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Late use of Plasma Exchange in Acute Liver Failure: The Battle is Lost? 急性肝衰竭患者晚期使用血浆置换术:战斗已经失败?
IF 25.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-06 DOI: 10.1016/j.jhep.2024.10.039
Valentin Coirier, Florent Artru, Christophe Camus

Section snippets

Declaration of Competing Interest

none

Financial disclosure

none

Author contributions

all authors contributed equally to the manuscript in terms of concept, writing, editing.
章节片段竞争利益声明无财务披露无作者贡献所有作者在构思、写作和编辑方面对稿件做出了同等贡献。
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引用次数: 0
Is there a safe limit for consumption of alcohol? 饮酒有安全限度吗?
IF 25.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.jhep.2024.10.024
Jessica Ann Musto, Randall Brown, Michael Ronan Lucey
In order to understand and curb the harms related to alcohol, it will be necessary to think beyond patterns of use that meet criteria for a diagnosis of alcohol use disorder, or addiction. Current research suggests that regular daily alcohol use does not confer a health benefit, and for many persons, even relatively low consumption is associated with a health risk. Determining a safe limit for alcohol consumption is challenging both for the individual person and for society. We conclude that excessive drinking is always risky. We provide a list of circumstances, such as chronic illness, driving a vehicle, or pregnancy where persons should be advised to abstain from alcohol. We recognize the need to encourage less consumption of alcohol, particularly in young adults, and in older adults with co-morbid conditions particularly when taking multiple medications. Finally, we offer the modest proposal that, for persons without the contributing negative influences described above, consumption which adheres to one drink per session, with interspersed abstinent days, does not constitute a meaningful risk to health.
为了了解和遏制与酒精有关的危害,有必要超越符合酒精使用障碍或成瘾诊断标准的使用模式。目前的研究表明,每天定期饮酒并不会给健康带来好处,对许多人来说,即使相对较少的饮酒量也会带来健康风险。对个人和社会而言,确定一个安全的饮酒限度都具有挑战性。我们的结论是,过度饮酒总是有风险的。我们列举了一些应建议人们戒酒的情况,如慢性疾病、驾驶车辆或怀孕。我们认识到有必要鼓励减少饮酒,尤其是年轻人和患有并发症的老年人,特别是在服用多种药物的情况下。最后,我们提出一个适度的建议,即对于没有上述不良影响的人来说,每次只饮一杯酒,中间有几天不饮酒,并不会对健康构成严重威胁。
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引用次数: 0
EASL Clinical Practice Guidelines on liver transplantation EASL 肝移植临床实践指南
IF 26.8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-31 DOI: 10.1016/j.jhep.2024.07.032
European Association for the Study of the Liver, Didier Samuel, EASL Governing Board Representative, Panel members
Liver transplantation (LT) is an established life-saving procedure. The field of LT has changed in the past 10 years from several perspectives, with the expansion of indications, transplantation of patients with acute-on-chronic liver failure, evolution of transplant oncology, the use of donations after cardiac death, new surgical techniques, and prioritisation of recipients on the waiting list. In addition, the advent of organ perfusion machines, the recognition of new forms of rejection, and the attention paid to the transition from paediatric to adult patients, have all improved the management of LT recipients. The purpose of the EASL guidelines presented here is not to cover all aspects of LT but to focus on developments since the previous EASL guidelines published in 2016.
肝移植(LT)是一项成熟的救生手术。过去 10 年,肝移植领域从多个角度发生了变化:适应症的扩大、急性慢性肝功能衰竭患者的移植、移植肿瘤学的发展、心脏死亡后捐献的使用、新的外科技术以及等待名单中受者的优先排序。此外,器官灌注机的出现、对新型排斥反应的认识以及对儿童患者向成人患者过渡的关注,都改善了对LT受者的管理。这里介绍的EASL指南的目的并不是涵盖LT的所有方面,而是关注自2016年发布上一份EASL指南以来的发展。
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引用次数: 0
Liver Cancer in 2021: Global Burden of Disease Study 2021 年的肝癌:全球疾病负担研究
IF 25.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-30 DOI: 10.1016/j.jhep.2024.10.031
En Ying Tan, Pojsakorn Danpanichkul, Jie Ning Yong, Zhenning Yu, Darren Jun Hao Tan, Wen Hui Lim, Benjamin Koh, Ryan Yan Zhe Lim, Ethan Kai Jun Tham, Kartik Mitra, Asahiro Morishita, Yao-Chun Hsu, Ju Dong Yang, Hirokazu Takahashi, Ming-Hua Zheng, Atsushi Nakajima, Cheng Han Ng, Karn Wijarnpreecha, Mark D. Muthiah, Amit G. Singal, Daniel Q. Huang

Background & Aims

The epidemiology of adult primary liver cancer continues to evolve, related to the increasing prevalence of metabolic disease, rising alcohol consumption, advancements in vaccination for hepatitis B (HBV), and antiviral therapy for hepatitis C (HCV). Disparities in care and the burden of liver cancer between populations persist. We assess trends in the burden of liver cancer and contributions by various etiologies across 204 countries and territories from 2010 to 2021.

Methods

Utilizing the methodological framework of the Global Burden of Disease Study 2021, we analyzed global and regional temporal trends in incidence and mortality, and the contributions of various etiologies of liver disease.

Results

In 2021, there were an estimated 529202 incident cases and 483875 deaths related to liver cancer. From 2010 to 2021, global liver cancer incident cases and deaths increased by 26% and 25%, respectively. Global age-standardized incidence rates (ASIRs) and death rates (ASDRs) for liver cancer declined but rose in the Americas and Southeast Asia. HBV remained the dominant cause of global incident liver cancer cases and deaths. Metabolic dysfunction-associated steatotic liver disease (MASLD) was the only etiology of liver cancer with rising ASIRs and ASDRs. By contrast, ASIRs and ASDRs remained stable for alcohol-related liver cancer, and declined for HBV- and HCV-related liver cancer.

Conclusions

While age-adjusted incidence and deaths from liver cancer have started to decline, the absolute number of incident cases and deaths continues to increase. Population growth and aging contribute to the observed disconnect in the temporal trends of absolute cases and rates. Disparities remain, and MASLD-related liver cancer continues to surge.
背景& 目的成人原发性肝癌的流行病学不断演变,这与代谢性疾病发病率的增加、饮酒量的增加、乙型肝炎(HBV)疫苗接种的进步以及丙型肝炎(HCV)抗病毒治疗有关。不同人群在肝癌治疗和负担方面的差异依然存在。我们评估了 204 个国家和地区从 2010 年到 2021 年的肝癌负担趋势以及各种病因造成的肝癌负担。方法利用《2021 年全球疾病负担研究》的方法框架,我们分析了全球和地区发病率和死亡率的时间趋势以及各种肝病病因造成的肝癌负担。从 2010 年到 2021 年,全球肝癌发病病例和死亡病例分别增加了 26% 和 25%。全球肝癌年龄标准化发病率(ASIRs)和死亡率(ASDRs)有所下降,但美洲和东南亚的发病率和死亡率有所上升。HBV仍然是全球肝癌发病和死亡的主要原因。代谢功能障碍相关性脂肪性肝病(MASLD)是肝癌病因中唯一一个ASIR和ASDR上升的病因。相比之下,酒精相关肝癌的年龄调整发病率和年龄调整死亡率保持稳定,而乙肝病毒和丙肝病毒相关肝癌的年龄调整发病率和年龄调整死亡率则有所下降。人口增长和老龄化导致了所观察到的绝对病例和发病率的时间趋势脱节。差异依然存在,与MASLD相关的肝癌继续激增。
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引用次数: 0
Blood markers for type-1,-2, and -3 inflammation are associated with severity of acutely decompensated cirrhosis 1、2 和 3 型炎症的血液标记物与急性失代偿期肝硬化的严重程度有关
IF 25.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-28 DOI: 10.1016/j.jhep.2024.10.028
Zhujun Cao, Yujing Yao, Minghao Cai, Chenxi Zhang, Yuhan Liu, Haiguang Xin, Baoyan An, Hui Wang, Yide Lu, Ziqiang Li, Yaoxing Chen, Yan Huang, Min Xin, Ruokun Li, Zhuping Qian, Yi Zhou, Xiaogang Xiang, Richard Moreau, Qing Xie

Background and aims

In patients with acutely decompensated cirrhosis (ADC) who present with clinically apparent precipitants (i.e., infections, acute liver injury), alterations in blood markers of inflammation associate with progression toward severe phenotypes (e.g., acute-on-chronic liver failure, ACLF). It is unclear whether alterations in blood inflammatory markers may associate with progression of ADC independently of precipitants.

Methods

We prospectively enrolled 394 patients admitted for ADC who were classified into four phenotypes of increasing severity: no organ dysfunction (n=168), organ dysfunction alone (n=72), organ failure without ACLF (n=91), and ACLF (n=63). Clinical blood cell counts and serum levels of inflammatory markers (including soluble markers related to type-1, type-2, and type-3 inflammation) were obtained at enrollment. Ordinal regression with adjacent categories logit model adjusted for confounders (including precipitants) was used to analyze associations between changes in each blood inflammatory marker and the worsening of ADC.

Results

Inflammatory markers that were associated with higher risk of progressing to the next more severe stage were as follows: increasing neutrophil counts (adjusted common odds ratio [cOR] 1.17, 95%CI 1.06-1.28); increasing levels of the type-2 cytokine interleukin (IL)-25 (cOR 1.21, 95%CI 1.06-1.39), type-3 cytokines IL-6 (cOR 1.15, 95%CI 1.02-1.28) and IL-22 (cOR 1.16, 95%CI 1.03-1.30), or anti-inflammatory soluble CD163 (cOR 1.94, 95%CI 1.58-2.38); decreasing lymphocyte counts (cOR 0.77, 95%CI 0.68-0.87), or decreasing levels of the type-1 cytokine IFN-γ (cOR 0.85, 95%CI 0.75-0.95).

Conclusions

Among patients with ADC, alterations in blood levels of cytokines related to type-1, type-2 and type-3 inflammation, together with neutrophilia, lymphopenia and elevated anti-inflammatory signals were individually associated with an increased risk of progressing toward ACLF, independently of the presence of clinically apparent precipitants.
背景和目的在临床上有明显诱因(如感染、急性肝损伤)的急性失代偿性肝硬化(ADC)患者中,血液炎症标志物的改变与向严重表型(如急性-慢性肝衰竭,ACLF)的进展有关。目前还不清楚血液中炎症标志物的改变是否与 ADC 的进展无关。方法我们前瞻性地纳入了 394 例因 ADC 入院的患者,这些患者被分为四种严重程度依次递增的表型:无器官功能障碍(168 例)、单纯器官功能障碍(72 例)、无 ACLF 的器官衰竭(91 例)和 ACLF(63 例)。临床血细胞计数和血清炎症标志物水平(包括与1型、2型和3型炎症相关的可溶性标志物)均在入组时获得。采用调整了混杂因素(包括诱发因素)的邻近类别对数模型进行顺序回归,分析每种血液炎症标记物的变化与 ADC 恶化之间的关系。结果与进展到下一个更严重阶段的更高风险相关的炎症标志物如下:中性粒细胞计数增加(调整后的共同几率比 [cOR] 1.17,95%CI 1.06-1.28);2型细胞因子白细胞介素(IL)-25(cOR 1.21,95%CI 1.06-1.39)、3型细胞因子IL-6(cOR 1.15,95%CI 1.02-1.28)和IL-22(cOR 1.16,95%CI 1.03-1.30),或抗炎可溶性 CD163(cOR 1.94,95%CI 1.58-2.38);淋巴细胞计数减少(cOR 0.77,95%CI 0.68-0.87),或 1 型细胞因子 IFN-γ 水平下降(cOR 0.85,95%CI 0.75-0.95)。结论在 ADC 患者中,血液中与 1 型、2 型和 3 型炎症相关的细胞因子水平的改变,以及中性粒细胞增多、淋巴细胞减少和抗炎信号升高,均与进展为 ACLF 的风险增加有关,与临床上明显的诱因无关。
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引用次数: 0
Metabolic dysfunction-associated steatohepatitis reduces interferon and macrophage liver gene signatures in patients with chronic hepatitis B 代谢功能障碍相关性脂肪性肝炎降低了慢性乙型肝炎患者的干扰素和巨噬细胞肝基因特征
IF 25.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-26 DOI: 10.1016/j.jhep.2024.10.032
Zgjim Osmani, Willem Pieter Brouwer, Dwin G.B. Grashof, Youkyung Lim, Michael Doukas, Harry L.A. Janssen, Harmen J.G. van de Werken, Andre Boonstra
<h3>Background & Aims</h3>Chronic HBV patients with concomitant metabolic dysfunction-associated steatohepatitis (MASH) have been shown to develop more advanced fibrosis faster with more severe liver disease as compared to patients with chronic HBV alone. However, our understanding of the underlying mechanisms is limited. Here we study how MASH co-morbidity impact immune activity in the liver of patients with chronic HBV infection.<h3>Methods</h3>Bulk RNA sequencing was performed on liver biopsies from patients with only MASH (n=10), only HBeAg-negative chronic HBV (ENEG; n=11), combined MASH/ENEG (n=9) and healthy controls (n=9). Biopsies with no or minimal fibrosis (≤F2) were selected to avoid confounding effects of fibrosis. We compared whole transcriptome data from patients with MASH/ENEG to those with ENEG alone to determine the impact of MASH co-morbidity on chronic hepatitis B.<h3>Results</h3>There is a high degree of overlap of liver gene expression profiles in patients with only ENEG versus those with only MASH compared to healthy controls, suggesting a largely shared mechanism of liver dysfunction and immune activity for these distinct conditions. In patients with ENEG, MASH co-morbidity significantly reduced interferon pathway activity (NES=2.03, p.adj=0.0251), the expression of ISGs (e.g., <em>IFIT2</em>, <em>IFI27</em>, <em>IFITM1</em>, <em>IFI6</em>), and macrophage gene signatures (e.g., <em>MARCO</em>, <em>CD163</em>, <em>CD5L</em>, <em>CD63</em>), when compared to patients with ENEG alone.<h3>Conclusions</h3>Transcriptomic profiling of the liver suggests that MASH negatively impacts ISGs expression in the liver of patients with ENEG, which may affect antiviral immune pathways, viral replication and inflammatory responses resulting in an increased risk of advanced fibrosis in patients with chronic hepatitis B. Our study provides valuable insights for guiding future research aimed at developing effective, tailored strategies for managing patients with both conditions.<h3>Impact and implications</h3>In recent decades, obesity and associated health issues have reached epidemic levels, with steatotic liver disease affecting up to 30% of adults in developed countries, and this trend is also observed among chronic hepatitis B patients. Given the high and rising prevalence of steatotic liver disease and its frequent co-occurrence in chronic hepatitis B patients, it is essential to understand how conditions such as metabolic dysfunction-associated steatohepatitis (MASH) impact immune responses in the liver. This study provides unique insights into the impact of MASH on HBV antiviral immune activity in the liver of patients with chronic hepatitis B. The rising number of patients with both conditions affects treatment outcomes and highlights the urgent need for novel, tailored therapeutic strategies. Our study holds significant relevance for guiding future research on developing treatment strategies for patients with both MASH and chron
背景& 目的 已有研究表明,与单纯慢性 HBV 患者相比,合并代谢功能障碍相关性脂肪性肝炎(MASH)的慢性 HBV 患者纤维化发展更快,肝病更严重。然而,我们对其潜在机制的了解还很有限。在此,我们研究了 MASH 并发症如何影响慢性 HBV 感染患者肝脏中的免疫活性。方法对仅有 MASH(10 例)、仅有 HBeAg 阴性慢性 HBV(ENEG;11 例)、合并 MASH/ENEG (9 例)和健康对照组(9 例)患者的肝活检组织进行大肠 RNA 测序。我们选择了无纤维化或纤维化程度极低(≤F2)的活检样本,以避免纤维化的混杂影响。我们比较了MASH/ENEG患者和单纯ENEG患者的全转录组数据,以确定MASH并发症对慢性乙型肝炎的影响。结果与健康对照组相比,单纯ENEG患者和单纯MASH患者的肝脏基因表达谱高度重叠,表明这些不同病症的肝脏功能障碍和免疫活动机制基本相同。在 ENEG 患者中,MASH 并发症显著降低了干扰素通路活性(NES=2.03,p.adj=0.0251)、ISGs(如 IFIT2、IFI27、IFITM1、IFI6)和巨噬细胞基因特征(如 MARCO、CD163、CD164、CD165、CD166、CD167、CD168)的表达、结论肝脏转录组学分析表明,MASH 对 ENEG 患者肝脏中 ISGs 的表达有负面影响,这可能会影响抗病毒免疫途径、病毒复制和炎症反应,导致慢性乙型肝炎患者发生晚期纤维化的风险增加。影响和意义近几十年来,肥胖和相关健康问题已达到流行病的程度,在发达国家,高达 30% 的成年人患有脂肪肝,慢性乙型肝炎患者中也出现了这种趋势。鉴于脂肪性肝病的发病率很高而且还在不断上升,而且慢性乙型肝炎患者中也经常出现脂肪性肝病,因此了解代谢功能障碍相关性脂肪性肝炎(MASH)等疾病如何影响肝脏的免疫反应至关重要。这项研究提供了关于代谢功能障碍相关性脂肪性肝炎(MASH)对慢性乙型肝炎患者肝脏中 HBV 抗病毒免疫活性的影响的独特见解。我们的研究对指导未来针对 MASH 和慢性乙型肝炎患者制定治疗策略的研究具有重要意义。
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引用次数: 0
Underrecognized Association of Porto-Sinusoidal Vascular Disorder and Telomere Biology Disorders 未被充分认识的门静脉血管疾病与端粒生物学紊乱的关联
IF 25.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-24 DOI: 10.1016/j.jhep.2024.10.029
Puru Rattan, Kianna Nguyen, Daniel D. Penrice, Davide Povero, Douglas A. Simonetto

Section snippets

Authors' contributions:

P.R., K.N.: Writing - Original Draft, Data curation, Formal Analysis; D.D.P, D.P.: Data curation, Formal Analysis, Writing - Review & Editing; D.A.S.: Conceptualization, Methodology, Formal Analysis, Writing – Review and Editing, Supervision.

Financial support:

NoneThe recently published multicenter study of Porto-Sinusoidal Vascular Disorder (PSVD) patients by Magaz and Giudicelli-Lett et al thoroughly details the clinical findings and disease progression of PSVD.1 Given the rarity of PSVD yet improved prognosis with early recognition, the authors stress the importance of clinical awareness of associated conditions to expedite diagnosis. To this point, is it important to note that PSVD has also been observed in the setting of telomere biology

Declaration of Competing Interest:

DAS is funded by National Institute of Health U01AA026886–03. DAS has consulted for Mallinckrodt, Evive, Resolution Therapeutics, BioVie, AstraZeneca, Iota and PharmaIN.
章节片段作者贡献:P.R.、K.N.:写作 - 原稿、数据整理、正式分析;D.D.P、D.P:数据整理、形式分析、写作 - 审稿 & 编辑;D.A.S:Magaz和Giudicelli-Lett等人最近发表的关于门静脉窦状血管紊乱(PSVD)患者的多中心研究详细阐述了PSVD的临床发现和疾病进展。1 鉴于PSVD的罕见性,但早期识别可改善预后,作者强调临床认识相关疾病以加快诊断的重要性。竞争利益声明:DAS 由美国国立卫生研究院 U01AA026886-03 资助。DAS 曾为 Mallinckrodt、Evive、Resolution Therapeutics、BioVie、AstraZeneca、Iota 和 PharmaIN 提供咨询服务。
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引用次数: 0
Real-World Evidence Supporting the Consensus-Driven DILI Control Compounds List: An Analysis of FAERS Data 支持共识驱动的 DILI 控制化合物清单的现实世界证据:FAERS 数据分析
IF 25.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-24 DOI: 10.1016/j.jhep.2024.10.030
Wukun Ge, Weiqin Chen, Haiyan Xie

Section snippets

Authors' contributions:

WG, WC and HX conceived and designed the study. WG and WC collected and analyzed the data. HX provided clinical expertise and interpreted the results. WG drafted the manuscript. All authors critically revised the manuscript and approved the final version.

Data Availability Statement

This data can be accessed through the FDA's FAERS Public Dashboard athttps://fis.fda.gov/extensions/FPD-QDE-FAERS/FPD-QDE-FAERS.html.

Funding information

The study was supported by Quzhou City Science and Technology Research Project in 2023 (Grant No. 2023k193).

Declaration of Competing Interest

The authors disclose no conflicts.
章节片段作者贡献:WG、WC 和 HX 构思并设计了这项研究。WG 和 WC 收集并分析了数据。HX 提供临床专业知识并解释结果。WG 起草手稿。所有作者对手稿进行了严格的修改,并批准了最终版本。数据可用性声明该数据可通过FDA的FAERS公共仪表板访问:https://fis.fda.gov/extensions/FPD-QDE-FAERS/FPD-QDE-FAERS.html.Funding information该研究得到了衢州市2023年科技攻关项目(批准号:2023k193)的支持。利益冲突声明作者未披露任何利益冲突。
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引用次数: 0
New nomenclature for fatty liver disease: problems of localization in the regions and the position of Russian Scientific Liver Society 脂肪肝的新命名法:地区定位问题和俄罗斯肝脏科学学会的立场
IF 25.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-23 DOI: 10.1016/j.jhep.2024.10.023
Karina Raikhelson, Sergey Okovityi, Dzhamal Abdurakhmanov

Section snippets

Authors' contributions

Karina Raikhelson wrote the original draft, Sergey Okovityi, Dzhamal Abdurakhmanov reviewed and edited this Correspondence; All the authors approved the final manuscript.

Financial support

The authors received no financial support to produce this manuscript.

Declaration of Competing Interest

The authors declare no conflict of interest pertaining to this article.
作者的贡献Karina Raikhelson撰写了原稿,Sergey Okovityi、Dzhamal Abdurakhmanov审阅并编辑了本通讯;所有作者都批准了最终稿件。
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引用次数: 0
Reply to: Optimising the treatment of HDV infection: efficacy of Bulevirtide, HBV-HDV interactions and the importance of statistical methods 答复优化 HDV 感染的治疗:布来维肽的疗效、HBV-HDV 相互作用以及统计方法的重要性
IF 25.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-23 DOI: 10.1016/j.jhep.2024.10.027
M. Dandri, L. Allweiss, B. Downie, J.J. Wallin

Section snippets

Author contributions

all authors contributed equally to the reply letter

Financial support

The study was supported by Gilead Sciences and the German Center for Infection Research (TTU Hepatitis 05.822; 05.820).

Declaration of Competing Interest

LA declares no conflict of interest. JJW and BD are employees of Gilead Sciences and holders of Gilead stock. MD: Research collaboration with Gilead Science.
章节片段作者贡献所有作者对回信的贡献相同财务支持本研究得到了吉利德科学公司和德国感染研究中心(TTU Hepatitis 05.822; 05.820)的支持。JJW 和 BD 是吉利德科学公司的员工和吉利德股票的持有者。MD:与吉利德科学公司有研究合作。
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引用次数: 0
期刊
Journal of Hepatology
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