Diabetes Mellitus Increases the Risk of Hepatocellular Carcinoma After Direct-Acting Antiviral Therapy: Systematic Review and Meta-Analysis

Background: Hepatitis C virus (HCV)-infected patients treated with direct-acting antivirals (DAAs) are still at risk of developing hepatocellular carcinoma (HCC) after sustained virologic response (SVR). This study aimed to investigate the role of diabetes mellitus (DM) as a potential predictive risk factor in developing de novo HCC in HCV-infected patients after DAA treatment.Methods: This study was registered on PROSPERO under registration number CRD42021230457. We performed a systematic search in four medical databases from inception through November 3rd, 2020. Studies were eligible if they reported on HCV-infected patients treated with DAAs and compared the frequency of de novo HCC in patients with and without DM. We calculated pooled odds ratios, unadjusted (UHR), and adjusted hazard ratios (AHR) with 95% confidence intervals (CIs) in meta-analysis.Results: We included 30 articles in our systematic review and meta-analysis. DM proved to be a significant risk factor of HCC in DAA-treated HCV patients in unadjusted (UHR = 1.44, CI: 1.15–1.79) and adjusted analyses (AHR = 1.31, CI: 1.06–1.62). In the group of patients achieving SVR after DAA therapy, DM increased the risk of HCC in unadjusted (UHR = 1.3, CI: 1.09–1.51) analysis; however, in adjusted results, the risk was non-significant (AHR = 1.07, CI: 0.89–1.28). In patients with advanced liver fibrosis, DM was a risk factor for HCC in adjusted (AHR = 1.36, CI: 1.03–1.8), but not in unadjusted analysis (UHR = 1.11, CI: 0.8–1.42).Conclusions: DM is an independent risk factor of de novo HCC after DAA treatment in HCV-infected patients.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=230457, identifier: CRD42021230457.

Evaluation of the effect of diastolic function on prognosis of patient with septic shock

Background Septic shock remains the leading cause of death in the intensive care unit (ICU), with an increasing incidence and a current mortality rate of approximately 30 %. Sepsis was defined by the presence of at least two criteria of systemic inflammatory response syndrome associated with a clinically or microbiologically documented, or a highly suspected infection. Severe sepsis was defined as a sepsis associated with at least one organ failure different from that responsible for the infection. Septic shock was defined as a severe sepsis associated with low blood pressure despite adequate vascular filling which required a vasopressor support. Cardiac dysfunction in sepsis is driven primarily by release of cytokines, mitochondrial dysfunction, and tissue hypoxia that leads to cardiac myocyte injury and death. Aim of the Work The aim of this study was to evaluate the effect of diastolic function on prognosis of septic shock in patients admitted to an intensive care unit (ICU). Patient and Methods This study was conducted on (50) patients with septic shock admitted to an intensive care unit (ICU) from November 2017 to November 2018. Results These patients was divided according to cardiac echocardiography findings into two groups:-Group 1:- 25 patients with preserved diastolic function and diastolic dysfunction grade I; 12 Male and 13 Female were included in the study, the average age was 43.44±13.69.Group 2:- Another 25 patients with diastolic dysfunction grade II and grade III; 11 Males and 14 Females were included in the study, the average age was 47.28±15.7. Conclusion We recommend assessment of patients admitted to the ICU with septic shock via echocardiography to determine the grade of diastolic dysfunction and using diastolic dysfunction as a predictive risk factor in various score assessment of ICU patients. Our study was limited by decreased sample size and we recommend further studies with increased sample size..

Individual differences in behavioral flexibility predict future volitional ethanol consumption in mice

ABSTRACTCognitive control is key to regulating alcohol intake and preventing relapse. Behavioral inflexibility can prevent adaptive strategies such as mindfulness or other relapse-prevention behaviors. In a mouse model we investigated whether individual variability in behavioral flexibility (using attentional set-shifting task; ASST) predicts future alcohol intake. Adult male and female C57BL/6J mice were subjected to ASST using a bowl digging paradigm where mice identify a baited bowl based on compound odor and textural cues. This was completed prior to any alcohol exposure. Individual performance across mice varied within the group. We integrated several metrics, specifically ASST stage completed, trials to completion and errors performed to produce an individual performance index measure of behavioral flexibility. After, ASST mice were trained to drink ethanol (15%, v/v, 1hr/day) for 3-4 weeks until intake stabilized. Using this prospective approach, we identified an inverse relationship between behavioral flexibility and drinking - less flexible mice had a propensity to consume more alcohol. Similar relationships have been identified previously in non-human primates and rats. Our results show that the relationship between alcohol and cognitive flexibility is a robust trait that is conserved across species and can be used in mice to study neural substrates underlying these behaviors.HIGHLIGHTS- ASST can be used to examine individual differences in cognitive function in mice- Behavioral inflexibility is related to future higher alcohol consumption- Executive function can be used as a predictive risk factor for alcohol intake- This relationship in mice supports previous findings across species

An analysis of eight family cluster cases in Wuhan, China: Peripheral blood lymphocyte count may predict Covid-19 mortality

Background: Since December 2019, a novel coronavirus (SARSCoV-2) causing COVID-19 has spread across the world in a global pandemic. Tens of thousands of people were infected, several thousand patients died. However, key risk factors for predicting mortality remain unclear. This study aims to analyze the differences in mortal risk factors between fatal and non-fatal cases within each family, to identify the key risk factors for COVID-19 mortality. Method: Retrospective, randomly selected eight family clusters consisting of 21 individual cases who had been confirmed positive for SARS-CoV-2 and admitted to the Wuhan Union Hospital, Wuhan, China, from February 6 to March 3, 2020. Clinical characteristics and demographic data were tracked up to March 3. Results: Among all 8 family cluster cases, 4 families had death cases. All deaths were elderly individuals (range, 77-88 years), all ICU and severe cases were also elderly individuals (72-88 years). Patient 2-M1, who was the oldest of all cases and first confirmed with COVID-19 on January 10, had four critical comorbid conditions including colon cancer, COPD, hypertension, and coronary disease. But he remains in stable condition after more than 50 days of inpatient treatment. We observed that the absolute count of peripheral blood lymphocyte dropped to less than 0.8G/L of all death and ICU cases, ranging from 0.22 G/L to 0.81 G/L. Conclusions: We found that elderly age is one of the main risk factors for mortality, comorbidities were not predictive of mortality due to COVID-19, although they may extend disease duration. Importantly, we discovered that within our study population the absolute count of peripheral blood lymphocyte is a predictive risk factor for mortality due to COVID-19, establishing that it may be a very important factor for judging a patient’s prognosis. Keywords: COVID-19; Family clusters; Mortality; Risk factors.

Abstract P556: Emergent Use of Ticagrelor and Glycoprotein IIbIIIa in Neuroendovascular Interventions

Introduction: Evidence regarding the optimal acute antiplatelet strategies in emergent endovascular therapies is scarce, and practices varies institutionally. Ticagrelor, a P2Y3B inhibitor with a lower incidence of resistance, may be effective in achieving rapid platelet inhibition. We explore the safety and efficacy of emergent Ticagrelor use in patient undergoing neurointerventions. Methods: We reviewed our database for all consecutive patients from 2016 to 2019 who received emergent administration of Ticagrelor (within 30 minutes before or after) for neuro-interventional procedures. The primary outcome measure was the incidence of major systemic hemorrhages including symptomatic intracranial hemorrhage as well as intraprocedural and post-procedural thrombotic events. Results: 81 patients were analyzed (Mean age 62±11, 70% male, 73 undergoing interventions for ischemic strokes, 8 aneurysm patients undergoing embolization). Twenty (24.7%) patients received Ticagrelor pre-puncture, 28 (35%) during and 33 (41%) after closure. Median PRU achieved in 43 patients after excluding for concomitant use of GPIIbIIIa use was 54 [36-111]. Major bleeding occurred in 7/81 patients (9.2%) - 4 gastrointestinal bleeding and 3 symptomatic ICH. Eleven (14%) patients experienced intraprocedural occlusions. Five (6.2%) cases were complicated by post-procedural occlusions while on Ticagrelor, two of which were asymptomatic. Pre-procedural Ticagrelor was associated with less frequent administration of subsequent GPIIbIIIa (OR = 0.15, 95% CI (0.03-0.64), p=0.01), as well as shorter procedure duration (Spearman’s rho 0.409, p =0.001). The use of GPIIbIIIa plus Ticagrelor was associated with increased bleeding complications (0% vs. 14%; p =0.04) than in patients receiving Ticagrelor only. Bleeding was an independently predictive risk factor for death by 3 months (OR 7.18, 95% CI (1.33-38.8, p=0.02 or 43% vs. 9.5%; p=0.04) Conclusion: Early and emergent use of Ticagrelor, prior to endovascular procedure as early as within 30 minutes, may obviate the need for administration of GPIIbIIIa. Combined use of GPIIbIIa antithrombotics with Ticagrelor was associated with hemorrhagic complications, which could contribute to increased mortality.

High waist circumference rather than high body mass index may be a predictive risk factor for the longer disease duration of chronic spontaneous urticaria

In a previous study, we found that higher waist circumference (WC) and higher body mass index (BMI) both increase the risk of chronic spontaneous urticaria (CSU). The aim of this study was to determine whether WC and BMI also increase the duration of CSU. We used multivariable Cox proportional hazards models to determine the hazard ratio (HR) for longer disease duration (longer than 3 years) according to WC and BMI. A total of 52,667 subjects were enrolled and their mean age was 54.5. After adjustments for other confounding variables the high WC/high BMI group had 1.062 times higher HR (95% CI, 1.028–1.098) than the normal WC/normal BMI group. Interestingly, the high WC/normal BMI group showed a significantly higher HR (1.053; 95% CI, 1.008–1.101) than the normal WC/normal BMI group, but not the normal WC/high BMI group (0.998; 95% CI, 0.951–1.046). Taken together, our results suggest that high WC rather than high BMI is a predictive risk factor for the longer disease duration of CSU.