeneration,but evidence for its efficacy in patients with severe AH and advanced alcohol-related liver disease is still very scarce and unconvincing,with established lack of efficacy in patients with compensated cirrhosis.In this review,we summarize the current knowledge on the pathogenesis and experimental therapies targeting liver regeneration.The lack of high-quality studies and evidence is a major obstacle in further treatment development.New insights into the pathogenesis of not only liver injury,but also liver regeneration processes are mandatory for the development of new treatment options.A reliable experimental model of the pathogenesis of AH and processes involved in liver recovery is still missing,and data obtained from animal studies are essential for future research.展开更多
To the Editor:I read the paper by Chen et al[1]with great interest.The authors performed a retrospective study to evaluate the short-term efficacy of antiviral therapy
Objective:Research on nursing method of artificial liver support system applied in severe hepatitis patients.Methods:Selected 50 severe hepatitis patients in our hospital during the period of January 2018 and January ...Objective:Research on nursing method of artificial liver support system applied in severe hepatitis patients.Methods:Selected 50 severe hepatitis patients in our hospital during the period of January 2018 and January 2019,observed and analyzed the clinical intervention effect of all treated by artificial liver support system cooperating with related nursing methods.Results:After the treatment,the clinical symptoms and abdominal distension of the patients were relieved,whose spirit took a turn for the better and the jaundice subsided.Among these patients,68%got improved enough to be released,26.00%gave up for financial concerns and 6.00%died.Before and after treatment,the patients’PT and INR,APTT,TT improved obviously,and the difference were quite a lot(P<0.05),while ALT and ALB showed few without any statistical significance(P>0.05).Conclusion:During the treatment and intervention of severe hepatitis patients with artificial liver support system,effective nursing interventions are needed,mainly including completely preoperative,intraoperative and postoperative care so as to ensure the treatment effect and promote the recovery of intervention,which has remarkable significance to clinical development.展开更多
Hepatitis A virus(HAV)infection is still an important health issue worldwide.Although several effective HAV vaccines are available,it is difficult to perform universal vaccination in certain countries.Therefore,it may...Hepatitis A virus(HAV)infection is still an important health issue worldwide.Although several effective HAV vaccines are available,it is difficult to perform universal vaccination in certain countries.Therefore,it may be better to develop antivirals against HAV for the prevention of severe hepatitis A.We found that several drugs potentially inhibit HAV internal ribosomal entry site-dependent translation and HAV replication.Artificial intelligence and machine learning could also support screening of anti-HAV drugs,using drug repositioning and drug rescue approaches.展开更多
Since October 2021 in Alabama,the United States,and March 2022 in central Scotland,the United Kingdom,the number of cases of severe acute hepatitis of unknown etiology/causes in children was found to increase,and the ...Since October 2021 in Alabama,the United States,and March 2022 in central Scotland,the United Kingdom,the number of cases of severe acute hepatitis of unknown etiology/causes in children was found to increase,and the total number of cases has reached 920 worldwide by June 22 this year,45 cases(5%)required liver transplantation,and 18 cases(2%)died according to World Health Organization(WHO).To understand the basic characteristics of this disease/syndrome,a literature search was performed at PubMed,websites of WHO,UK Health Security Agency,and US and European Centers for Disease Control and Prevention,and more than 20 reports were enrolled as references for this review.The main clinical manifestations are anorexia,vomiting,fatigue,jaundice,and so forth.Most of the cases seemed to have a self-limited course of the disease,about 6%of cases may develop life-threatening acute liver failure.The disease seems to be transmissible from person to person.Human adenovirus was detected in up to 75%of cases,but this virus seems not to be the only and major etiologic agent,other cofactors probably are involved.Researchers proposed many hypotheses concerning the etiology and pathogenesis,and many important works and studies are ongoing.This mini-review is aimed at summarizing,reviewing,and further understanding the characteristics of the disease,raising some clinically relevant questions,and trying to discuss some questions that may be related to the treatment of the disease for consideration.展开更多
Recently,cases of severe acute hepatitis of unknown cause(SAHUC)in children have suddenly increased in the United States,the United Kingdom,and other countries.In order to understand the progress in the diagnosis and ...Recently,cases of severe acute hepatitis of unknown cause(SAHUC)in children have suddenly increased in the United States,the United Kingdom,and other countries.In order to understand the progress in the diagnosis and treatment of this disease,and to prepare for the relevant plans in advance,the“Expert Symposium on the Severe Acute Hepatitis of Unknown Cause in Children”was successfully held on May 13,2022,online organized by Beijing Children's Hospital(BCH),Capital Medical University,Beijing Institute of Pediatrics Integrated Chinese and Western Medicine,Futang Research Center of Pediatric Development,and Branch of Hepatobiliary Diseases,China Association of Chinese Medicine.More than 9200 people watched the meeting online.Professors Yan Hu,Yan Yang,and Jing Hao,from the Department of Traditional Chinese Medicine(TCM),BCH,Capital Medical University,hosted the symposium.展开更多
1|OUTBREAK OF SEVERE ACUTE HEPATITIS OF UNKNOWN ORIGIN IN CHILDREN Severe acute hepatitis of unknown origin in children was first reported by the United Kingdom to the World Health Organization on April 5,2022.Subsequ...1|OUTBREAK OF SEVERE ACUTE HEPATITIS OF UNKNOWN ORIGIN IN CHILDREN Severe acute hepatitis of unknown origin in children was first reported by the United Kingdom to the World Health Organization on April 5,2022.Subsequently,650 probable cases were reported worldwide by May 26,2022,1 and four patients were analyzed after reviewing the clinical records of a children's hospital in Alabama since October 1,2021.2 Although most patients recovered,the disease progressed to acute liver failure in several patients,who further required liver transplantation;thus,additional research is required to determine the disease pathogenesis.展开更多
Background Human adenovirus(HAdV)infection can cause a variety of diseases.It is a major pathogen of pediatric acute respiratory tract infections(ARIs)and can be life-threatening in younger children.We described the e...Background Human adenovirus(HAdV)infection can cause a variety of diseases.It is a major pathogen of pediatric acute respiratory tract infections(ARIs)and can be life-threatening in younger children.We described the epidemiology and subtypes shifting of HAdV among children with ARI in Guangzhou,China.Methods We conducted a retrospective study of 161,079 children diagnosed with acute respiratory illness at the Guangzhou Women and Children’s Medical Center between 2010 and 2021.HAdV specimens were detected by real-time PCR and the hexon gene was used for phylogenetic analysis.Results Before the COVID-19 outbreak in Guangzhou,the annual frequency of adenovirus infection detected during this period ranged from 3.92%to 13.58%,with an epidemic peak every four to fve years.HAdV demonstrated a clear seasonal distribution,with the lowest positivity in March and peaking during summer(July or August)every year.A signifcant increase in HAdV cases was recorded for 2018 and 2019,which coincided with a shift in the dominant HAdV subtype from HAdV-3 to HAdV-7.The latter was associated with a more severe disease compared to HAdV-3.The average mortality proportion for children infected with HAdV from 2016 to 2019 was 0.38%but increased to 20%in severe cases.After COVID-19 emerged,HAdV cases dropped to 2.68%,suggesting that non-pharmaceutical interventions probably reduced the transmission of HAdV in the community.Conclusion Our study provides the foundation for the understanding of the epidemiology of HAdV and its associated risks in children in Southern China.展开更多
文摘Around 450 cases of acute severe hepatitis of unknown origin in children have been reported in 21 countries and region globally since April 2022,which has exceeded the past annual incidences of related regions,and has aroused wide concern.Affected patients were predominantly children under 16years of age,presented with symptoms of acute hepatitis with markedly elevated liver enzymes,and had been ruled out of common viral infections such as hepatitis A,B,C,D,and E.Similar cases have not been reported in China yet.However,considering that the severe acute hepatitis has involved worldwide areas,still with unknown origin,and incidences of severity is relatively high,we formulated this recommendation to standardize diagnosis and treatment of acute severe hepatitis of unknown origin in Peking Union Medical College Hospital,to get fully prepared to the possible public health events.
基金Supported by the National Natural Science Foundation of China,No.81960120 and 81660110the Postgraduate Innovation Special Foundation of Jiangxi Province,No.YC2022-B052“Gan-Po Talent 555”Project of Jiangxi Province,No.GCZ(2012)-1.
文摘BACKGROUND The lymphocyte-to-white blood cell ratio(LWR)is a blood marker of the systemic inflammatory response.The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)remains unclear.AIM To explore whether LWR could stratify the risk of poor outcomes in HBV-ACLF patients.METHODS This study was conducted by recruiting 330 patients with HBV-ACLF at the Department of Gastroenterology in a large tertiary hospital.Patients were divided into survivor and non-survivor groups according to their 28-d prognosis.The independent risk factors for 28-d mortality were calculated by univariate and multivariate Cox regression analyses.Patients were divided into low-and high-LWR groups according to the cutoff values.Kaplan-Meier analysis was performed according to the level of LWR.RESULTS During the 28-d follow-up time,135 patients died,and the mortality rate was 40.90%.The LWR level in non-surviving patients was significantly decreased compared to that in surviving patients.A lower LWR level was an independent risk factor for poor 28-d outcomes(hazard ratio=0.052,95%confidence interval:0.005-0.535).The LWR level was significantly negatively correlated with the Child-Turcotte-Pugh,model for end-stage liver disease,and Chinese Group on the Study of Severe Hepatitis B-ACLF II scores.In addition,the 28-d mortality was higher for patients with LWR<0.11 than for those with LWR≥0.11.CONCLUSION LWR may serve as a simple and useful tool for stratifying the risk of poor 28-d outcomes in HBVACLF patients.
文摘Severe alcoholic hepatitis(AH)is a distinct entity in the spectrum of alcoholrelated liver disease,with limited treatment options and high mortality.Supportive medical care with corticosteroids in selected patients is the only currently available treatment option,often with poor outcomes.Based on the insights into the pathogenetic mechanisms of AH,which are mostly obtained from animal studies,several new treatment options are being explored.Studies have implicated impaired and deranged liver regeneration processes as one of the culprit mechanisms and a potential therapeutic target.Acknowledging evidence for the beneficial effects of granulocyte colony-stimulating factor(G-CSF)on liver regeneration and immunomodulation in animal models,several human studies investigated its role in the treatment of advanced alcohol-related liver disease and AH.Contrary to the previously published studies suggesting benefits of G-CSF in the outcomes of patients with severe AH,these effects were not confirmed by a recently published multicenter randomized trial,suggesting that other options should rather be pursued.Stem cell transplantation represents another option for improving liver regeneration,but evidence for its efficacy in patients with severe AH and advanced alcohol-related liver disease is still very scarce and unconvincing,with established lack of efficacy in patients with compensated cirrhosis.In this review,we summarize the current knowledge on the pathogenesis and experimental therapies targeting liver regeneration.The lack of high-quality studies and evidence is a major obstacle in further treatment development.New insights into the pathogenesis of not only liver injury,but also liver regeneration processes are mandatory for the development of new treatment options.A reliable experimental model of the pathogenesis of AH and processes involved in liver recovery is still missing,and data obtained from animal studies are essential for future research.
文摘To the Editor:I read the paper by Chen et al[1]with great interest.The authors performed a retrospective study to evaluate the short-term efficacy of antiviral therapy
文摘Objective:Research on nursing method of artificial liver support system applied in severe hepatitis patients.Methods:Selected 50 severe hepatitis patients in our hospital during the period of January 2018 and January 2019,observed and analyzed the clinical intervention effect of all treated by artificial liver support system cooperating with related nursing methods.Results:After the treatment,the clinical symptoms and abdominal distension of the patients were relieved,whose spirit took a turn for the better and the jaundice subsided.Among these patients,68%got improved enough to be released,26.00%gave up for financial concerns and 6.00%died.Before and after treatment,the patients’PT and INR,APTT,TT improved obviously,and the difference were quite a lot(P<0.05),while ALT and ALB showed few without any statistical significance(P>0.05).Conclusion:During the treatment and intervention of severe hepatitis patients with artificial liver support system,effective nursing interventions are needed,mainly including completely preoperative,intraoperative and postoperative care so as to ensure the treatment effect and promote the recovery of intervention,which has remarkable significance to clinical development.
基金Supported by The Japan Agency for Medical Research and Development,No.JP20fk0210075.
文摘Hepatitis A virus(HAV)infection is still an important health issue worldwide.Although several effective HAV vaccines are available,it is difficult to perform universal vaccination in certain countries.Therefore,it may be better to develop antivirals against HAV for the prevention of severe hepatitis A.We found that several drugs potentially inhibit HAV internal ribosomal entry site-dependent translation and HAV replication.Artificial intelligence and machine learning could also support screening of anti-HAV drugs,using drug repositioning and drug rescue approaches.
文摘Since October 2021 in Alabama,the United States,and March 2022 in central Scotland,the United Kingdom,the number of cases of severe acute hepatitis of unknown etiology/causes in children was found to increase,and the total number of cases has reached 920 worldwide by June 22 this year,45 cases(5%)required liver transplantation,and 18 cases(2%)died according to World Health Organization(WHO).To understand the basic characteristics of this disease/syndrome,a literature search was performed at PubMed,websites of WHO,UK Health Security Agency,and US and European Centers for Disease Control and Prevention,and more than 20 reports were enrolled as references for this review.The main clinical manifestations are anorexia,vomiting,fatigue,jaundice,and so forth.Most of the cases seemed to have a self-limited course of the disease,about 6%of cases may develop life-threatening acute liver failure.The disease seems to be transmissible from person to person.Human adenovirus was detected in up to 75%of cases,but this virus seems not to be the only and major etiologic agent,other cofactors probably are involved.Researchers proposed many hypotheses concerning the etiology and pathogenesis,and many important works and studies are ongoing.This mini-review is aimed at summarizing,reviewing,and further understanding the characteristics of the disease,raising some clinically relevant questions,and trying to discuss some questions that may be related to the treatment of the disease for consideration.
文摘Recently,cases of severe acute hepatitis of unknown cause(SAHUC)in children have suddenly increased in the United States,the United Kingdom,and other countries.In order to understand the progress in the diagnosis and treatment of this disease,and to prepare for the relevant plans in advance,the“Expert Symposium on the Severe Acute Hepatitis of Unknown Cause in Children”was successfully held on May 13,2022,online organized by Beijing Children's Hospital(BCH),Capital Medical University,Beijing Institute of Pediatrics Integrated Chinese and Western Medicine,Futang Research Center of Pediatric Development,and Branch of Hepatobiliary Diseases,China Association of Chinese Medicine.More than 9200 people watched the meeting online.Professors Yan Hu,Yan Yang,and Jing Hao,from the Department of Traditional Chinese Medicine(TCM),BCH,Capital Medical University,hosted the symposium.
基金National Natural Science Foundation,Grant/Award Number:82172254 and 1.3.5 project for disciplines of excellenceWest China Hospital,Sichuan University,Grant/Award Number:ZYGD20009。
文摘1|OUTBREAK OF SEVERE ACUTE HEPATITIS OF UNKNOWN ORIGIN IN CHILDREN Severe acute hepatitis of unknown origin in children was first reported by the United Kingdom to the World Health Organization on April 5,2022.Subsequently,650 probable cases were reported worldwide by May 26,2022,1 and four patients were analyzed after reviewing the clinical records of a children's hospital in Alabama since October 1,2021.2 Although most patients recovered,the disease progressed to acute liver failure in several patients,who further required liver transplantation;thus,additional research is required to determine the disease pathogenesis.
基金supported by the National Natural Science Foundation of China:[grant number 82072264]Natural Science Foundation of Guangdong Province,China:[grant number 2021A1515011071]+2 种基金Guangzhou School(Institute)Joint Funding Project(No.202102010202)Municipal Science and Technology Bureau Foundation of Guangzhou(201803040004)Guangzhou Basic Research Program Co-funded by Zhongnanshan Medical Foundation of Guangdong Province:[grant number 202102010364,ZNSA-2020003].
文摘Background Human adenovirus(HAdV)infection can cause a variety of diseases.It is a major pathogen of pediatric acute respiratory tract infections(ARIs)and can be life-threatening in younger children.We described the epidemiology and subtypes shifting of HAdV among children with ARI in Guangzhou,China.Methods We conducted a retrospective study of 161,079 children diagnosed with acute respiratory illness at the Guangzhou Women and Children’s Medical Center between 2010 and 2021.HAdV specimens were detected by real-time PCR and the hexon gene was used for phylogenetic analysis.Results Before the COVID-19 outbreak in Guangzhou,the annual frequency of adenovirus infection detected during this period ranged from 3.92%to 13.58%,with an epidemic peak every four to fve years.HAdV demonstrated a clear seasonal distribution,with the lowest positivity in March and peaking during summer(July or August)every year.A signifcant increase in HAdV cases was recorded for 2018 and 2019,which coincided with a shift in the dominant HAdV subtype from HAdV-3 to HAdV-7.The latter was associated with a more severe disease compared to HAdV-3.The average mortality proportion for children infected with HAdV from 2016 to 2019 was 0.38%but increased to 20%in severe cases.After COVID-19 emerged,HAdV cases dropped to 2.68%,suggesting that non-pharmaceutical interventions probably reduced the transmission of HAdV in the community.Conclusion Our study provides the foundation for the understanding of the epidemiology of HAdV and its associated risks in children in Southern China.
