Meta-analysis of Helicobacter pylori eradication therapy using vonoprazan as an acid suppressor compared with bismuth quadruple therapy.

BACKGROUND: Vonoprazan, a novel acid suppressant, has recently emerged as a regimen for eradicating Helicobacter pylori. However, uncertainties exist about the effectiveness and safety of VPZ-based regimens compared with those of bismuth-based quadruple therapy in eradicating H. pylori. The present meta-analysis was performed to compare the effectiveness and safety of vonoprazan-based regimens with those of bismuth quadruple therapy in eradicating H. pylori. MATERIALS AND METHODS: All randomized controlled trials and non-randomized controlled trials comparing the vonoprazan-based therapy with the bismuth quadruple therapy were included in this meta-analysis. Information was also extracted by two evaluators, and if heterogeneity existed, a random-effects model was used to calculate the combined relative ratio and 95% confidence interval; otherwise, a fixed-effects model was used. And subgroup analyses were performed to explore the sources of heterogeneity. RESULTS: A total of 10 studies, comprising 2587 patients were included in the meta-analysis. The results showed that the combined eradication rate of patients treated with the vonoprazan-based regimen was significantly higher than that of patients treated with bismuth quadruple therapy, in both intention-to-treat and per-protocol analyses, and the differences were statistically significant. Among the intention-to-treat analyses results: (90.28% vs. 83.64% [odds ratio (OR) = 1.85, 95% confidence interval (CI) (1.27, 2.70), p = 0.001]); in the per-protocol analyses: (94.80% vs. 89.88%, [OR = 2.25, 95% CI (1.37, 3.69), p = 0.001]). The occurrence of adverse events was significantly lower in patients treated with vonoprazan-based regimens than in those treated with bismuth quadruple therapy, (14.50% vs. 25.89%, [OR = 0.49, 95% CI (0.32, 0.75), p = 0.001]). CONCLUSIONS: For eradicating H. pylori, vonoprazan-based regimens are remarkably advantageous over bismuth quadruple therapy. Furthermore, vonoprazan-based regimens exhibit a lower rate of adverse events than bismuth quadruple therapy.

Glucocorticoid efficacy and treatment strategies for drug-induced liver injury: a literature review.

Drug-induced liver injury (DILI) is an adverse reaction to drugs and their metabolites. The activation of adaptive immune and inflammatory responses plays an important role in the pathogenesis of DILI. Glucocorticoids (GCs) have powerful anti-inflammatory and immunosuppressive effects and have been used to treat a variety of immune-mediated liver diseases. Due to the important role of the immune system in DILI, GCs are widely used in the clinical treatment of DILI; however, whether they are beneficial to patients remains controversial. There is no uniform standard for the timing, dosage, and population selection of GCs, which mainly depend on the clinician's experience. Therefore, elucidating whether GCs are beneficial for patients with DILI is an urgent clinical problem. Our review summarizes the recent literature and discusses the clinical efficacy, applicable population, application timing, and efficacy of GCs in special types of DILI, providing a reference for the clinical application of GCs.

Biodegradation of mixed litter-derived dissolved organic matter with varying evenness in a temperate freshwater wetland.

Litter-derived dissolved organic matter (DOM) plays an essential role in biogeochemical cycles. In wetlands, species relative abundance and its change have great influences on input features of litter-derived DOM, including chemical characteristics per se and functional diversity of chemical characteristics. Functional diversity is an important factor controlling organic matter biodegradation, but little is known in terms of the DOM. We mixed litter leachates of four macrophytes with a constant concentration (20 mg DOC L-1) but varying dominant species and volume ratios, i.e. 15:1:1:1 (low-evenness), 5:1:1:1 (mid-evenness), and 2:1:1:1 (high-evenness), generating a gradient of chemical characteristics and functional diversity (represented by functional dispersion index FDis). Based on a 42-d incubation, we measured degradation dynamics of these DOM mixtures, and analyzed potential determinants. After 42 days of incubation, the high-evenness treatments, along with mid-evenness treatments sometimes, had most degradation, while the low-evenness treatments always had least degradation. The degradation of mixtures related significantly to not only the volume-weighted mean chemical characteristics but also FDis. Furthermore, the FDis even explained more variation of degradation. The non-additive mixing effects, synergistic effects (faster degradation than predicted) in particular, on degradation of DOM mixtures were rather common, especially in the high- and mid-evenness treatments. Remarkably, the mixing effects increased linearly with the FDis values (r2adj. = 0.426). This study highlights the critical role of functional diversity in regulating degradation of mixed litter-derived DOM. Resulting changes in chemistry and composition of litter leachates due to plant community succession may exert substantial influences on biogeochemical cycling.

An Anionic Indium-Organic Framework with Spirobifluorene-Based Ligand for Selective Adsorption of Organic Dyes.

Ionic metal-organic frameworks (MOFs) with an ionic skeleton and unique porous structures could selectively adsorb charged dyes with specific dimensions. However, the ion-exchange-based and size-exclusion-based process as a chromatography method needs to be further explored. In this study, a new microporous anionic MOF, JUC-210, was synthesized using a spirobifluorene-based ligand and trivalent metal indium. JUC-210 has a two-fold interpenetrated pts framework with a large void space, possessing suitable pore sizes and an anionic skeleton for efficient separation of certain organic dyes. Different types of dyes were used to observe the selective adsorption ability of the as-synthesized MOF. JUC-210 displayed high selective adsorption toward the cationic dye methylene blue with positive charges based on ion exchange and size exclusion. Moreover, the effect of solvent on the selective adsorption behaviors of JUC-210 was investigated. The exploration of novel MOF materials would provide potential efficient adsorbents for separation of organic dyes.

Small-molecule inhibition of TLR8 through stabilization of its resting state.

Endosomal Toll-like receptors (TLR3, TLR7, TLR8, and TLR9) are highly analogous sensors for various viral or bacterial RNA and DNA molecular patterns. Nonetheless, few small molecules can selectively modulate these TLRs. In this manuscript, we identified the first human TLR8-specific small-molecule antagonists via a novel inhibition mechanism. Crystal structures of two distinct TLR8-ligand complexes validated a unique binding site on the protein-protein interface of the TLR8 homodimer. Upon binding to this new site, the small-molecule ligands stabilize the preformed TLR8 dimer in its resting state, preventing activation. As a proof of concept of their therapeutic potential, we have demonstrated that these drug-like inhibitors are able to suppress TLR8-mediated proinflammatory signaling in various cell lines, human primary cells, and patient specimens. These results not only suggest a novel strategy for TLR inhibitor design, but also shed critical mechanistic insight into these clinically important immune receptors.

Native and engineered extracellular vesicles: novel tools for treating liver disease.

Liver diseases are classified as acute liver damage and chronic liver disease, with recurring liver damage causing liver fibrosis and progression to cirrhosis and hepatoma. Liver transplantation is the only effective treatment for end-stage liver diseases; therefore, novel therapies are required. Extracellular vesicles (EVs) are endogenous nanocarriers involved in cell-to-cell communication that play important roles in immune regulation, tissue repair and regeneration. Native EVs can potentially be used for various liver diseases owing to their high biocompatibility, low immunogenicity and tissue permeability and engineered EVs with surface modification or cargo loading could further optimize therapeutic effects. In this review, we firstly introduced the mechanisms and effects of native EVs derived from different cells and tissues to treat liver diseases of different etiologies. Additionally, we summarized the possible methods to facilitate liver targeting and improve cargo-loading efficiency. In the treatment of liver disease, the detailed engineered methods and the latest delivery strategies were also discussed. Finally, we pointed out the limitations and challenges of EVs for future development and applications. We hope that this review could provide a useful reference for the development of EVs and promote the clinical translation.

Causal associations between gut microbiota and Cholestatic liver diseases: a Mendelian randomization study.

Background: The etiological factors of Cholestatic Liver Diseases especially primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC) are not fully illustrated. It has been reported in previous observational studies that gut microbiota are associated with cholestatic liver diseases. However, there is uncertainty regarding the causality of this association. By using Mendelian randomization, this study aimed to examine the causal impact of gut microbiota on cholestatic liver diseases. Methods: From large-scale genome-wide association studies, genetic instruments for each gut microbiota taxa as well as primary biliary cholangitis and primary sclerosing cholangitis were developed. Subsequently, we conducted a two-sample Mendelian randomization analysis, supplemented by multiple post hoc sensitivity analyses. Additionally, we performed reverse MR analyses to investigate the possibility of the reverse causal association. Result: This two-sample MR study indicated that the order Bacillales, family Peptostreptococcaceae, family Ruminococcaceae, genus Anaerotruncu was associated with a decreased risk of developing PBC, and that order Selenomonadales, family Bifidobacteriaceae may be factors that increase the risk of PBC. On the other hand, we also identified order Selenomonadales, family Rhodospirillaceae, and genus RuminococcaceaeUCG013 were positively associated with PSC. The order Actinomycetales, family Actinomycetaceae, genus Actinomyces, genus Alloprevotella, genus Barnesiella, and genus Peptococcus were found negative associations with the risk of PSC. The reverse MR analysis demonstrated no statistically significant relationship between PBC, PSC and these specific gut microbial taxa. Conclusion: Our findings offered novel evidence that the abundance of particular bacteria contributes to the risk of PBC and PSC, which may contribute to more effective approaches to PBC and PSC therapy and prevention.

Prevalence and effect on prognosis of sarcopenia in patients with primary biliary cholangitis.

Background: Sarcopenia adversely affects the treatment outcomes in Cirrhosis and NAFLD. However, such research is limited in primary biliary cholangitis (PBC) patients. This study was performed to examine the prevalence of sarcopenia and its impact on PBC patients' prognoses. Methods: This study enrolled confirmed PBC patients who had an abdominal CT scan. Sarcopenia was determined by the L3-skeletal muscle index with a Chinese population-based cut-off value. Laboratory test values and liver stiffness measurements values were obtained from the electronic medical records. Results: In total, 174 PBC patients with a median age of 54 (IQR, 48, 62) years old, were enrolled. 45 (25.9%) patients among them were diagnosed with sarcopenia. Univariate and multivariate logistic regression results illustrated that male gender (OR = 9.152, 95%CI = 3.131-26.751, p < 0.001) and LSM ≥ 12.8 kPa (OR = 4.539, 95%CI = 1.651, 12.478, p = 0.003) were the independent risk factors of sarcopenia in PBC patients. In the prognosis analysis, sarcopenia was determined as a risk factor for indicating adverse events in PBC patients (HR = 4.058, 95%CI = 1.955-8.424, p < 0.001) by Cox proportional hazards regression. Conclusion: The current findings illustrate that comprehensive evaluation and management of sarcopenia may contribute to the improvement of treatment outcomes and life quality of PBC patients.

The relationship between diabetic retinopathy and diabetic nephropathy in type 2 diabetes.

Context: Diabetic retinopathy (DR) and diabetic nephropathy (DN), are major microvascular complications of diabetes. DR is an important predictor of DN, but the relationship between the severity of DR and the pathological severity of diabetic glomerulopathy remains unclear. Objective: To investigate the relationship between severity of diabetic retinopathy (DR) and histological changes and clinical indicators of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). Methods: Patients with T2DM (n=272) who underwent a renal biopsy were eligible. Severity of DR was classified as non-diabetic retinopathy, non-proliferative retinopathy, and proliferative retinopathy (PDR). Relationship between DN and DR and the diagnostic efficacy of DR for DN were explored. Results: DN had a higher prevalence of DR (86.4%) and DR was more severe. The sensitivity and specificity of DR in DN were 86.4% and 78.8%, while PDR was 26.4% and 98.5%, respectively. In DN patients, the severity of glomerular lesions (p=0.001) and prevalence of KW nodules (p<0.001) significantly increased with increasing severity of DR. The presence of KW nodules, lower hemoglobin levels, and younger age were independent risk factors associated with more severe DR in patients with DN. Conclusion: DR was a good predictor of DN. In DN patients, the severity of DR was associated with glomerular injury, and presence of KW nodules, lower hemoglobin levels and younger age were independent risk factors associated with more severe DR. Trial registration: ClinicalTrails.gov, NCT03865914.

Correlation between retinal vascular geometric parameters and pathologically diagnosed type 2 diabetic nephropathy.

Background: Diabetic nephropathy (DN) and diabetic retinopathy (DR) are common microvascular complications of diabetes. The purpose of this study was to investigate the correlation between retinal vascular geometric parameters and pathologically diagnosed type 2 DN and to determine the capacity of retinal vascular geometric parameters in differentiating DN from non-diabetic renal disease (NDRD). Methods: The study participants were adult patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease who underwent a renal biopsy. Univariate and multivariable regression analyses were performed to evaluate associations between retinal vessel geometry parameters and pathologically diagnosed DN. Multivariate binary logistic regression analyses were performed to establish a differential diagnostic model for DN. Results: In total, 403 patients were examined in this cross-sectional study, including 152 (37.7%) with DN, 157 (39.0%) with NDRD and 94 (23.3%) with DN combined with NDRD. After univariate logistic regression, total vessel fractal dimension, arteriolar fractal dimension and venular fractal dimension were all found to be associated with DN. In multivariate analyses adjusting for age, sex, blood pressure, diabetes, DR and other factors, smaller retinal vascular fractal dimensions were significantly associated with DN (P < .05). We developed a differential diagnostic model for DN combining traditional clinical indicators and retinal vascular geometric parameters. The area under the curve of the model established by multivariate logistic regression was 0.930. Conclusions: Retinal vessel fractal dimension is of great significance for the rapid and non-invasive differentiation of DN. Incorporating retinal vessel fractal dimension into the diagnostic model for DN and NDRD can improve the diagnostic efficiency.

[Effects of the body fat mass and blood sugar and plasma resistin to slim exercise prescription for overweight and obesity students].

OBJECTIVE: To explore the influences of slim exercise prescription on body fat mass, blood sugar and plasma resistin for overweight and obesity students. METHODS: Subjects were 9 males and 13 females for simple overweight and obesity students of freshman and junior. The function capacity (FC) were defined after examine of body shape, physical function and exercise capacity. The slim goals and exercise projects were determined according to different objects. The exercise intensity was 60%-70% of FC and 13-15 levels of RPE. Exercise with each time was 60 min, exercise frequency was 5 times perweek, energy metabolism was 500-600 kcal at a time. The relative indexes were detected after 8 weeks. RESULTS: Implementing programmes of slim exercise prescription for 8 weeks, before and after the experiment in the males and females group. The weight, BMI, percentage of body fat (FAT%), waist and hip circumference ratio (WHR), body surface area (BS), fat indexes, the density of body for overweight and obesity the male and female students were significantly decreased (P < 0.01). Body fat mass (FM) and blood sugar were significantly decreased (P < 0.01). Plasma resistin of the male students were significant different (P < 0.01), but the female students were significant different (P < 0.05). Analysis of Bivariate Correlation was Pearson Correlation, plasma resistin and BMI, WHR the male students had correlation, but the female had no correlation. CONCLUSION: The exercise prescription was safe and sure, and could improve weight, BMI, FAT%, FM, WHR, BS, fat indexes, the density of body, blood sugar, plasma resistin in obesity without the diet control.

Defect Regulation of Efficient Dion-Jacobson Quasi-2D Perovskite Solar Cells via a Polyaspartic Acid Interlayer.

Interfacial modification is a promising strategy to fabricate highly efficient perovskite solar cells (PSCs). Nevertheless, research studies about optimization for the performance of Dion-Jacobson (DJ)-phase quasi-2D PSCs by underlying surface modification are rarely reported. The relevant influence of interfacial modification on defect regulation in the bulk and at the interface for PSCs is still unexplored. Herein, an interlayer of polyaspartic acid (PASP) was introduced at the interface of a hole transporting layer and a perovskite absorber to regulate both the film quality and interface property for BDA-based DJ quasi-2D PSCs (n = 5). The PASP interlayer suppressed the charge recombination, restricted the interfacial charge accumulation, and promoted the charge transport in devices and therefore improved the power conversion efficiency of PSCs from 15.03 to 17.34%. Moreover, through device simulation, it was concluded that the increase of open-circuit voltage (Voc) was mainly attributed to the suppression of interface defects, while the increase of short-circuit current (Jsc) was ascribed to the restriction of interface defects and perovskite bulk defects. The improvement of both Voc and Jsc originated from the passivation of shallow defect states. The present work provides a promising route for the fabrication of efficient quasi-2D PSCs and enriches the fundamental understanding of defect regulation on photovoltaic performance.

Nickel-Catalyzed Desulfonylative Reductive Cross-Coupling of Aryl Sulfones with Aryl Bromides.

Herein, a nickel catalysis system for desulfonylative C(sp2)-C(sp2) reductive cross-coupling reactions of aryl sulfone derivatives with a range of aryl bromides has been established to form diverse biaryl compounds. The complex Ar-Ni(II)-SO2CF3 bearing a phosphine ligand through oxidative addition of aryl sulfone to Ni(0) species was isolated and confirmed by an X-ray, which provides solid evidence for the understanding of the C(Ar)-SO2 bond activation and reaction mechanism.

Evaluation of Renal Impairment in Patients with Diabetic Kidney Disease by Integrated Chinese and Western Medicine.

OBJECTIVE: To investigate the factors related to renal impairment in patients with diabetic kidney disease (DKD) from the perspective of integrated Chinese and Western medicine. METHODS: Totally 492 patients with DKD in 8 Chinese hospitals from October 2017 to July 2019 were included. According to Kidney Disease Improving Global Outcomes (KDIGO) staging guidelines, patients were divided into a chronic kidney disease (CKD) 1-3 group and a CKD 4-5 group. Clinical data were collected, and logistic regression was used to analyze the factors related to different CKD stages in DKD patients. RESULTS: Demographically, male was a factor related to increased CKD staging in patients with DKD (OR=3.100, P=0.002). In clinical characteristics, course of diabetes >60 months (OR=3.562, P=0.010), anemia (OR=4.176, P<0.001), hyperuricemia (OR=3.352, P<0.001), massive albuminuria (OR=4.058, P=0.002), atherosclerosis (OR=2.153, P=0.007) and blood deficiency syndrome (OR=1.945, P=0.020) were factors related to increased CKD staging in patients with DKD. CONCLUSIONS: Male, course of diabetes >60 months, anemia, hyperuricemia, massive proteinuria, atherosclerosis, and blood deficiency syndrome might indicate more severe degree of renal function damage in patients with DKD. (Registration No. NCT03865914).

Unilateral pulmonary vein atresia presenting with recurrent hydrothorax in an adult: A case report.

UPVA (Unilateral pulmonary vein atresia) is the failure of connection between the common pulmonary vein and the left atrium. UPVA is a rare malformation of common pulmonary vein caused by embryonic development defects. Isolated UPVA is uncommon, the diagnosis commonly occurs during early childhood because of asthma, recurrent pneumonia or hemoptysis, but diagnosis in adults is unusual. Some patients can be asymptomatic until adulthood. In this report, we describe a case about UPVA presenting with recurrent hydrothorax in an adult. We gradually carried out routine diagnostic methods and eventually confirmed the rare UPVA according to the two common clinical manifestations of repeated pleural effusion and hilar soft tissue shadow.

Protocol for evaluation and validation of TLR8 antagonists in HEK-Blue cells via secreted embryonic alkaline phosphatase assay.

Toll-like receptor 8 (TLR8) is a pattern recognition receptor that senses RNA degradation products and initiates immune responses. TLR8 overactivation is associated with autoimmune diseases. Herein, we describe the evaluation and validation of TLR8 antagonists in HEK-Blue cells via secreted embryonic alkaline phosphatase (SEAP) assay, WST assay, ITC and immunoblotting. These assays can facilitate the development of TLR8 antagonists; this protocol can also be adapted to analyze agonists and antagonists for other TLRs. For complete details on the use and execution of this protocol, please refer to Hu et al. (2018).

Insight into the Catalytic Activity of Amorphous Multimetallic Catalysts under a Magnetic Field toward the Oxygen Evolution Reaction.

Slow kinetics in the oxygen evolution reaction (OER) remains a Gordian knot to develop an efficient and cost-effective electrocatalyst in electrochemical water splitting. In recent studies, either a synergistic effect on multimetallic catalysts or spin polarization in ferromagnetic materials is considered as a desirable way to improve water electrolysis. Herein, the OER performance of amorphous FeNiCo-based multimetallic catalysts with adjustable composition was investigated from the perspective of atomic structure. Mössbauer spectra results demonstrate that the OER activities exhibit a significant dependence on the local structure of catalysts in which a catalyst with a high content of Fe clusters of low coordination numbers tends to obtain higher activity. Furthermore, benefiting from the spin polarization of these ferromagnetic catalysts, the OER activity is notably enhanced in the presence of a magnetic field. In particular, overpotential reduction exceeding 20 mV (above 100 mA cm-2) in alkaline OER performance is observed for strong ferromagnetic catalysts in comparison with the weak ferromagnetic ones. An increment of 65.2% in turnover frequency is achieved for the catalyst with the strongest ferromagnetism. This magnetic enhancement strategy affords an effective way of improving the water oxidation performance on amorphous ferromagnetic catalysts.

Cascade of C(sp2)-H Addition to Carbonyl and C(sp2)-CN/C(sp2)-H Coupling Enabled by Brønsted Acid: Construction of Benzo[a]carbazole Frameworks.

Herein, we report an unprecedented cascade reaction of C(sp2)-H addition to carbonyl and the C(sp2)-CN/C(sp2)-H coupling of 2-(2-oxo-2-arylethyl)benzonitriles with indoles enabled by commercially available TsOH·H2O. The protocol represents the first metal-free C(sp2)-CN/C(sp2)-H coupling, affording a new route for the synthesis of various benzo[a]carbazole derivatives with a broad substrate scope, high yields, and simple conditions.

C(sp2)-C(sp2) Reductive Cross-Coupling of Triarylphosphines with Aryl Halides by Palladium/Nickel Co-catalysis.

Herein, we report the first general C(sp2)-C(sp2) reductive cross-coupling reaction of diverse triarylphosphines with a wide range of aryl halides by palladium/nickel co-catalysis. This protocol offers a unique route for the synthesis of biaryl compounds via the activation of inert C(Ar)-P bonds. The mechanistic studies demonstrate that the formation of the phosphonium salts in situ plays a key role in the catalytic cycle.

Tetrasubstituted imidazoles as incognito Toll-like receptor 8 a(nta)gonists.

Small-molecule modulators of TLR8 have drawn much interests as it plays pivotal roles in the innate immune response to single-stranded RNAs (ssRNAs) derived from viruses. However, their clinical uses are limited because they can invoke an uncontrolled, global inflammatory response. The efforts described herein culminate in the fortuitous discovery of a tetrasubstituted imidazole CU-CPD107 which inhibits R848-induced TLR8 signaling. In stark contrast, CU-CPD107 shows unexpected synergistic agonist activities in the presence of ssRNA, while CU-CPD107 alone is unable to influence TLR8 signaling. CU-CPD107's unique, dichotomous behavior sheds light on a way to approach TLR agonists. CU-CPD107 offers the opportunity to avoid the undesired, global inflammation side effects that have rendered imidazoquinolines clinically irrelevant, providing an insight for the development of antiviral drugs.