Background:Acute-on-chronic liver failure(ACLF)is a life-threatening syndrome defined as acute decompensation in patients with chronic liver disease.Liver transplantation(LT)is the most effective treatment.We aimed to...Background:Acute-on-chronic liver failure(ACLF)is a life-threatening syndrome defined as acute decompensation in patients with chronic liver disease.Liver transplantation(LT)is the most effective treatment.We aimed to assess the impact of cirrhosis-related complications pre-LT on the posttransplant prognosis of patients with ACLF.Methods:This was an observational cohort study conducted between January 2018 and December 2020.Clinical characteristics,cirrhosis-related complications at LT and patient survival post-LT were collected.All liver recipients with ACLF were followed for 1 year post-LT.Results:A total of 212 LT recipients with ACLF were enrolled,including 75(35.4%)patients with ACLF-1,64(30.2%)with ACLF-2,and 73(34.4%)with ACLF-3.The median waiting time for LT was 11(4-24)days.The most prevalent cirrhosis-related complication was ascites(78.8%),followed by hepatic encephalopathy(57.1%),bacterial infections(48.1%),hepatorenal syndrome(22.2%)and gastrointestinal bleeding(11.3%).Survival analyses showed that patients with complications at LT had a significantly lower survival probability at both 3 months and 1 year after LT than those without complications(all P<0.05).A simplified model was developed by assigning one point to each complication:transplantation for ACLF with cirrhosis-related complication(TACC)model.Risk stratification of TACC model identified 3 strata(≥4,=3,and≤2)with high,median and low risk of death after LT(P<0.001).Moreover,the TACC model showed a comparable ability for predicting the outcome post-LT to the other four prognostic models(chronic liver failure-consortium ACLF score,Chinese Group on the Study of Severe Hepatitis B-ACLF score,model for end-stage liver disease score and Child-Turcotte-Pugh score).Conclusions:The presence of cirrhosis-related complications pre-LT increases the risk of death post-LT in patients with ACLF.The TACC model based on the number of cirrhosis-related complications pre-LT could stratify posttransplant survival,which might help to determine transplant timing for ACLF.展开更多
BACKGROUND： Hepatitis B virus（HBV） infection may impose an economic burden to patients or their families. The prevention and control of HBV could effectively reduce the burden. However, the management of HBV-relate...BACKGROUND： Hepatitis B virus（HBV） infection may impose an economic burden to patients or their families. The prevention and control of HBV could effectively reduce the burden. However, the management of HBV-related patients has not been well controlled in China. With the development of general practitioner（GP） system in this country, GPs may greatly improve the management of the patients with HBV infection. However, the role of GPs in controlling HBV infection has been rarely studied.DATA SOURCES： A literature search of PubMed, CNKI,Wanfang data and VIP was performed with the following key words： ＂general practitioner＂, ＂family physician＂, ＂community management＂, ＂community health care workers＂, ＂family practice＂, ＂hepatitis B virus＂, ＂HBV＂, ＂HBV vaccination＂, ＂HBV prevention＂, ＂HBV management＂, ＂HBV treatment＂, ＂antiviral therapy＂ and ＂chronic hepatitis B（CHB）＂. The information about the GPs-involved prevention, diagnosis and treatment of CHB was reviewed.RESULTS： The reports on the role of GPs in the prevention,diagnosis and treatment of HBV infection are few. But the experiences from Western countries demonstrated that GPs could play a significant role in the management of patients withCHB. The importance of GPs is obvious although there are some difficulties in China. GPs and health officials at different levels should work together in the management of patients with CHB.CONCLUSIONS： The involvement of GPs in the management of patients with HBV infection is effective in China. But GPs＇ knowledge and skills for the control of HBV infection have to be improved currently. GPs＇ involvement will enforce the management of CHB in China in the near future.展开更多
Alternative antimicrobial therapies are urgently needed for a variety of multidrug-resistant bacterial pathogens.Faropenem is an orally available b-lactam in the class of carbapenem antibiotics.Thus far,little informa...Alternative antimicrobial therapies are urgently needed for a variety of multidrug-resistant bacterial pathogens.Faropenem is an orally available b-lactam in the class of carbapenem antibiotics.Thus far,little information is available on faropenem susceptibility of multidrug-resistant clinical isolates from China.Therefore,in the current study 141 contemporary clinical isolates,including methicillin-resistant Staphylococcus aureus(MRSA:n=18),coagulase-negative staphylococci(CNS:n=16),Enterococcus faecalis(n=14),Enterococcus faecium(n=7),Pseudomonas aeruginosa(n=25),Klebsiella pneumoniae(n=21),Escherichia coli(n=20),and Acinetobacter baumannii(n=20),were collected between March 2018 and March 2019 and tested for susceptibility to faropenem and other antimicrobials using the broth microdilution method.All E.faecium,P.aeruginosa,and A.baumannii isolates were fully resistant to faropenem.However,most of the MRSA,CNS,E.faecalis,K.pneumonia,and E.coli isolates appeared to be susceptible to faropenem,with minimal inhibitory concentration90 values of 4mg/L,2mg/L,2mg/L,4mg/L,and 2mg/L,respectively.Therefore,faropenem could be considered as alternative therapy for future treatment of multidrug-resistant MRSA,CNS,E.faecalis,K.pneumonia,and E.coli infections in China.展开更多
基金supported by grants from the National Key R&D Program of China(2021YFC2301800)Zhejiang Basic Public Welfare Research Program(LGF20H030008)the National Natural Sci-ence Foundation of China(81874038)。
文摘Background:Acute-on-chronic liver failure(ACLF)is a life-threatening syndrome defined as acute decompensation in patients with chronic liver disease.Liver transplantation(LT)is the most effective treatment.We aimed to assess the impact of cirrhosis-related complications pre-LT on the posttransplant prognosis of patients with ACLF.Methods:This was an observational cohort study conducted between January 2018 and December 2020.Clinical characteristics,cirrhosis-related complications at LT and patient survival post-LT were collected.All liver recipients with ACLF were followed for 1 year post-LT.Results:A total of 212 LT recipients with ACLF were enrolled,including 75(35.4%)patients with ACLF-1,64(30.2%)with ACLF-2,and 73(34.4%)with ACLF-3.The median waiting time for LT was 11(4-24)days.The most prevalent cirrhosis-related complication was ascites(78.8%),followed by hepatic encephalopathy(57.1%),bacterial infections(48.1%),hepatorenal syndrome(22.2%)and gastrointestinal bleeding(11.3%).Survival analyses showed that patients with complications at LT had a significantly lower survival probability at both 3 months and 1 year after LT than those without complications(all P<0.05).A simplified model was developed by assigning one point to each complication:transplantation for ACLF with cirrhosis-related complication(TACC)model.Risk stratification of TACC model identified 3 strata(≥4,=3,and≤2)with high,median and low risk of death after LT(P<0.001).Moreover,the TACC model showed a comparable ability for predicting the outcome post-LT to the other four prognostic models(chronic liver failure-consortium ACLF score,Chinese Group on the Study of Severe Hepatitis B-ACLF score,model for end-stage liver disease score and Child-Turcotte-Pugh score).Conclusions:The presence of cirrhosis-related complications pre-LT increases the risk of death post-LT in patients with ACLF.The TACC model based on the number of cirrhosis-related complications pre-LT could stratify posttransplant survival,which might help to determine transplant timing for ACLF.
基金supported by a grant from the National Scientific and Technological Major Project of China(2013ZX10004904-001-005)
文摘BACKGROUND： Hepatitis B virus（HBV） infection may impose an economic burden to patients or their families. The prevention and control of HBV could effectively reduce the burden. However, the management of HBV-related patients has not been well controlled in China. With the development of general practitioner（GP） system in this country, GPs may greatly improve the management of the patients with HBV infection. However, the role of GPs in controlling HBV infection has been rarely studied.DATA SOURCES： A literature search of PubMed, CNKI,Wanfang data and VIP was performed with the following key words： ＂general practitioner＂, ＂family physician＂, ＂community management＂, ＂community health care workers＂, ＂family practice＂, ＂hepatitis B virus＂, ＂HBV＂, ＂HBV vaccination＂, ＂HBV prevention＂, ＂HBV management＂, ＂HBV treatment＂, ＂antiviral therapy＂ and ＂chronic hepatitis B（CHB）＂. The information about the GPs-involved prevention, diagnosis and treatment of CHB was reviewed.RESULTS： The reports on the role of GPs in the prevention,diagnosis and treatment of HBV infection are few. But the experiences from Western countries demonstrated that GPs could play a significant role in the management of patients withCHB. The importance of GPs is obvious although there are some difficulties in China. GPs and health officials at different levels should work together in the management of patients with CHB.CONCLUSIONS： The involvement of GPs in the management of patients with HBV infection is effective in China. But GPs＇ knowledge and skills for the control of HBV infection have to be improved currently. GPs＇ involvement will enforce the management of CHB in China in the near future.
基金Project supported by the National Science and Technology Major Project of China During the 13th Five-Year Plan Period(Nos.2017ZX 10202102 , 2018ZX10715014)。
基金supported by the National Science and Technology Major project of 13th Five Year of China(2017ZX10105001006001).
文摘Alternative antimicrobial therapies are urgently needed for a variety of multidrug-resistant bacterial pathogens.Faropenem is an orally available b-lactam in the class of carbapenem antibiotics.Thus far,little information is available on faropenem susceptibility of multidrug-resistant clinical isolates from China.Therefore,in the current study 141 contemporary clinical isolates,including methicillin-resistant Staphylococcus aureus(MRSA:n=18),coagulase-negative staphylococci(CNS:n=16),Enterococcus faecalis(n=14),Enterococcus faecium(n=7),Pseudomonas aeruginosa(n=25),Klebsiella pneumoniae(n=21),Escherichia coli(n=20),and Acinetobacter baumannii(n=20),were collected between March 2018 and March 2019 and tested for susceptibility to faropenem and other antimicrobials using the broth microdilution method.All E.faecium,P.aeruginosa,and A.baumannii isolates were fully resistant to faropenem.However,most of the MRSA,CNS,E.faecalis,K.pneumonia,and E.coli isolates appeared to be susceptible to faropenem,with minimal inhibitory concentration90 values of 4mg/L,2mg/L,2mg/L,4mg/L,and 2mg/L,respectively.Therefore,faropenem could be considered as alternative therapy for future treatment of multidrug-resistant MRSA,CNS,E.faecalis,K.pneumonia,and E.coli infections in China.
