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Biomarkers of transfusion transmitted occult hepatitis B virus infection: Where are we and what next? 输血传播隐性乙型肝炎病毒感染的生物标志物:进展如何?
IF 9 2区 医学 Q1 VIROLOGY Pub Date : 2024-03-01 DOI: 10.1002/rmv.2525
Michael X Fu, Peter Simmonds, Monique Andersson, Heli Harvala

Blood transfusion is a vital procedure, where transfusion-transmitted infection of hepatitis B virus (HBV) remains an important issue, especially from blood donors with occult hepatitis B virus infection (OBI). Occult hepatitis B virus infection is a complex entity to detect using surrogate blood biomarkers for intrahepatic viral transcriptional activity, requiring a continually refined battery of tests utilised for screening. This review aims to critically evaluate the latest advances in the current blood biomarkers to guide the identification of OBI donors and discuss novel HBV markers that could be introduced in future diagnostic practice. Challenges in detecting low HBV surface antigen levels, mutants, and complexes necessitate ultrasensitive multivalent dissociation assays, whilst HBV DNA testing requires improved sensitivity but worsens inaccessibility. Anti-core antibody assays defer almost all potentially infectious donations but have low specificity, and titres of anti-surface antibodies that prevent infectivity are poorly defined with suboptimal sensitivity. The challenges associated with these traditional blood HBV markers create an urgent need for alternative biomarkers that would help us better understand the OBI. Emerging viral biomarkers, such as pre-genomic RNA and HBV core-related antigen, immunological HBV biomarkers of T-cell reactivity and cytokine levels, and host biomarkers of microRNA and human leucocyte antigen molecules, present potential advances to gauge intrahepatic activity more accurately. Further studies on these markers may uncover an optimal diagnostic algorithm for OBI using quantification of various novel and traditional blood HBV markers. Addressing critical knowledge gaps identified in this review would decrease the residual risk of transfusion-transmitted HBV infection without compromising the sustainability of blood supplies.

输血是一项重要的程序,其中乙型肝炎病毒(HBV)的输血传播感染仍是一个重要问题,尤其是来自隐性乙型肝炎病毒感染(OBI)献血者的感染。隐匿性乙型肝炎病毒感染是一个复杂的实体,需要使用肝内病毒转录活性的代用血液生物标志物进行检测,因此需要不断完善用于筛查的一系列检测方法。本综述旨在批判性地评估当前血液生物标志物的最新进展,以指导确定 OBI 献血者,并讨论可在未来诊断实践中引入的新型 HBV 标志物。由于在检测低水平 HBV 表面抗原、突变体和复合物方面存在挑战,因此有必要采用超灵敏的多价解离测定法,而 HBV DNA 检测需要提高灵敏度,但却增加了不可及性。抗核心抗体检测几乎可以推迟所有潜在感染性捐献,但特异性较低,而防止感染的抗表面抗体滴度定义不清,灵敏度也不理想。这些传统的血液 HBV 标志物所面临的挑战使我们急需能帮助我们更好地了解 OBI 的替代生物标志物。新出现的病毒生物标记物,如前基因组 RNA 和 HBV 核心相关抗原、T 细胞反应性和细胞因子水平等免疫学 HBV 生物标记物,以及微 RNA 和人类白细胞抗原分子等宿主生物标记物,为更准确地评估肝内活动提供了潜在的进展。对这些标志物的进一步研究可能会发现一种利用各种新型和传统血液 HBV 标志物定量的 OBI 最佳诊断算法。解决本综述中发现的关键知识缺口将降低输血传播 HBV 感染的残余风险,同时又不影响血液供应的可持续性。
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引用次数: 0
Overview of reemerging mpox infection with a focus on neurological manifestations. 新发麻风腮病毒感染概述,重点关注神经系统表现。
IF 9 2区 医学 Q1 VIROLOGY Pub Date : 2024-03-01 DOI: 10.1002/rmv.2527
Mohammed Alissa, Abdullah Alghamdi, Suad A Alghamdi

Mpox, a reemerging zoonotic disease caused by the mpox virus, has garnered increasing attention due to its potential for severe clinical manifestations. While the cutaneous and systemic presentations of mpox have been well-documented, its neurological complications have recently emerged as an area of concern. This review provides a brief overview of the neurological aspects of mpox infection, highlighting the key findings and challenges in understanding and managing these complications. Neurological manifestations in mpox patients range from mild symptoms such as headaches and dizziness to more severe conditions, including encephalitis and seizures. The pathogenesis of neurological involvement is not yet fully elucidated but is thought to involve viral dissemination to the central nervous system. This dissemination may occur through haematogenous or neuronal routes, contributing to the diverse clinical spectrum observed. Early recognition and diagnosis of neurological complications in mpox are crucial for implementing appropriate therapeutic interventions and improving patient outcomes.

麻腮风是由麻腮风病毒引起的一种重新出现的人畜共患疾病,因其可能出现严重的临床表现而日益受到关注。尽管痘疹的皮肤和全身表现已得到充分证实,但其神经系统并发症近来也成为一个值得关注的领域。本综述简要概述了水痘感染的神经系统方面,重点介绍了在了解和处理这些并发症方面的主要发现和挑战。麻风病人的神经系统表现从头痛和头晕等轻微症状到脑炎和癫痫发作等更严重的病症不等。神经系统受累的发病机制尚未完全阐明,但据认为涉及病毒向中枢神经系统的传播。这种传播可能通过血液或神经元途径发生,从而导致临床表现多种多样。早期识别和诊断水痘的神经系统并发症对于实施适当的治疗干预和改善患者预后至关重要。
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引用次数: 0
Risk of kidney and liver diseases after COVID-19 infection: A systematic review and meta-analysis. 感染 COVID-19 后患肝肾疾病的风险:系统回顾与荟萃分析。
IF 9 2区 医学 Q1 VIROLOGY Pub Date : 2024-03-01 DOI: 10.1002/rmv.2523
Bei Pan, Xiaoman Wang, Honghao Lai, Robin W M Vernooij, Xiyuan Deng, Ning Ma, Dan Li, Jiajie Huang, Weilong Zhao, Jinling Ning, Jianing Liu, Jinhui Tian, Long Ge, Kehu Yang

COVID-19 is not only associated with substantial acute liver and kidney injuries, but also with an elevated risk of post-acute sequelae involving the kidney and liver system. We aimed to investigate whether COVID-19 exposure increases the long-term risk of kidney and liver disease, and what are the magnitudes of these associations. We searched PubMed, Embase, Web of Science, ClinicalTrials.gov, and the Living Overview of the Evidence COVID-19 Repository for cohort studies estimating the association between COVID-19 and kidney and liver outcomes. Random-effects meta-analyses were performed to combine the results of the included studies. We assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. Fifteen cohort studies with more than 32 million participants were included in the systematic review COVID-19 was associated with a 35% greater risk of kidney diseases (10 more per 1000 persons; low certainty evidence) and 54% greater risk of liver disease (3 more per 1000 persons; low certainty evidence). The absolute increases due to COVID-19 for acute kidney injury, chronic kidney disease, and liver test abnormality were 3, 8, and 3 per 1000 persons, respectively. Subgroup analyses found no differences between different type of kidney and liver diseases. The findings provide further evidence for the association between COVID-19 and incident kidney and liver conditions. The absolute magnitude of the effect of COVID-19 on kidney and liver outcomes was, however, relatively small.

COVID-19 不仅与严重的急性肝肾损伤有关,还与肝肾系统急性后遗症的风险升高有关。我们旨在研究接触 COVID-19 是否会增加肝肾疾病的长期风险,以及这些关联的程度如何。我们检索了PubMed、Embase、Web of Science、ClinicalTrials.gov和Living Overview of the Evidence COVID-19 Repository,以了解估计COVID-19与肾脏和肝脏结果之间关系的队列研究。我们对纳入的研究结果进行了随机效应荟萃分析。我们采用 "建议分级评估、发展和评价 "方法对证据的确定性进行了评估。系统综述纳入了 15 项队列研究,参与者超过 3200 万人,COVID-19 与肾脏疾病风险增加 35% 相关(每 1000 人增加 10 人;低确定性证据),与肝脏疾病风险增加 54% 相关(每 1000 人增加 3 人;低确定性证据)。COVID-19导致急性肾损伤、慢性肾脏疾病和肝脏检测异常的绝对增加率分别为每千人3例、8例和3例。分组分析发现,不同类型的肾病和肝病之间没有差异。这些研究结果进一步证明了 COVID-19 与肾脏和肝脏疾病之间的关联。然而,COVID-19对肾脏和肝脏结果影响的绝对值相对较小。
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引用次数: 0
Ferritin: Significance in viral infections. 铁蛋白:在病毒感染中的意义。
IF 9 2区 医学 Q1 VIROLOGY Pub Date : 2024-03-01 DOI: 10.1002/rmv.2531
Xia Zhao, Yuntao Zhou, Yong Zhang, Yan Zhang

As an indispensable trace element, iron is essential for many biological processes. Increasing evidence has shown that virus infection can perturb iron metabolism and play a role in the occurrence and development of viral infection-related diseases. Ferritin plays a crucial role in maintaining the body's iron homoeostasis. It is an important protein to stabilise the iron balance in cells. Ferritin is a 24-mer hollow iron storage protein composed of two subunits: ferritin heavy chain and ferritin light chain. It was reported that ferritin is not only an intra-cellular iron storage protein, but also a pathogenic mediator that enhances the inflammatory process and stimulates the further inflammatory pathway, which is a key member of the vicious pathogenic cycle to perpetuate. Ferritin exerts immuno-suppressive and pro-inflammatory functions during viral infection. In this review, we describe in detail the basic information of ferritin in the first section, including its structural features, the regulation of ferritin. In the second part, we focus on the role of ferritin in viral infection-related diseases and the molecular mechanisms by which viral infection regulates ferritin. The last section briefly outlines the potential of ferritin in antiviral therapy. Given the importance of iron and viral infection, understanding the role of ferritin during viral infection helps us understand the relationship between iron metabolic dysfunction and viral infection, which provides a new direction for the development of antiviral therapeutic drugs.

作为一种不可或缺的微量元素,铁对许多生物过程都至关重要。越来越多的证据表明,病毒感染会扰乱铁代谢,并在病毒感染相关疾病的发生和发展中发挥作用。铁蛋白在维持人体铁平衡方面发挥着至关重要的作用。它是稳定细胞中铁平衡的重要蛋白质。铁蛋白是一种 24 聚体的中空铁储存蛋白,由两个亚基组成:铁蛋白重链和铁蛋白轻链。据报道,铁蛋白不仅是一种细胞内铁贮存蛋白,还是一种致病介质,能增强炎症过程,刺激炎症通路的进一步发展,是恶性致病循环得以延续的关键成员。铁蛋白在病毒感染过程中发挥免疫抑制和促炎功能。在这篇综述中,我们将在第一部分详细介绍铁蛋白的基本信息,包括其结构特征、铁蛋白的调控。第二部分,我们将重点讨论铁蛋白在病毒感染相关疾病中的作用以及病毒感染调控铁蛋白的分子机制。最后一部分简要概述了铁蛋白在抗病毒治疗中的潜力。鉴于铁与病毒感染的重要性,了解铁蛋白在病毒感染过程中的作用有助于我们理解铁代谢功能障碍与病毒感染之间的关系,这为开发抗病毒治疗药物提供了新的方向。
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引用次数: 0
Clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands: A systematic review and meta-analysis. 太平洋岛屿登革热、寨卡病毒和基孔肯雅病毒的临床表现:系统回顾和荟萃分析。
IF 9 2区 医学 Q1 VIROLOGY Pub Date : 2024-03-01 DOI: 10.1002/rmv.2521
Sahil Kharwadkar, Nipun Herath

Dengue, Zika and chikungunya outbreaks pose a significant public health risk to Pacific Island communities. Differential diagnosis is challenging due to overlapping clinical features and limited availability of laboratory diagnostic facilities. There is also insufficient information regarding the complications of these arboviruses, particularly for Zika and chikungunya. We conducted a systematic review and meta-analysis to calculate pooled prevalence estimates with 95% confidence intervals (CI) for the clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands. Based on pooled prevalence estimates, clinical features that may help to differentiate between the arboviruses include headache, haemorrhage and hepatomegaly in dengue; rash, conjunctivitis and peripheral oedema in Zika; and the combination of fever and arthralgia in chikungunya infections. We estimated that the hospitalisation and mortality rates in dengue were 9.90% (95% CI 7.67-12.37) and 0.23% (95% CI 0.16-0.31), respectively. Severe forms of dengue occurred in 1.92% (95% CI 0.72-3.63) of reported cases and 23.23% (95% CI 13.58-34.53) of hospitalised patients. Complications associated with Zika virus included Guillain-Barré syndrome (GBS), estimated to occur in 14.08 (95% CI 11.71-16.66) per 10,000 reported cases, and congenital brain malformations such as microcephaly, particularly with first trimester maternal infection. For chikungunya, the hospitalisation rate was 2.57% (95% CI 1.30-4.25) and the risk of GBS was estimated at 1.70 (95% CI 1.06-2.48) per 10,000 reported cases. Whilst ongoing research is required, this systematic review enhances existing knowledge on the clinical manifestations of dengue, Zika and chikungunya infections and will assist Pacific Island clinicians during future arbovirus outbreaks.

登革热、寨卡病毒和基孔肯雅病毒的爆发对太平洋岛屿社区的公共卫生构成了重大风险。由于临床特征重叠和实验室诊断设施有限,鉴别诊断具有挑战性。有关这些虫媒病毒(尤其是寨卡和基孔肯雅)并发症的信息也不足。我们进行了一项系统回顾和荟萃分析,以计算太平洋岛屿登革热、寨卡和基孔肯雅临床表现的集合流行率估计值及 95% 的置信区间 (CI)。根据汇总的流行率估计值,有助于区分虫媒病毒的临床特征包括:登革热患者的头痛、出血和肝肿大;寨卡患者的皮疹、结膜炎和外周水肿;以及基孔肯雅病毒感染患者的发热和关节痛。我们估计,登革热的住院率和死亡率分别为 9.90% (95% CI 7.67-12.37) 和 0.23% (95% CI 0.16-0.31)。在报告的登革热病例中,有 1.92%(95% CI 0.72-3.63)的患者出现了严重形式的登革热,在住院患者中,有 23.23%(95% CI 13.58-34.53)的患者出现了严重形式的登革热。与寨卡病毒相关的并发症包括吉兰-巴雷综合征(GBS),估计每 10,000 例报告病例中就有 14.08 例(95% CI 11.71-16.66)发生,以及先天性脑畸形(如小头畸形),尤其是孕前三个月的母体感染。基孔肯雅病的住院率为 2.57%(95% CI 1.30-4.25),每 10,000 例报告病例中发生 GBS 的风险估计为 1.70(95% CI 1.06-2.48)。虽然还需要继续开展研究,但这一系统性综述增进了人们对登革热、寨卡和基孔肯雅感染临床表现的现有了解,并将在未来虫媒病毒爆发时为太平洋岛屿的临床医生提供帮助。
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引用次数: 0
Regulatory role of miRNAs in the human immune and inflammatory response during the infection of SARS-CoV-2 and other respiratory viruses: A comprehensive review. miRNA 在 SARS-CoV-2 和其他呼吸道病毒感染期间人类免疫和炎症反应中的调控作用:综述。
IF 9 2区 医学 Q1 VIROLOGY Pub Date : 2024-03-01 DOI: 10.1002/rmv.2526
Chiranjib Chakraborty, Manojit Bhattacharya, Sang-Soo Lee

miRNAs are single-stranded ncRNAs that act as regulators of different human body processes. Several miRNAs have been noted to control the human immune and inflammatory response during severe acute respiratory infection syndrome (SARS-CoV-2) infection. Similarly, many miRNAs were upregulated and downregulated during different respiratory virus infections. Here, an attempt has been made to capture the regulatory role of miRNAs in the human immune and inflammatory response during the infection of SARS-CoV-2 and other respiratory viruses. Firstly, the role of miRNAs has been depicted in the human immune and inflammatory response during the infection of SARS-CoV-2. In this direction, several significant points have been discussed about SARS-CoV-2 infection, such as the role of miRNAs in human innate immune response; miRNAs and its regulation of granulocytes; the role of miRNAs in macrophage activation and polarisation; miRNAs and neutrophil extracellular trap formation; miRNA-related inflammatory response; and miRNAs association in adaptive immunity. Secondly, the miRNAs landscape has been depicted during human respiratory virus infections such as human coronavirus, respiratory syncytial virus, influenza virus, rhinovirus, and human metapneumovirus. The article will provide more understanding of the miRNA-controlled mechanism of the immune and inflammatory response during COVID-19, which will help more therapeutics discoveries to fight against the future pandemic.

miRNAs 是单链 ncRNAs,是人体不同过程的调节因子。人们注意到,在严重急性呼吸道感染综合征(SARS-CoV-2)感染期间,一些 miRNA 可控制人体免疫和炎症反应。同样,在不同的呼吸道病毒感染过程中,许多 miRNA 上调或下调。本文试图研究 miRNA 在 SARS-CoV-2 和其他呼吸道病毒感染期间对人类免疫和炎症反应的调控作用。首先,我们描绘了 miRNA 在感染 SARS-CoV-2 期间人类免疫和炎症反应中的作用。在这个方向上,讨论了有关 SARS-CoV-2 感染的几个重要观点,如 miRNAs 在人类先天性免疫反应中的作用;miRNAs 及其对粒细胞的调控;miRNAs 在巨噬细胞活化和极化中的作用;miRNAs 与中性粒细胞胞外陷阱的形成;miRNA 相关炎症反应;以及 miRNAs 在适应性免疫中的关联。其次,文章描绘了人类呼吸道病毒(如人类冠状病毒、呼吸道合胞病毒、流感病毒、鼻病毒和人类偏肺病毒)感染过程中的 miRNAs 图谱。这篇文章将使人们对 COVID-19 期间免疫和炎症反应的 miRNA 控制机制有更多的了解,从而有助于发现更多的治疗方法来对抗未来的大流行。
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引用次数: 0
Duration of protective immunity following COVID‐19 vaccination of individuals with underlying health conditions: A rapid review 有潜在健康问题的人接种 COVID-19 疫苗后的保护性免疫持续时间:快速回顾
IF 11.1 2区 医学 Q1 Medicine Pub Date : 2024-02-03 DOI: 10.1002/rmv.2504
K. Walsh, Helen O’Donnell, Mark O’Loughlin, Heather Eames, Jingjing Jiang, Katie M. O’Brien, N. Broderick, Kirsty O'Brien, M. Carrigan, L. Comber, Karen Cardwell, Joan Quigley, Susan M. Smith, Eamon O Murchu, Karina Butler, Brenda Corcoran, Kevin Connolly, P. Harrington, M. Ryan, M. O’Neill
The World Health Organization has stated that the primary goal of immunisation in the COVID‐19 pandemic remains to protect against hospitalisation, severe disease and death. Vaccination is particularly important for those with underlying health conditions given the high risk of severe disease in this population. The aim of this review was to examine the change in efficacy and effectiveness of COVID‐19 vaccination over time in individuals with underlying conditions. A rapid review was undertaken in Cochrane, Embase, Medline, Europe PMC, MedRxiv and Google Scholar from 01/01/2020 to 27/10/2021. A total of 14 unique studies (3 randomised controlled trials and 11 observational studies) were included. Overall, there was limited and inconsistent evidence regarding vaccine efficacy and effectiveness in those with underlying health conditions. However, the evidence suggests potentially faster waning of vaccine effectiveness against infection, severe disease and death in individuals with underlying conditions, particularly for older adults with these conditions, and in those who are immunocompromised. Protection in younger age groups with underlying conditions who are not immunocompromised, may be largely comparable to that observed in the general population, though this is uncertain. Given the significant burden of infection on individuals with underlying conditions, any small decrease in protection is likely to have a substantial impact in this population. Hence, the evidence supports a policy of providing additional doses to those who are immunocompromised, and boosters to all those with underlying health conditions. Further research is required to understand the impact of new variants on vaccine efficacy/effectiveness in this population.
世界卫生组织指出,在 COVID-19 大流行中,免疫接种的主要目标仍然是防止住院、重症和死亡。鉴于有潜在健康问题的人群罹患严重疾病的风险较高,因此接种疫苗对这些人群尤为重要。本综述旨在研究 COVID-19 疫苗接种的效力和有效性随时间推移在患有基础疾病的人群中的变化情况。自 2020 年 1 月 1 日至 2021 年 10 月 27 日,我们在 Cochrane、Embase、Medline、Europe PMC、MedRxiv 和 Google Scholar 上进行了快速综述。共纳入了 14 项独特的研究(3 项随机对照试验和 11 项观察性研究)。总体而言,有关疫苗对有潜在健康问题的人群的效力和有效性的证据有限且不一致。不过,有证据表明,疫苗对患有基础疾病的人,尤其是患有这些疾病的老年人和免疫力低下的人,在预防感染、严重疾病和死亡方面的效果可能会更快地减弱。对于有基础疾病但免疫力未受损的年轻群体,疫苗的保护作用可能与普通人群的保护作用基本相当,但这一点尚不确定。鉴于基础疾病患者的感染负担沉重,保护能力的任何微小下降都可能对这一人群产生重大影响。因此,证据支持为免疫力低下的人群提供额外剂量的疫苗,并为所有患有基础疾病的人群提供强化疫苗的政策。要了解新变异株对这一人群的疫苗效力/有效性的影响,还需要进一步的研究。
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引用次数: 0
Duration of protective immunity following COVID‐19 vaccination of individuals with underlying health conditions: A rapid review 有潜在健康问题的人接种 COVID-19 疫苗后的保护性免疫持续时间:快速回顾
IF 11.1 2区 医学 Q1 Medicine Pub Date : 2024-02-03 DOI: 10.1002/rmv.2504
K. Walsh, Helen O’Donnell, Mark O’Loughlin, Heather Eames, Jingjing Jiang, Katie M. O’Brien, N. Broderick, Kirsty O'Brien, M. Carrigan, L. Comber, Karen Cardwell, Joan Quigley, Susan M. Smith, Eamon O Murchu, Karina Butler, Brenda Corcoran, Kevin Connolly, P. Harrington, M. Ryan, M. O’Neill
The World Health Organization has stated that the primary goal of immunisation in the COVID‐19 pandemic remains to protect against hospitalisation, severe disease and death. Vaccination is particularly important for those with underlying health conditions given the high risk of severe disease in this population. The aim of this review was to examine the change in efficacy and effectiveness of COVID‐19 vaccination over time in individuals with underlying conditions. A rapid review was undertaken in Cochrane, Embase, Medline, Europe PMC, MedRxiv and Google Scholar from 01/01/2020 to 27/10/2021. A total of 14 unique studies (3 randomised controlled trials and 11 observational studies) were included. Overall, there was limited and inconsistent evidence regarding vaccine efficacy and effectiveness in those with underlying health conditions. However, the evidence suggests potentially faster waning of vaccine effectiveness against infection, severe disease and death in individuals with underlying conditions, particularly for older adults with these conditions, and in those who are immunocompromised. Protection in younger age groups with underlying conditions who are not immunocompromised, may be largely comparable to that observed in the general population, though this is uncertain. Given the significant burden of infection on individuals with underlying conditions, any small decrease in protection is likely to have a substantial impact in this population. Hence, the evidence supports a policy of providing additional doses to those who are immunocompromised, and boosters to all those with underlying health conditions. Further research is required to understand the impact of new variants on vaccine efficacy/effectiveness in this population.
世界卫生组织指出,在 COVID-19 大流行中,免疫接种的主要目标仍然是防止住院、重症和死亡。鉴于有潜在健康问题的人群罹患严重疾病的风险较高,因此接种疫苗对这些人群尤为重要。本综述旨在研究 COVID-19 疫苗接种的效力和有效性随时间推移在患有基础疾病的人群中的变化情况。自 2020 年 1 月 1 日至 2021 年 10 月 27 日,我们在 Cochrane、Embase、Medline、Europe PMC、MedRxiv 和 Google Scholar 上进行了快速综述。共纳入了 14 项独特的研究(3 项随机对照试验和 11 项观察性研究)。总体而言,有关疫苗对有潜在健康问题的人群的效力和有效性的证据有限且不一致。不过,有证据表明,疫苗对患有基础疾病的人,尤其是患有这些疾病的老年人和免疫力低下的人,在预防感染、严重疾病和死亡方面的效果可能会更快地减弱。对于有基础疾病但免疫力未受损的年轻群体,疫苗的保护作用可能与普通人群的保护作用基本相当,但这一点尚不确定。鉴于基础疾病患者的感染负担沉重,保护能力的任何微小下降都可能对这一人群产生重大影响。因此,证据支持为免疫力低下的人群提供额外剂量的疫苗,并为所有患有基础疾病的人群提供强化疫苗的政策。要了解新变异株对这一人群的疫苗效力/有效性的影响,还需要进一步的研究。
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引用次数: 0
Opportunities and challenges for the application of artificial intelligence paradigms into the management of endemic viral infections: The example of Chronic Hepatitis C Virus 将人工智能范例应用于地方性病毒感染管理的机遇与挑战:以慢性丙型肝炎病毒为例
IF 11.1 2区 医学 Q1 Medicine Pub Date : 2024-02-02 DOI: 10.1002/rmv.2514
Ahmed N. Farrag, Ahmed M. Kamel, Iman A. El-Baraky
Despite the advent of direct-acting antiviral agents (DAAs) as a definitive therapy for chronic hepatitis C virus (HCV) infection, the burden of the disease remains globally elevated. The emerging big data on different HCV paradigms fostered the introduction of artificial intelligence/machine learning (AI/ML) applications to help decrease that burden by providing more optimised strategies for early diagnosis and treatment prioritisation. The current review provides descriptive and analytical insight into the recently published AI/ML applications in five medical aspects of HCV infection. In addition, it highlights the opportunities these powerful tools offer in designing national health policies that prioritise HCV patients for the costly DAAs and developing broadly neutralising HCV antibodies. Finally, this paper highlights the challenges encountered in developing and applying these AI/ML models to clinical practice and suggests schemes to overcome some of them. The presented models were primarily evaluated using the Matthews correlation coefficient and the F1-score to make a more reliable inference about their predictive power under imbalanced datasets. Many published AI/ML applications offered great utilities for predicting novel HCV treatments and prioritising patients for DAAs receipt, especially in settings of limited resources and high HCV burden. Some outperformed the classical diagnostic tools, such as third-generation serological tests, alpha-fetoprotein, and ultrasound, in detecting HCV infections and early HCV-associated hepatocellular carcinoma, respectively. However, further statistical and clinical validation of AI/ML models is highly advocated before incorporating these applications into clinical practice.
尽管直接作用抗病毒药物(DAAs)作为慢性丙型肝炎病毒(HCV)感染的最终疗法已经问世,但全球范围内的疾病负担仍然很重。有关不同丙型肝炎病毒范例的新兴大数据促进了人工智能/机器学习(AI/ML)应用的引入,通过为早期诊断和优先治疗提供更优化的策略,帮助减轻这一负担。本综述对最近发表的人工智能/机器学习在 HCV 感染的五个医学方面的应用进行了描述和分析。此外,本文还强调了这些强大的工具在设计国家卫生政策方面所提供的机遇,这些政策可优先考虑让HCV患者接受昂贵的DAAs治疗,并开发广泛中和的HCV抗体。最后,本文强调了在开发这些人工智能/ML 模型并将其应用于临床实践时遇到的挑战,并提出了克服其中一些挑战的方案。本文介绍的模型主要使用马修斯相关系数和 F1 分数进行评估,以便在不平衡数据集下对其预测能力做出更可靠的推断。许多已发表的人工智能/ML 应用程序为预测新型 HCV 治疗方法和优先安排患者接受 DAAs 治疗提供了极大的帮助,尤其是在资源有限和 HCV 负担较高的情况下。在检测HCV感染和早期HCV相关肝细胞癌方面,一些应用优于传统诊断工具,如第三代血清学检测、甲胎蛋白和超声波。不过,在将这些应用纳入临床实践之前,我们强烈建议对人工智能/ML 模型进行进一步的统计和临床验证。
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引用次数: 0
Increased risk of new-onset cardiovascular disease after COVID-19: A systematic review and meta-analysis of 14 cohorts COVID-19 后新发心血管疾病的风险增加:对14个队列的系统回顾和荟萃分析
IF 11.1 2区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1002/rmv.2518
Mingyao Sun, Mengyuan Yuan, Honghao Lai, Qian Wang, Hengyang Wang, Lina Xing, Jinhui Tian, Zhigang Zhang, Long Ge
Cardiovascular diseases (CVD) are common in long COVID, yet the associated risk remains uncertain. We aimed to quantify the risk of new-onset cardiovascular diseases after COVID-19. We searched PubMed, Embase, and Web of Science from inception up to October 2022. Cohort studies that provided information on the number, proportion, or relative risks (RR) of cardiovascular diseases after COVID-19 were included. Paired reviewers independently screened studies, extracted data, and assessed the risk of bias. We performed random-effects models meta-analyses to calculate RR and corresponding 95% confidence interval (95%CI), and conducted subgroup analyses and meta-regression to explore the potential risk factors. Absolute effects were calculated to facilitate interpretation. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess the certainty of evidence. Outcomes of interest were any CVD, major adverse cardiovascular events (MACE), arrhythmias, heart failure, myocarditis, and thrombotic events. Fourteen cohort studies with over 25.37 million participants were included. The results showed a 2.42 times higher risk of any CVD (RR = 2.42, 95% CI: 1.24–4.71; 51 more per 1000), a 95% higher risk of MACE (RR = 1.95, 95% CI: 1.59–2.40; 4 more per 1000), a 61% higher risk of arrhythmias (RR = 1.61, 95% CI: 1.42–1.83; 12 more per 1000), a 71% higher risk of heart failure (RR = 1.71, 95% CI: 1.33–2.21; 2 more per 1000), a 5 times higher risk of myocarditis (RR = 5.06, 95% CI: 3.78–6.77; 4 more per 1000), and a 2.49 times higher risk of thrombotic events (RR = 2.49, 95% CI: 1.22–5.06; 6 more per 1000) associated with COVID-19. Besides, for thrombotic events, a statistically significant subgroup effect was observed in male participants compared to females (Pinteraction = 0.008). The certainty of evidence was high for myocarditis, but low or very low for other outcomes. The results clearly showed varying degrees of elevated new-onset CVD risk in post-COVID-19 individuals. Additionally, our findings suggest that male patients face a higher risk of thrombotic events. However, the differences in pooled results between studies, and the over-precision due to the large sample size of the included studies resulted in high heterogeneity of exceeding 90% in most outcomes, which led to low certainty of evidence.
心血管疾病(CVD)在长期 COVID 中很常见,但相关风险仍不确定。我们旨在量化 COVID-19 后新发心血管疾病的风险。我们检索了从开始到 2022 年 10 月的 PubMed、Embase 和 Web of Science。纳入了提供 COVID-19 后心血管疾病的数量、比例或相对风险 (RR) 信息的队列研究。配对审稿人独立筛选研究、提取数据并评估偏倚风险。我们进行了随机效应模型荟萃分析以计算RR和相应的95%置信区间(95%CI),并进行了亚组分析和荟萃回归以探讨潜在的风险因素。为便于解释,还计算了绝对效应。采用推荐、评估、发展和评价分级法评估证据的确定性。研究结果包括任何心血管疾病、主要不良心血管事件(MACE)、心律失常、心力衰竭、心肌炎和血栓事件。共纳入了 14 项队列研究,参与者超过 2537 万人。结果显示,发生任何心血管疾病的风险高出 2.42 倍(RR = 2.42,95% CI:1.24-4.71;每 1000 人多 51 人),发生 MACE 的风险高出 95%(RR = 1.95,95% CI:1.59-2.40;每 1000 人多 4 人),发生心律失常的风险高出 61%(RR = 1.61,95% CI:1.42-1.83;每 1000 人多 12 人),发生心力衰竭的风险高出 71%(RR = 1.71,95% CI:1.33-2.21;每 1000 人增加 2 人),心肌炎风险增加 5 倍(RR = 5.06,95% CI:3.78-6.77;每 1000 人增加 4 人),血栓事件风险增加 2.49 倍(RR = 2.49,95% CI:1.22-5.06;每 1000 人增加 6 人)。此外,就血栓事件而言,与女性相比,男性参与者中出现了具有统计学意义的亚组效应(Pinteraction = 0.008)。心肌炎的证据确定性较高,但其他结果的证据确定性较低或很低。研究结果清楚地表明,COVID-19 后患者新发心血管疾病的风险有不同程度的升高。此外,我们的研究结果表明,男性患者面临更高的血栓事件风险。然而,不同研究之间的汇总结果存在差异,而且由于纳入研究的样本量大而过于精确,导致大多数结果的异质性很高,超过了 90%,因此证据的确定性较低。
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Reviews in Medical Virology
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