Regression in hepatic fibrosis in elderly Chinese patients with hepatitis C receiving direct-acting antiviral treatment.

BACKGROUND: Patients infected with Hepatitis C virus (HCV) are recommended to receive treatment with direct-acting antiviral agents (DAAs), which have been certified to obtain a high sustained virological response (SVR). However, little is known about the benefits of successful anti-viral treatment to elderly patients with hepatic fibrosis. In this study, we aimed to assess degree of fibrosis in elderly patients with chronic hepatitis C (CHC) treated with DAAs, and to evaluate the correlations between identified factors associated with these changes. METHODS: This study retrospectively enrolled elderly patients with CHC who received DAAs in Tianjin Second People's Hospital from April 2018 to April 2021. The degree of liver fibrosis was assessed using serum biomarkers and transient elastography (TE) expressed as the liver stiffness (LSM), while the hepatic steatosis was evaluated by controlled attenuated parameter (CAP). Changes in factors related to hepatic fibrosis were examined following treatment with DAAs, and associated prognostic factors were further evaluated. RESULTS: We included 347 CHC patients in our analysis, where 127 of these were elderly patients. For the elderly group, the median LSM was 11.6 (7.9-19.9) kPa, and this value was significantly reduced to 9.7 (6.2-16.6) kPa following DAA treatment. Similarly, GPR, FIB-4 and APRI indices were significantly reduced from 0.445 (0.275-1.022), 3.072 (2.047-5.129) and 0.833 (0.430-1.540) to 0.231 (0.155-0.412), 2.100 (1.540-3.034) and 0.336 (0.235-0.528), respectively. While in younger patients, the median LSM reduced from 8.8 (6.1-16.8) kPa to 7.2 (5.3-12.4) kPa, and the trends of GPR, FIB-4 and APRI were also consistent. The CAP in younger patients increased with statistical significance, but we did not observe any significant change in CAP for the elderly group. Based on multivariate analysis, age, LSM, and CAP before baseline were identified as determinants for LSM improvement in the elderly. CONCLUSION: In this study, we found that elderly CHC patients treated with DAA had significantly lower LSM, GPR, FIB-4, and APRI values. DAA treatment did not significantly change CAP. Furthermore, we observed correlations between three noninvasive serological evaluation markers and LSM. Finally, age, LSM, and CAP were identified as independent predictors of fibrosis regression in elderly patients with CHC.

Spatial-temporal shifts of ecological vulnerability of Karst Mountain ecosystem-impacts of global change and anthropogenic interference.

Under the background of global climate change, the natural environment of the southwest karst mountain region is undergoing profound changes. Considering the differences in the relative importance of each index in the vulnerability evaluation system in different periods, this study presents the dynamic weight determination method and then establishes the dynamic weight table of the ecological vulnerability evaluation index in the southwest karst mountain region. At the same time, net primary productivity (NPP) is introduced to help determine the ecological vulnerability classification threshold in different periods, and then the spatial-temporal change pattern and driving mechanism of ecological vulnerability in the past 15 years are analyzed. Results show the following: (1) Dynamic weight determination method has good application in the study of ecological vulnerability in long-term series, and the threshold of vulnerability classification based on NPP can ensure the comparability of ecological vulnerability evaluation results in different periods; (2) From 2000 to 2015, the southwest karst mountain region generally belonged to the moderate vulnerability category, and a decreasing trend is observed from the Sichuan-Yunnan-Guizhou border area to its surrounding region in a spatial distribution pattern; (3) In the past 15 years, the ecological vulnerability of the southwest karst mountain region increased first and then decreased; (4) The spatial-temporal change pattern of ecological vulnerability in the southwest karst mountain region is significantly affected by GDP of different industries, precipitation, soil erosion, rocky desertification. These results would be in particular useful for planning the conservation strategies or assessments of the conservation priorities. In addition, the method employed could provide a technical support and references for the ecological assessment and restoration of other similar karst mountain ecosystem zones in China or worldwide.

Improved evaluation method of the soil wind erosion intensity based on the cloud-AHP model under the stress of global climate change.

Under the stress of global climate change, soil wind erosion has become a major environmental issue in the Three-River Source Region (TRSR) of China. However, few large-scale studies have been conducted on soil wind erosion owing to the lack of investigational data or complex parameters. Moreover, the uncertainty and randomness in the weight determination process cannot be avoided using the traditional method. Thus, a cloud-analytic hierarchy process (cloud-AHP) model was proposed to construct a wind erosion intensity index model for the TRSR based on seven typical land surface parameters. The following results were obtained. (1) The cloud-AHP model can better eliminate the randomness and uncertainty in the weight determination process. (2) The proposed evaluation method of wind erosion intensity has better applicability in the TRSR with overall accuracy of 93%. (3) The overall wind erosion intensity in this region is moderate. The wind erosion intensity was the largest in the Yangtze River (0.55, moderate erosion) and smallest in the source region of the Lancang River (0.50, mild erosion). (4) Significant differences are observed in the influences of various vegetation types on wind erosion intensity. Bare land exhibits the highest wind erosion intensity, whereas a coniferous forest exhibits the smallest. Moreover, grassland is a key control zone of soil and water conservation because it has the largest spatial heterogeneity of internal erosion intensity. These results can provide data and technical support for preventing and controlling soil erosion and protecting the environment in the region.