K. Bagheri Lankarani, B. Honarvar, Ali Davoodi, Naeimehossadat Asmarian, M. Serati, Mohsen Ali Akbarpour, Erfan Sadeghi, Touba Narimani Moghadam, Hossein Molavi Vardanjani
Background: Chronic immunity to hepatitis A (HA) is largely influenced by environmental factors, such as socioeconomic indicators, public health conditions, and access to safe water. In the past two decades, Iran has witnessed improvements in socioeconomic status, increased urbanization, enhanced health education, improved access to safe drinking water sources, and better public health conditions. However, these changes have not been uniform across all regions of Iran, and varying epidemiological situations are expected. Objectives: This study aimed to delineate the pattern of HA chronic immunity across different regions of Iran using geographical information system (GIS) mapping. Methods: The study included a total of 3255 individuals who tested positive for anti-hepatitis A virus (anti-HAV) immunoglobulin G (IgG). This study analyzed factors such as place of residence, marital status, age, and gender to explore possible relationships. Univariate and multivariable analyses were conducted to identify independently associated factors for HA. A locally weighted scatterplot smoothing (LOWESS) multivariate model was developed using a backward stepwise approach. Geographical variations in the prevalence of HA chronic immunity in the general population of Iran were assessed to understand spatial effects and risk factors. A Bayesian spatial model was employed to identify the spatial pattern of HA chronic immunity prevalence, using OpenBUGS version 3.2.3. Results: The prevalence of HAV immunity was higher in regions with mild semi-dry climates (aPR = 2.37, 95% confidence interval [CI] = 2.30 - 3.33, P< 0.001), medium semi-dry climates (aPR = 1.37, 95% CI = 1.14 - 1.63, P< 0.001), dry climates (aPR = 1.13, 95% CI = 0.9 - 1.4), and ultra-dry climates (aPR = 1.79, 95% CI = 1.05 - 2.98, P = 0.033), compared to semi-humid climates. Other variables did not exhibit a significant relationship with HA chronic immunity. The GIS analysis map revealed that immunity to HA was generally lower in the capital cities of Iran’s provinces. However, most central regions of Iran exhibit medium endemicity; nevertheless, higher immunity to HA was observed in border areas and coastal regions, particularly in the northern part of the country. Conclusions: Different regions of Iran display distinct patterns of HAV endemicity, influenced by the country’s climatic diversity.
{"title":"Hepatitis A Chronic Immunity in Iran: A Geographic Information System-Based Study","authors":"K. Bagheri Lankarani, B. Honarvar, Ali Davoodi, Naeimehossadat Asmarian, M. Serati, Mohsen Ali Akbarpour, Erfan Sadeghi, Touba Narimani Moghadam, Hossein Molavi Vardanjani","doi":"10.5812/hepatmon-138329","DOIUrl":"https://doi.org/10.5812/hepatmon-138329","url":null,"abstract":"Background: Chronic immunity to hepatitis A (HA) is largely influenced by environmental factors, such as socioeconomic indicators, public health conditions, and access to safe water. In the past two decades, Iran has witnessed improvements in socioeconomic status, increased urbanization, enhanced health education, improved access to safe drinking water sources, and better public health conditions. However, these changes have not been uniform across all regions of Iran, and varying epidemiological situations are expected. Objectives: This study aimed to delineate the pattern of HA chronic immunity across different regions of Iran using geographical information system (GIS) mapping. Methods: The study included a total of 3255 individuals who tested positive for anti-hepatitis A virus (anti-HAV) immunoglobulin G (IgG). This study analyzed factors such as place of residence, marital status, age, and gender to explore possible relationships. Univariate and multivariable analyses were conducted to identify independently associated factors for HA. A locally weighted scatterplot smoothing (LOWESS) multivariate model was developed using a backward stepwise approach. Geographical variations in the prevalence of HA chronic immunity in the general population of Iran were assessed to understand spatial effects and risk factors. A Bayesian spatial model was employed to identify the spatial pattern of HA chronic immunity prevalence, using OpenBUGS version 3.2.3. Results: The prevalence of HAV immunity was higher in regions with mild semi-dry climates (aPR = 2.37, 95% confidence interval [CI] = 2.30 - 3.33, P< 0.001), medium semi-dry climates (aPR = 1.37, 95% CI = 1.14 - 1.63, P< 0.001), dry climates (aPR = 1.13, 95% CI = 0.9 - 1.4), and ultra-dry climates (aPR = 1.79, 95% CI = 1.05 - 2.98, P = 0.033), compared to semi-humid climates. Other variables did not exhibit a significant relationship with HA chronic immunity. The GIS analysis map revealed that immunity to HA was generally lower in the capital cities of Iran’s provinces. However, most central regions of Iran exhibit medium endemicity; nevertheless, higher immunity to HA was observed in border areas and coastal regions, particularly in the northern part of the country. Conclusions: Different regions of Iran display distinct patterns of HAV endemicity, influenced by the country’s climatic diversity.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":"65 5","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138600460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The clinical efficacy of Lenvatinib (a multi‐kinase inhibitor) and Nivolumab (an immune checkpoint inhibitor) have been shown in the management of hepatocellular carcinoma (HCC). However, real-life experience data of HCC patients receiving the Nivolumab and Lenvatinib combination are scarce, especially those who experienced the first-line or even multi-line treatment. Methods: Recurrent HCC patients (n = 28) treated with Nivolumab plus Lenvatinib as salvage therapy in Hunan Provincial People's Hospital from December 2016 to March 31, 2020, were analyzed. All patients were treated with Nivolumab (3 mg/kg), and Lenvatinib (8 mg/day), and administered every three weeks. Demographics, clinical statistics, and start and end dates of combination therapy were collected and recorded. In addition, progression-free survival (PFS) and OS were calculated from the start of Nivolumab plus Lenvatinib. Treatment outcomes were scored based on the Common Toxicity Criteria for Adverse Events (CTCAE), version 4.0. SPSS17.0 software and GraphPad Prism were used for statistical analyses. Results: All the patients had portal vein tumor thrombus (PVTT) who were in Child-Pugh grade A and Barcelona Clinic Liver Cancer (BCLC) stage C. 11 patients (39.3%) were treated with sorafenib only, and 17 patients (60.7%) were treated with at least two lines of multi-target treatment. The disease control rate (CR+PR+SD) was 23/28 (82.1%), with the median overall survival (OS) and median progression-free survival (PFS) of 8.7 months and 5.7 months, respectively. Hyperbilirubinemia was the most common adverse event encountered with these combinations. However, no grade 3 or 4 toxicity was found in all HCC patients. Conclusions: The combination salvage therapy of Nivolumab and Lenvatinib was found effective in HCC patients, and most importantly, the side effects were controllable, and no grade 3 - 4 side effects were observed.
{"title":"Salvage Treatment of Nivolumab and Lenvatinib in Patients with Recurrent Hepatocellular Carcinoma","authors":"Lijun Zhou, Wei Peng, Huaxin Duan, Tan Deng","doi":"10.5812/hepatmon-137824","DOIUrl":"https://doi.org/10.5812/hepatmon-137824","url":null,"abstract":"Background: The clinical efficacy of Lenvatinib (a multi‐kinase inhibitor) and Nivolumab (an immune checkpoint inhibitor) have been shown in the management of hepatocellular carcinoma (HCC). However, real-life experience data of HCC patients receiving the Nivolumab and Lenvatinib combination are scarce, especially those who experienced the first-line or even multi-line treatment. Methods: Recurrent HCC patients (n = 28) treated with Nivolumab plus Lenvatinib as salvage therapy in Hunan Provincial People's Hospital from December 2016 to March 31, 2020, were analyzed. All patients were treated with Nivolumab (3 mg/kg), and Lenvatinib (8 mg/day), and administered every three weeks. Demographics, clinical statistics, and start and end dates of combination therapy were collected and recorded. In addition, progression-free survival (PFS) and OS were calculated from the start of Nivolumab plus Lenvatinib. Treatment outcomes were scored based on the Common Toxicity Criteria for Adverse Events (CTCAE), version 4.0. SPSS17.0 software and GraphPad Prism were used for statistical analyses. Results: All the patients had portal vein tumor thrombus (PVTT) who were in Child-Pugh grade A and Barcelona Clinic Liver Cancer (BCLC) stage C. 11 patients (39.3%) were treated with sorafenib only, and 17 patients (60.7%) were treated with at least two lines of multi-target treatment. The disease control rate (CR+PR+SD) was 23/28 (82.1%), with the median overall survival (OS) and median progression-free survival (PFS) of 8.7 months and 5.7 months, respectively. Hyperbilirubinemia was the most common adverse event encountered with these combinations. However, no grade 3 or 4 toxicity was found in all HCC patients. Conclusions: The combination salvage therapy of Nivolumab and Lenvatinib was found effective in HCC patients, and most importantly, the side effects were controllable, and no grade 3 - 4 side effects were observed.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":"42 6","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138605183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Activated hepatic stellate cells (HSC) through the TGF-β signaling pathway are likely to exacerbate liver fibrosis, which is a later stage of NASH, a condition in which, in addition to HSC activation, the overexpression of extracellular matrix (ECM) proteins, specifically collagen-I α and α-SMA, is expected. MicroRNA-126a, a modulator of HSC activation, influences the phosphorylation of Smad2/3. Objectives: This study aimed to investigate the impact of exosomes on miRNAs implicated in the progression of liver fibrosis by focusing on the role of miR-126a in the HSC-T6 cell line. Methods: In the present study, we investigated the effects of exosomes derived from LPS-stimulated mesenchymal stem cells (MSCs) on the expression of miR-126a and the phosphorylation of Smad3c in the HSC-T6 cell line. First, HSC-T6 cells were cultured in DMEM supplemented with 10% FBS. Next, we isolated exosomes derived from MSCs using the ExoCib kit. Finally, we examined the gene expression levels of collagen-Iα, α-SMA, and miR-126a using real-time PCR. Results: The results showed that treatment with TGFβ1 increased the phosphorylation of p-Smad3c (P < 0.0001), as well as the expression of α-SMA and Collagen-Iα. Conversely, miR-126a expression was down-regulated after treatment with TGFβ1 (P < 0.01). However, exposure to LPS-treated MSC-derived exosomes resulted in a significant decrease in the levels of p-Smad3c phosphorylation (P < 0.001) and the gene expression of α-SMA and Collagen-Iα, accompanied by the up-regulation of miR-126a (P < 0.05). Conclusions: Based on our observations, MSCs-derived exosomes were able to reduce the expression of the genes associated with hepatic fibrosis, such as collagen-Iα and α-SMA. Furthermore, exosomes inhibited Smad3c phosphorylation by increasing miR-126a expression, ultimately hindering the progression of liver fibrosis. Therefore, exosomes should be recognized as a valuable and beneficial therapeutic tool for liver fibrosis.
背景:通过TGF-β信号通路激活的肝星状细胞(HSC)可能加剧肝纤维化，这是NASH的后期阶段，在这种情况下，除了HSC激活外，细胞外基质(ECM)蛋白，特别是胶原- i α和α- sma的过度表达是预期的。MicroRNA-126a是HSC活化的调节因子，影响Smad2/3的磷酸化。目的:本研究旨在通过关注miR-126a在HSC-T6细胞系中的作用来研究外泌体对涉及肝纤维化进展的mirna的影响。方法:在本研究中，我们研究了来自lps刺激的间充质干细胞(MSCs)的外泌体对HSC-T6细胞系中miR-126a表达和Smad3c磷酸化的影响。首先，将HSC-T6细胞培养在添加10%胎牛血清的DMEM中。接下来，我们使用ExoCib试剂盒分离来自MSCs的外泌体。最后，我们使用实时PCR检测了胶原- i α、α-SMA和miR-126a的基因表达水平。结果:tgf - β1处理后，P - smad3c磷酸化水平升高(P < 0.0001)， α-SMA和胶原- i α表达升高。相反，tgf - β1处理后miR-126a表达下调(P < 0.01)。然而，暴露于lps处理的msc来源的外泌体导致P - smad3c磷酸化水平显著降低(P < 0.001)， α-SMA和胶原- i - α基因表达显著降低，同时miR-126a上调(P < 0.05)。结论:根据我们的观察，间质干细胞衍生的外泌体能够降低与肝纤维化相关的基因的表达，如胶原- i α和α-SMA。此外，外泌体通过增加miR-126a的表达来抑制Smad3c磷酸化，最终阻碍肝纤维化的进展。因此，外泌体应该被认为是一种有价值和有益的肝纤维化治疗工具。
{"title":"Pretreatment of Exosomes Derived from hUCMSCs with LPS Ameliorates Liver Fibrosis by Inhibiting the Smad3C Through Upregulating MiR-126 in the HSC-T6 Cell Line","authors":"Maryam Cheraghzadeh, Emad Matour, Benyamin Kabizadeh, Elham Shakerian, Mojtaba Rashidi","doi":"10.5812/hepatmon-137083","DOIUrl":"https://doi.org/10.5812/hepatmon-137083","url":null,"abstract":"Background: Activated hepatic stellate cells (HSC) through the TGF-β signaling pathway are likely to exacerbate liver fibrosis, which is a later stage of NASH, a condition in which, in addition to HSC activation, the overexpression of extracellular matrix (ECM) proteins, specifically collagen-I α and α-SMA, is expected. MicroRNA-126a, a modulator of HSC activation, influences the phosphorylation of Smad2/3. Objectives: This study aimed to investigate the impact of exosomes on miRNAs implicated in the progression of liver fibrosis by focusing on the role of miR-126a in the HSC-T6 cell line. Methods: In the present study, we investigated the effects of exosomes derived from LPS-stimulated mesenchymal stem cells (MSCs) on the expression of miR-126a and the phosphorylation of Smad3c in the HSC-T6 cell line. First, HSC-T6 cells were cultured in DMEM supplemented with 10% FBS. Next, we isolated exosomes derived from MSCs using the ExoCib kit. Finally, we examined the gene expression levels of collagen-Iα, α-SMA, and miR-126a using real-time PCR. Results: The results showed that treatment with TGFβ1 increased the phosphorylation of p-Smad3c (P < 0.0001), as well as the expression of α-SMA and Collagen-Iα. Conversely, miR-126a expression was down-regulated after treatment with TGFβ1 (P < 0.01). However, exposure to LPS-treated MSC-derived exosomes resulted in a significant decrease in the levels of p-Smad3c phosphorylation (P < 0.001) and the gene expression of α-SMA and Collagen-Iα, accompanied by the up-regulation of miR-126a (P < 0.05). Conclusions: Based on our observations, MSCs-derived exosomes were able to reduce the expression of the genes associated with hepatic fibrosis, such as collagen-Iα and α-SMA. Furthermore, exosomes inhibited Smad3c phosphorylation by increasing miR-126a expression, ultimately hindering the progression of liver fibrosis. Therefore, exosomes should be recognized as a valuable and beneficial therapeutic tool for liver fibrosis.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":"112 5","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138607297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammad Javad Pourgholamali, Parvin Khalili, Vahid Mirzaei, Z. Jamali, Zohreh Rajabi, Afshin Tahmasbi
Background: The aspartate aminotransferase to platelet ratio index (APRI) is a non-invasive method used to investigate liver fibrosis in patients with hepatitis C virus (HCV). Objectives: This study aimed to determine the APRI before and after the treatment of HCV patients with sofosbuvir/daclatasvir (Sovodak) in the city of Rafsanjan, southeast Iran. Methods: This study was conducted on 45 patients with HCV from March 2021 to March 2022 in Rafsanjan. Demographic information, including age, gender, a history of human immunodeficiency virus (HIV) infection, and intravenous (IV) drug injection, was collected. Polymerase chain reaction (PCR) was performed after treatment with Sovodak to calculate sustained virological response (SVR). Also, the APRI was calculated before and after treatment. Results: Among 45 HCV patients (97.8% = male, 2.2% = female, age range = 26 to 59 years), the administration of Sovodak to all patients resulted in an efficacy of 100% in the assessment of SRV in 12 weeks (SVR12). Also, the APRI level decreased significantly after treatment with Sovodak (0.35 vs. 0.68, P-value: 0.000), even in HCV patients with a history of HIV (0.77 vs. 1.47, P-value: 0.028) or HCV patients with a history of injecting drugs in the last 12 months (0.38 vs. 0.66, P-value: 0.000). Conclusions: The present study indicated that the APRI level in HCV patients decreased significantly after treatment with Sovodak, regardless of having a history of HIV infection or a history of drug injection. Therefore, Sovodak in HCV patients can reduce the odds of liver fibrosis and subsequent hepatocellular carcinoma (HCC) by reducing the APRI level.
背景:天冬氨酸转氨酶血小板比值指数(APRI)是一种用于丙型肝炎病毒(HCV)患者肝纤维化的无创方法。目的:本研究旨在确定伊朗东南部拉夫桑詹市HCV患者接受sofosbuvir/daclatasvir (Sovodak)治疗前后的APRI。方法:本研究于2021年3月至2022年3月在拉夫桑詹进行了45例HCV患者的研究。收集人口统计信息，包括年龄、性别、人类免疫缺陷病毒(HIV)感染史和静脉注射药物。用Sovodak治疗后进行聚合酶链反应(PCR)计算持续病毒学反应(SVR)。并计算治疗前后的APRI。结果:在45例HCV患者中(97.8%为男性，2.2%为女性，年龄26 ~ 59岁)，所有患者在12周SRV评估(SVR12)中给予Sovodak的有效率为100%。此外，即使在有HIV感染史的HCV患者(0.77 vs. 1.47, p值:0.028)或在过去12个月内有注射毒品史的HCV患者(0.38 vs. 0.66, p值:0.000)，接受索vodak治疗后APRI水平也显著下降(0.35 vs. 0.68, p值:0.000)。结论:本研究表明，无论是否有HIV感染史或有药物注射史，丙型肝炎患者在接受索vodak治疗后，APRI水平均显著降低。因此，在HCV患者中，Sovodak可以通过降低APRI水平来降低肝纤维化和随后的肝细胞癌(HCC)的发生率。
{"title":"Aspartate Aminotransferase to Platelet Ratio Index Before and After the Treatment of Chronic Hepatitis C Patients with Sofosbuvir/Daclatasvir","authors":"Mohammad Javad Pourgholamali, Parvin Khalili, Vahid Mirzaei, Z. Jamali, Zohreh Rajabi, Afshin Tahmasbi","doi":"10.5812/hepatmon-138049","DOIUrl":"https://doi.org/10.5812/hepatmon-138049","url":null,"abstract":"Background: The aspartate aminotransferase to platelet ratio index (APRI) is a non-invasive method used to investigate liver fibrosis in patients with hepatitis C virus (HCV). Objectives: This study aimed to determine the APRI before and after the treatment of HCV patients with sofosbuvir/daclatasvir (Sovodak) in the city of Rafsanjan, southeast Iran. Methods: This study was conducted on 45 patients with HCV from March 2021 to March 2022 in Rafsanjan. Demographic information, including age, gender, a history of human immunodeficiency virus (HIV) infection, and intravenous (IV) drug injection, was collected. Polymerase chain reaction (PCR) was performed after treatment with Sovodak to calculate sustained virological response (SVR). Also, the APRI was calculated before and after treatment. Results: Among 45 HCV patients (97.8% = male, 2.2% = female, age range = 26 to 59 years), the administration of Sovodak to all patients resulted in an efficacy of 100% in the assessment of SRV in 12 weeks (SVR12). Also, the APRI level decreased significantly after treatment with Sovodak (0.35 vs. 0.68, P-value: 0.000), even in HCV patients with a history of HIV (0.77 vs. 1.47, P-value: 0.028) or HCV patients with a history of injecting drugs in the last 12 months (0.38 vs. 0.66, P-value: 0.000). Conclusions: The present study indicated that the APRI level in HCV patients decreased significantly after treatment with Sovodak, regardless of having a history of HIV infection or a history of drug injection. Therefore, Sovodak in HCV patients can reduce the odds of liver fibrosis and subsequent hepatocellular carcinoma (HCC) by reducing the APRI level.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":"83 14","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138606073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Narges Milkarizi, H. Barghchi, Saba Belyani, F. Rajabzadeh, Andisheh Norouzian Ostad, Seyede Yegane Ghelichi Kheyrabadi, Maryam Razavidarmian, L. Goshayeshi, Farkhondeh Farkhondeh, S. Sobhani, Mohsen Nematy, Vahidreza Askari
Background: Non-alcoholic fatty liver disease (NAFLD) is a serious public health issue. Even though various natural and synthetic therapies are in the advanced stages of development, there is no authorized therapy for NAFLD. The use of anti-oxidant and anti-inflammatory compounds is one of these natural treatments. Portulaca oleracea aerial parts' extracts have shown various pharmacological properties, including antioxidant, anti-inflammatory, and liver protection due to alkaloid compounds, flavonoids, terpenoids, sterols, omega-3 unsaturated fatty acids, and many vitamins and minerals. Objectives: We intend to examine the effectiveness of Portulaca oleracea extract in improving the symptoms caused by NAFLD. Methods: A randomized, double-blinded, controlled, parallel clinical trial is designed to study the effects of P. oleracea supplementation on the clinical and paraclinical findings in patients with NAFLD. An intervention group will get 700 mg of P. oleracea supplementation for eight weeks, while a control group will receive a placebo. Throughout the intervention, the clinical and nutritional status will be assessed three times. At the 0, 30, and 60th days of the intervention, anthropometric evaluation, blood pressure, and gastrointestinal problems will be monitored. Transient elastography will be done at the start and end of the research to assess the liver state. In addition, an International Physical Activity Questionnaire (IPAQ) and a 3-day food record will be collected, as well as biochemical variables, such as CBC-diff (complete blood count with differential count), lipid profiles, FBS, Fasting Blood Sugar; serum insulin, hepatic-related parameters, namely enzymes [ALP (alkaline phosphatase), AST (aspartate aminotransferase), ALT (alanine aminotransferase), GGT (gamma-glutamyl transferase)], total and direct bilirubin, and inflammatory [hs-CRP (C-reactive protein), ESR (erythrocyte sedimentation rate) and IL-6 (interleukin-6)] and oxidative stress markers [SOD (super oxide dismutase), GSH-Px (glutathione peroxidase) and MDA (malondialdehyde)]. Discussion: This is the first randomized clinical trial (RCT) protocol specifically created for patients with NAFLD to evaluate the impact of P. oleracea supplementation. We intend to demonstrate that the suggested procedure is a novel and effective approach to decreasing NAFLD's laboratory and clinical symptoms. We also expect that supplementation with 700 mg of P. oleracea for 60 days will improve liver steatosis and clinical and nutritional status and reduce NAFLD patients' inflammation and oxidative stress.
{"title":"Effect of Complementary Therapy with Hydro-Ethanolic Extract of Aerial Parts of Portulaca oleracea on Clinical and Paraclinical Findings in Patients with Non-alcoholic Fatty Liver Disease: A Randomized Clinical Trial Protocol","authors":"Narges Milkarizi, H. Barghchi, Saba Belyani, F. Rajabzadeh, Andisheh Norouzian Ostad, Seyede Yegane Ghelichi Kheyrabadi, Maryam Razavidarmian, L. Goshayeshi, Farkhondeh Farkhondeh, S. Sobhani, Mohsen Nematy, Vahidreza Askari","doi":"10.5812/hepatmon-138692","DOIUrl":"https://doi.org/10.5812/hepatmon-138692","url":null,"abstract":"Background: Non-alcoholic fatty liver disease (NAFLD) is a serious public health issue. Even though various natural and synthetic therapies are in the advanced stages of development, there is no authorized therapy for NAFLD. The use of anti-oxidant and anti-inflammatory compounds is one of these natural treatments. Portulaca oleracea aerial parts' extracts have shown various pharmacological properties, including antioxidant, anti-inflammatory, and liver protection due to alkaloid compounds, flavonoids, terpenoids, sterols, omega-3 unsaturated fatty acids, and many vitamins and minerals. Objectives: We intend to examine the effectiveness of Portulaca oleracea extract in improving the symptoms caused by NAFLD. Methods: A randomized, double-blinded, controlled, parallel clinical trial is designed to study the effects of P. oleracea supplementation on the clinical and paraclinical findings in patients with NAFLD. An intervention group will get 700 mg of P. oleracea supplementation for eight weeks, while a control group will receive a placebo. Throughout the intervention, the clinical and nutritional status will be assessed three times. At the 0, 30, and 60th days of the intervention, anthropometric evaluation, blood pressure, and gastrointestinal problems will be monitored. Transient elastography will be done at the start and end of the research to assess the liver state. In addition, an International Physical Activity Questionnaire (IPAQ) and a 3-day food record will be collected, as well as biochemical variables, such as CBC-diff (complete blood count with differential count), lipid profiles, FBS, Fasting Blood Sugar; serum insulin, hepatic-related parameters, namely enzymes [ALP (alkaline phosphatase), AST (aspartate aminotransferase), ALT (alanine aminotransferase), GGT (gamma-glutamyl transferase)], total and direct bilirubin, and inflammatory [hs-CRP (C-reactive protein), ESR (erythrocyte sedimentation rate) and IL-6 (interleukin-6)] and oxidative stress markers [SOD (super oxide dismutase), GSH-Px (glutathione peroxidase) and MDA (malondialdehyde)]. Discussion: This is the first randomized clinical trial (RCT) protocol specifically created for patients with NAFLD to evaluate the impact of P. oleracea supplementation. We intend to demonstrate that the suggested procedure is a novel and effective approach to decreasing NAFLD's laboratory and clinical symptoms. We also expect that supplementation with 700 mg of P. oleracea for 60 days will improve liver steatosis and clinical and nutritional status and reduce NAFLD patients' inflammation and oxidative stress.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":"12 7","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139211016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Z. Khajehahmadi, H. Tavilani, J. Karimi, Mohammad Rafiee, Zahra Arab-Sadeghabadi, Roohollah Mohseni, Sina Mohagheghi
Background: The evaluation of different cell proliferation and apoptosis indicators in cirrhotic tissues caused by different injuries may help recognize the etiology of cirrhosis and the risk of progression to hepatocellular carcinoma. Objectives: This study aimed to measure p53 gene expression and AMPK and pAMPK protein expressions, as well as AgNOR features in cirrhotic tissues associated with five different etiologies in comparison with simple hepatic steatosis and controls. Methods: In this case-control study, AMPK and PAMPK protein expressions, p53 gene expression, and AgNOR features were investigated in 68 cirrhotic liver tissues obtained from patients with NASH (n = 15), HBV/HCV (n = 14), AIH (n = 15), PSC (n = 15), and alcohol toxicity (n = 9) and compared with tissues from individuals with simple steatosis (n = 15) and control subjects (n = 15). Protein and gene expressions were determined using western blotting and quantitative real-time polymerase chain reaction, respectively. Silver nitrate staining was used to assess AgNOR features. Results: Significantly higher levels of AMPK and pAMPK were detected in all cirrhotic tissues compared to controls (P < 0.05). Also, a significantly and simultaneously higher p53 gene expression (P < 0.01) and AgNOR features, including total AgNOR length (TAL) (P < 0.001), total AgNOR number (TAN) (P < 0.01), and total AgNOR area (TAA) (P < 0.01), was detected in the hepatic cirrhotic tissues obtained from patients with PSC, NASH, and AIH. There was a significant positive correlation between p53 gene expression and AgNOR features in cirrhotic tissues (P < 0.01). Conclusions: Increased AMPK and pAMPK protein levels may be a general response to cirrhosis. Cirrhotic patients diagnosed with AIH, PSC, and NASH have a higher risk of progressing to hepatocellular carcinoma than those diagnosed with viral and alcoholic cirrhosis.
{"title":"Non-Alcoholic Steatohepatitis and Autoimmune Hepatitis Cirrhosis May Have a Higher Risk of Progression to Hepatocellular Carcinoma","authors":"Z. Khajehahmadi, H. Tavilani, J. Karimi, Mohammad Rafiee, Zahra Arab-Sadeghabadi, Roohollah Mohseni, Sina Mohagheghi","doi":"10.5812/hepatmon-138449","DOIUrl":"https://doi.org/10.5812/hepatmon-138449","url":null,"abstract":"Background: The evaluation of different cell proliferation and apoptosis indicators in cirrhotic tissues caused by different injuries may help recognize the etiology of cirrhosis and the risk of progression to hepatocellular carcinoma. Objectives: This study aimed to measure p53 gene expression and AMPK and pAMPK protein expressions, as well as AgNOR features in cirrhotic tissues associated with five different etiologies in comparison with simple hepatic steatosis and controls. Methods: In this case-control study, AMPK and PAMPK protein expressions, p53 gene expression, and AgNOR features were investigated in 68 cirrhotic liver tissues obtained from patients with NASH (n = 15), HBV/HCV (n = 14), AIH (n = 15), PSC (n = 15), and alcohol toxicity (n = 9) and compared with tissues from individuals with simple steatosis (n = 15) and control subjects (n = 15). Protein and gene expressions were determined using western blotting and quantitative real-time polymerase chain reaction, respectively. Silver nitrate staining was used to assess AgNOR features. Results: Significantly higher levels of AMPK and pAMPK were detected in all cirrhotic tissues compared to controls (P < 0.05). Also, a significantly and simultaneously higher p53 gene expression (P < 0.01) and AgNOR features, including total AgNOR length (TAL) (P < 0.001), total AgNOR number (TAN) (P < 0.01), and total AgNOR area (TAA) (P < 0.01), was detected in the hepatic cirrhotic tissues obtained from patients with PSC, NASH, and AIH. There was a significant positive correlation between p53 gene expression and AgNOR features in cirrhotic tissues (P < 0.01). Conclusions: Increased AMPK and pAMPK protein levels may be a general response to cirrhosis. Cirrhotic patients diagnosed with AIH, PSC, and NASH have a higher risk of progressing to hepatocellular carcinoma than those diagnosed with viral and alcoholic cirrhosis.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":"194 ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139250531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Modern marketing strategies, accompanied by tools such as social media, mobile platforms, and applications, play a significant role in discovering the healthcare sector's needs and desires of target audiences. Additionally, the emergence of influential individuals, known as influencers, in domains such as marketing, public health promotion, physical and mental well-being, sexual health, beauty, and lifestyle is expanding daily. The inspiration and motivation generated by such influencers tend to offer an attractive opportunity for effective communication with the audience. Objectives: This study aims to extract and identify indicators and factors of influencer marketing in the health domain. Methods: This study employed a mixed-methods approach, combining qualitative and quantitative analyses. Literature in the field was reviewed, coded, and subjected to analysis. Subsequently, influencer marketing indicators were extracted and screened. Based on the identified factors, a questionnaire consisting of 26 questions was developed and distributed as a survey among a study population of 1126 individuals related to medical and non-medical sciences. The extracted factors were then examined through exploratory factor analysis and confirmatory factor analysis. A structural factor model was developed, and the fit of the model and the number of factors were assessed. Results: A total of 26 influencer indicators were identified and categorized into 5 factors: Active and skill-related features, infrastructure actions, consequential features, inherent and intrinsic features, and behavioral characteristics in the health domain. The identified factors were validated through exploratory factor analysis (EFA) and confirmed through confirmatory factor analysis. In addition, the fit model was approved. Conclusions: The study revealed that establishing international and local influencers within the health domain, incorporating influencer indicators and features alongside an analysis of environmental conditions, plays a pivotal role in shaping the healthcare system and fostering public health promotion across countries.
{"title":"Determination of Influencers' Characteristics in the Health Sector","authors":"Mohammadreza Pourkarim, Shahnaz Nayebzadeh, Seyed Moayed Alavian, Seyyed Hassan Hataminasab","doi":"10.5812/hepatmon-140317","DOIUrl":"https://doi.org/10.5812/hepatmon-140317","url":null,"abstract":"Background: Modern marketing strategies, accompanied by tools such as social media, mobile platforms, and applications, play a significant role in discovering the healthcare sector's needs and desires of target audiences. Additionally, the emergence of influential individuals, known as influencers, in domains such as marketing, public health promotion, physical and mental well-being, sexual health, beauty, and lifestyle is expanding daily. The inspiration and motivation generated by such influencers tend to offer an attractive opportunity for effective communication with the audience. Objectives: This study aims to extract and identify indicators and factors of influencer marketing in the health domain. Methods: This study employed a mixed-methods approach, combining qualitative and quantitative analyses. Literature in the field was reviewed, coded, and subjected to analysis. Subsequently, influencer marketing indicators were extracted and screened. Based on the identified factors, a questionnaire consisting of 26 questions was developed and distributed as a survey among a study population of 1126 individuals related to medical and non-medical sciences. The extracted factors were then examined through exploratory factor analysis and confirmatory factor analysis. A structural factor model was developed, and the fit of the model and the number of factors were assessed. Results: A total of 26 influencer indicators were identified and categorized into 5 factors: Active and skill-related features, infrastructure actions, consequential features, inherent and intrinsic features, and behavioral characteristics in the health domain. The identified factors were validated through exploratory factor analysis (EFA) and confirmed through confirmatory factor analysis. In addition, the fit model was approved. Conclusions: The study revealed that establishing international and local influencers within the health domain, incorporating influencer indicators and features alongside an analysis of environmental conditions, plays a pivotal role in shaping the healthcare system and fostering public health promotion across countries.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":"17 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135043219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Liver cancer is one of the most common types of cancer, in which early detection plays a significant role in preventing progression and reducing mortality. Ultrasound is one of the methods of liver examination recommended by guidelines due to its performance in detecting focal liver lesions. These small lesions may be missed in the early stages or diagnosed only when the prognosis is poor. Objectives: This study aimed to implement the best classification model for two liver stages by extracting optimal feature subsets to be used in computer-aided diagnosis systems (CAD). Methods: The model classifies the liver into two stages using B-mode ultrasound images of the liver. It involves extracting statistical texture features utilizing Discrete Wavelet Transform (DWT) and Gray Level Co-Occurrence Matrix (GLCM). This study applied two feature selection methods: T-test and Sequential Forward Floating Selection (SFFS). The subset of selected features was presented to the k-nearest neighbor classifier for incorporation into a CAD system. Results: The accuracy, sensitivity, and specificity of the k-NN classifier were 98.75%, 98.82%, and 99.1%, respectively. Conclusions: Image analysis approaches were successfully performed to extract and select useful features. Therefore, this model is recommended for classifying two liver stages, normal and HCC.
{"title":"Hepatocellular Carcinoma Diagnosis Based on Ultrasound Images Using Feature Selection Techniques and K-nearest Neighbor Classifier","authors":"Fatemeh Azimi Nanvaee, Saeed Setayeshi","doi":"10.5812/hepatmon-136213","DOIUrl":"https://doi.org/10.5812/hepatmon-136213","url":null,"abstract":"Background: Liver cancer is one of the most common types of cancer, in which early detection plays a significant role in preventing progression and reducing mortality. Ultrasound is one of the methods of liver examination recommended by guidelines due to its performance in detecting focal liver lesions. These small lesions may be missed in the early stages or diagnosed only when the prognosis is poor. Objectives: This study aimed to implement the best classification model for two liver stages by extracting optimal feature subsets to be used in computer-aided diagnosis systems (CAD). Methods: The model classifies the liver into two stages using B-mode ultrasound images of the liver. It involves extracting statistical texture features utilizing Discrete Wavelet Transform (DWT) and Gray Level Co-Occurrence Matrix (GLCM). This study applied two feature selection methods: T-test and Sequential Forward Floating Selection (SFFS). The subset of selected features was presented to the k-nearest neighbor classifier for incorporation into a CAD system. Results: The accuracy, sensitivity, and specificity of the k-NN classifier were 98.75%, 98.82%, and 99.1%, respectively. Conclusions: Image analysis approaches were successfully performed to extract and select useful features. Therefore, this model is recommended for classifying two liver stages, normal and HCC.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":"19 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135043203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdul Hussain Sahib Kadhim, Maryam Esghaei, Mohammad Hadi Karbalaie Niya, Hadi Sayah, Mohammad Hossein Razizadeh, Ali Gholami, Leila Mousavizadeh, Hossein Keyvani
Objectives: The present study was conducted to assess the pattern of HBV Core/Pre-Core mutations and HBV genotype in Iraqi patients with chronic hepatitis B virus (HBV) infection. Methods: In the current cross-sectional study in an Iraqi province, we evaluated 134 patients diagnosed with HBV hepatitis. We used PCR and, subsequently, Sanger sequencing to assess HBV Core/Pre-Core mutations. Sanger sequencing reads were further used for phylogenetic analysis and multiple sequence alignment. A phylogenetic tree was generated according to the neighbor-joining method. Results: The current study revealed that 58 (45%) of the patients were male, and 72 (55%) of them were female. The mean age of the patients was 36 ± 12.7 years, and the mean duration of infection was 5.2 ± 4.8 years. The results revealed 21 nucleic acid alterations in the samples analyzed. The generated phylogenetic tree divided samples into two genotypes. Pre-core/Core mutations were significantly associated with the treatment received (P = 0.0.001) but not with laboratory parameters. Most samples were matched with the genotype D clade, while only four samples were positioned adjacent to the genotype E clade. Direct nucleic acid translation disclosed five nucleic acid variants (73T>G, 347T>G, 364A>G, 365T>C, and 366A>G) on the core protein. Conclusions: This study has detected 21 nucleotide variants and 5 amino acid alterations within the coding sequences of the C gene. This study revealed that genotype D represents the primary genotype for the identified viral infections. The current study highlights the importance of these mutations evaluation for future, more comprehensive studies.
{"title":"A Survey of HBV Core/Pre-Core Mutations in Iraqi Patients with Chronic Hepatitis","authors":"Abdul Hussain Sahib Kadhim, Maryam Esghaei, Mohammad Hadi Karbalaie Niya, Hadi Sayah, Mohammad Hossein Razizadeh, Ali Gholami, Leila Mousavizadeh, Hossein Keyvani","doi":"10.5812/hepatmon-137139","DOIUrl":"https://doi.org/10.5812/hepatmon-137139","url":null,"abstract":"Objectives: The present study was conducted to assess the pattern of HBV Core/Pre-Core mutations and HBV genotype in Iraqi patients with chronic hepatitis B virus (HBV) infection. Methods: In the current cross-sectional study in an Iraqi province, we evaluated 134 patients diagnosed with HBV hepatitis. We used PCR and, subsequently, Sanger sequencing to assess HBV Core/Pre-Core mutations. Sanger sequencing reads were further used for phylogenetic analysis and multiple sequence alignment. A phylogenetic tree was generated according to the neighbor-joining method. Results: The current study revealed that 58 (45%) of the patients were male, and 72 (55%) of them were female. The mean age of the patients was 36 ± 12.7 years, and the mean duration of infection was 5.2 ± 4.8 years. The results revealed 21 nucleic acid alterations in the samples analyzed. The generated phylogenetic tree divided samples into two genotypes. Pre-core/Core mutations were significantly associated with the treatment received (P = 0.0.001) but not with laboratory parameters. Most samples were matched with the genotype D clade, while only four samples were positioned adjacent to the genotype E clade. Direct nucleic acid translation disclosed five nucleic acid variants (73T>G, 347T>G, 364A>G, 365T>C, and 366A>G) on the core protein. Conclusions: This study has detected 21 nucleotide variants and 5 amino acid alterations within the coding sequences of the C gene. This study revealed that genotype D represents the primary genotype for the identified viral infections. The current study highlights the importance of these mutations evaluation for future, more comprehensive studies.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":"22 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135272223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ying Liu, Lihua Zheng, Wenxiong Xu, Qihuan Xu, Xinhua Li, Qu Lin, Lu Wang, Jing Lai
Background: Immune checkpoint inhibitor (ICI)-related hepatitis has been increasing in the past decade. Objectives: This study aimed to investigate the effectiveness of plasma exchange (PE) and a double-plasma molecular absorption system (DPMAS) for ICI-related hepatitis. Methods: A retrospective analysis was conducted on patients with ICI-related hepatitis treated at the Third Affiliated Hospital of Sun Yat-Sen University (China). The collected data included biochemical indices, treatments, the use of an artificial liver support system (ALSS), and outcomes. Results: From June 2021 to January 2023, 16 patients were treated and included in the analysis. Eight patients in group A received general support. The other 8 patients in group B received general support, plus 3 rounds of ALSS every 2 - 4 days (4 patients were treated with PE and the others with DPMAS + PE). There was no significant difference in age and treatment days between the two groups. Before treatment, there was no significant difference in direct bilirubin (DBIL), glutamine transpeptidase (GGT), alkaline phosphatase (ALP), aspartate transaminase, alanine transaminase (ALT), procalcitonin, the international normalized ratio (INR), model for end-stage liver disease scores, albumin, globulin, and hemocyte count between groups A and B (in all cases, P > 0.05). However, the total bilirubin (TBIL) of group B was significantly higher than that of group A (P = 0.029). After treatment, TBIL and DBIL were significantly decreased in group B (both P < 0.05), and group B had a significantly lower GGT (P = 0.028) and higher INR (P = 0.004) than group A. The ALP level of group B was also lower, but the difference was not significant (P = 0.068). No allergic reaction or severe adverse effect was observed. Conclusions: Both PE and DPMAS + PE can effectively improve ICI-related hepatitis within the short term and are more effective for patients with hyperbilirubinemia. Liver function should be monitored continuously during treatment.
{"title":"Efficacy of Plasma Exchange and a Double-Plasma Molecular Absorption System for Treating Immune Checkpoint Inhibitor-Related Hepatitis","authors":"Ying Liu, Lihua Zheng, Wenxiong Xu, Qihuan Xu, Xinhua Li, Qu Lin, Lu Wang, Jing Lai","doi":"10.5812/hepatmon-137153","DOIUrl":"https://doi.org/10.5812/hepatmon-137153","url":null,"abstract":"Background: Immune checkpoint inhibitor (ICI)-related hepatitis has been increasing in the past decade. Objectives: This study aimed to investigate the effectiveness of plasma exchange (PE) and a double-plasma molecular absorption system (DPMAS) for ICI-related hepatitis. Methods: A retrospective analysis was conducted on patients with ICI-related hepatitis treated at the Third Affiliated Hospital of Sun Yat-Sen University (China). The collected data included biochemical indices, treatments, the use of an artificial liver support system (ALSS), and outcomes. Results: From June 2021 to January 2023, 16 patients were treated and included in the analysis. Eight patients in group A received general support. The other 8 patients in group B received general support, plus 3 rounds of ALSS every 2 - 4 days (4 patients were treated with PE and the others with DPMAS + PE). There was no significant difference in age and treatment days between the two groups. Before treatment, there was no significant difference in direct bilirubin (DBIL), glutamine transpeptidase (GGT), alkaline phosphatase (ALP), aspartate transaminase, alanine transaminase (ALT), procalcitonin, the international normalized ratio (INR), model for end-stage liver disease scores, albumin, globulin, and hemocyte count between groups A and B (in all cases, P > 0.05). However, the total bilirubin (TBIL) of group B was significantly higher than that of group A (P = 0.029). After treatment, TBIL and DBIL were significantly decreased in group B (both P < 0.05), and group B had a significantly lower GGT (P = 0.028) and higher INR (P = 0.004) than group A. The ALP level of group B was also lower, but the difference was not significant (P = 0.068). No allergic reaction or severe adverse effect was observed. Conclusions: Both PE and DPMAS + PE can effectively improve ICI-related hepatitis within the short term and are more effective for patients with hyperbilirubinemia. Liver function should be monitored continuously during treatment.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135168217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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