Characteristics and risk factors for invasive fungal infection in hospitalized patients with acute-on-chronic hepatitis B liver failure: a retrospective cohort study from 2010 to 2023.

Background and aim: The global burden of invasive fungal infections (IFIs) is emerging in immunologic deficiency status from various disease. Patients with acute-on-chronic hepatitis B liver failure (ACHBLF) are prone to IFI and their conditions are commonly exacerbated by IFI. However, little is known about the characteristics and risk factors for IFI in hospitalized ACHBLF patients. Methods: A total of 243 hospitalized ACHBLF patients were retrospectively enrolled from January 2010 to July 2023. We performed restricted cubic spline analysis to determine the non-linear associations between independent variables and IFI. The risk factors for IFI were identified using logistic regression and the extreme gradient boosting (XGBoost) algorithm. The effect values of the risk factors were determined by the SHapley Additive exPlanations (SHAP) method. Results: There were 24 ACHBLF patients (9.84%) who developed IFI on average 17.5 (13.50, 23.00) days after admission. The serum creatinine level showed a non-linear association with the possibility of IFI. Multiple logistic regression revealed that length of hospitalization (OR = 1.05, 95% CI: 1.02-1.08, P = 0.002) and neutrophilic granulocyte percentage (OR = 1.04, 95% CI: 1.00-1.09, P = 0.042) were independent risk factors for IFI. The XGBoost algorithm showed that the use of antibiotics (SHAP value = 0.446), length of hospitalization (SHAP value = 0.406) and log (qHBV DNA) (SHAP value = 0.206) were the top three independent risk factors for IFI. Furthermore, interaction analysis revealed no multiplicative effects between the use of antibiotics and the use of glucocorticoids (P = 0.990). Conclusion: IFI is a rare complication that leads to high mortality in hospitalized ACHBLF patients, and a high neutrophilic granulocyte percentage and length of hospitalization are independent risk factors for the occurrence of IFI.

Two homochiral EuIII and SmIII enantiomeric pairs showing circularly polarized luminescence, photoluminescence and triboluminescence.

Two homochiral EuIII and SmIII tris(ß-diketonate) enantiomeric pairs, based on fluorinated ß-diketone (Hbtfa) and enantiopure asymmetric N,N'-donor ligands (LR and LS), Λ-Eu(btfa)3LR (R-1-Eu)/Δ-Eu(btfa)3LS (S-1-Eu) and Λ-Sm(btfa)3LR (R-2-Sm)/Δ-Sm(btfa)3LS (S-2-Sm) (btfa- = 4,4,4-trifluoro-1-phenyl-1,3-butanedionate and LR/LS = (-)/(+)-4,5-pineno-2,2'-bipyridine) were synthesized. The electronic circular dichroism (ECD) spectra confirmed their enantiomeric nature. R-1-Eu/S-1-Eu and R-2-Sm/S-2-Sm exhibit intense characteristic emissions of EuIII (red) and SmIII (orange-red) ions both in the solid state and in DCM with long lifetimes and high luminescence quantum yields. For example, the overall quantum yields reach up to 61% and 53% along with very high sensitization efficiency values of 82 and 79 for R-1-Eu in the solid state and in DCM, respectively. Notably, the corresponding values are determined to be 6.5% (solid state) and 3.1% (DCM) for R-2-Sm, which are among the highest quantum yields for rare SmIII tris(ß-diketonate) luminescent complexes reported to date. Furthermore, R-1-Eu and R-2-Sm show a strong triboluminescence (TL) phenomenon visible with the naked eye in daylight. Moreover, R-1-Eu/S-1-Eu and R-2-Sm/S-2-Sm show circularly polarized luminescence (CPL) properties. Particularly, the luminescence dissymmetry factors (glum) for R-2-Sm/S-2-Sm are larger than those for R-1-Eu/S-1-Eu despite the fact that SmIII complexes usually show poorer emission than EuIII homologues, which is very rare in the reported EuIII and SmIII CPL-active complexes.

Biomarkers for hepatitis B virus replication: an overview and a look to the future.

INTRODUCTION: Hepatitis B virus (HBV) infection is a major public health issue but there are no powerful drugs to eradicate the virus. HBV markers including HBsAg, HBcrAg, HBV RNA, HBcAb, and HBV DNA are becoming promising biomarkers to reflect the natural phases of chronic HBV infection and predict the outcome of anti-HBV treatment. AREAS COVERED: The authors summarized the biomarkers of HBV replication and presented the current advances of these biomarkers on predicting the outcome of anti-HBV treatment and identifying the progression of chronic HBV infection. EXPERT OPINION: HBsAg, HBcrAg, HBV RNA, HBcAb, and HBV DNA are noninvasive and feasible biomarkers for monitoring the process of anti-HBV therapy and predicting the progress of HBV infection. However, there are still no strong biomarkers with high sensitivity and specificity for clinical application. Combination of two or more HBV biomarkers, new technique for measuring HBV cccDNA, and searching novel HBV biomarkers are essential for anti-HBV treatment in the future.

Plasma diamine oxidase level predicts 6-month readmission for patients with hepatitis B virus-related decompensated cirrhosis.

BACKGROUND AND AIMS: Hepatitis B virus-related decompensated cirrhosis is difficult to cure but has a high readmission rate due to multiple complications. Our aim was to investigate the diagnostic potential value of plasma diamine oxidase (DAO) for 6-month readmission of patients with HBV-related decompensated cirrhosis. METHODS: A total of 135 patients with HBV-related decompensated cirrhosis were prospectively collected at the onset of discharge of hospital, and then were followed up for at least 6 months with the readmission as the primary outcome. The plasma DAO level was measured using enzyme linked immunosorbent assay. In addition, 120 age and sex matched patients with HBV-related compensated cirrhosis were included as controls. RESULTS: A total of 36 patients (36.7%) with decompensated cirrhosis admitted to hospital during the 6-month follow up. The plasma DAO level of readmission group [21.1 (14.5; 29.0) ng/ml] was significantly higher than that in the non-readmission group [12.7 (9.3; 18.0) ng/mL, P < 0.001]. Multivariate analysis showed that the plasma DAO level (HR = 1.102, P < 0.05) and hepatic encephalopathy (HE) (HR = 5.018, P < 0.05) were independent factors for 6-month readmission of decompensated cirrhosis. DAO level showed higher area under the curve of receiver operating characteristic (AUROC) than HE (0.769 vs. 0.598, P < 0.05) and Child-Pugh-Turcotte (CPT) score (0.769 vs. 0.652, P < 0.05) for predicting 6-month readmission rate, with the best cut-off value as 19.7 ng/mL. Furthermore, plasma DAO level (HR = 1.184, P < 0.05) was an independent factor and has the higher AUROC than CPT score for the onset of recurrent HE (0.905 vs. 0.738, P < 0.05) during the 6-month follow up. CONCLUSIONS: Plasma DAO level > 19.7 ng/mL predicts high rate of 6-month readmission in patients with HBV-related decompensated cirrhosis.

Syntheses, structures and catalytic properties of Evans-Showell-type polyoxometalate-based 3D metal-organic complexes constructed from the semi-rigid bis(pyridylformyl)piperazine ligand and transition metals.

Herein, two novel Evans-Showell-type polyoxometalate (POM)-based metal-organic complexes, namely, {[Cu(L)(H2O)3][Cu(L)0.5(H2O)][Cu(L)0.5(H2O)4][Co2Mo10H4O38]}·5H2O (1) and [(H2L)0.5]2{[Zn(L)0.5(H2O)4]2[Co2Mo10H4O38]}·2H2O (2) (L = N,N'-bis(3-pyridinecarboxamide)-piperazine), were hydrothermally synthesized using a semi-rigid bis-pyridyl-bis-amide ligand and structurally characterized via single-crystal X-ray diffraction, elemental analysis, IR spectroscopy, powder X-ray diffraction (PXRD) and thermogravimetric analyses (TGA). The single-crystal X-ray diffraction analysis shows that complex 1 is a 3D Evans-Showell-type POM-based metal-organic network. In complex 1, the 1D infinite double chain structure constructed from {{Cu[Co2Mo10H4O38]}4-L} units and the µ4-bridging L ligand are linked by quadrate Cu2L2 loops to form a 2D layer, which is further connected by µ2-bridging L ligands, forming a 3D (2,3,4)-connected metal-organic framework. Complex 2 displays 3D supramolecular networks based on 1D {[Co2Mo10H4O38]-Zn-L}n infinite chains, which are constructed from Evans-Showell-type polyoxoanions and µ2-bridging 3-bpfp ligands (via ligation of pyridyl nitrogen atoms). The different coordination modes of the POM polyanions, bis(pyridylformyl)piperazine ligands and ratios play key roles in the construction of the title complexes. Significantly, the ligand L shows a µ4-bridging coordination mode in complex 1, which is observed for the first time in a POM system. Compounds 1 and 2 represent the first examples of metal-organic complexes based on Evans-Showell-type polyoxoanion and transition metal-bis-pyrazine-bis-amide coordination complexes. The fluorescence properties of the title complexes are reported herein. In addition, the title complexes act as heterogeneous Lewis acid catalysts for the oxidation of benzyl alcohol, and can also be recovered and reused without any significant loss in activity. Significantly, compound 1 with a 3D metal-organic framework showed higher catalytic performance with 99.4% conversion and 98.8% selectivity for benzoic acid at 10 h than compound 2 with 3D supramolecular networks.

Evans-Showell-type polyoxometalate-based metal-organic complexes with novel 3D structures constructed from flexible bis-pyrazine-bis-amide ligands and copper metals: syntheses, structures, and fluorescence and catalytic properties.

Two new Evans-Showell-type polyoxometalate (POM)-based metal-organic complexes, namely {Cu3(L1)1.5(H2O)5[Co2Mo10H4O38]}·5H2O (1), {[Cu(L2)0.5(H2O)2]2[Co2Mo10H4O38]}·6H2O (2) (L1 = N,N'-bis(2-pyrazinecarboxamide)-1,4-butane, L2 = N,N'-bis(2-pyrazinecarboxamide)-1,6-hexane), were successfully synthesized and structurally characterized by single-crystal X-ray diffraction, elemental analysis, IR spectroscopy, powder X-ray diffraction (PXRD) and thermogravimetric analyses (TGA). In complex 1, the adjacent [Co2Mo10H4O38]6- polyoxoanions are linked by CuII ions to form a 1D Cu-[Co2Mo10H4O38]6- inorganic chain, which is further linked by ligand L1 and [Co2Mo10H4O38]6- polyoxoanions, forming a 3D metal-organic framework. In complex 2, the adjacent [Co2Mo10H4O38]6- polyoxoanions link the CuII ions to generate a 2D Cu-[Co2Mo10H4O38]6- inorganic layer, which is further connected with bidentate ligands L2 to obtain a 3D metal-organic framework. The structural diversities of compounds 1 and 2 showed that the spacer lengths of the flexible bis-pyrazine-bis-amide ligands play important roles in tuning the structures of the title complexes. Compounds 1 and 2 represent the first examples of 3D frameworks based on the Evans-Showell-type polyoxoanions and Cu-bis-pyrazine-bis-amide coordination complexes. Moreover, the ligand L1 was first successfully introduced into the POM system. The electrochemical and fluorescence properties of compounds 1 and 2 were discussed. As heterogeneous catalysts, compounds 1 and 2 have good catalytic activity for the oxidation of benzyl alcohol. Moreover, compound 2 has higher catalytic performance with 100% conversion and 98.0% selectivity for benzoic acid at 10 h. The difference in their catalytic performance may be mainly due to the difference of their structures. The catalysts can be recovered and reused without displaying any significant loss of activity.

Plasma concentration of diamine oxidase (DAO) predicts 1-month mortality of acute-on-chronic hepatitis B liver failure.

BACKGROUND: Acute-on-chronic hepatitis B liver failure (ACHBLF) has high 1-month mortality but it is difficult to predict. This present study was aimed to determine the diagnostic value of plasma diamine oxidase (DAO) in predicting the 1-month mortality of ACHBLF. METHODS: A total of 106 consecutive newly diagnosed ACHBLF patients were retrospectively collected. The plasma expression of DAO was determined using enzyme-linked immunosorbent assay (ELISA). RESULTS: The plasma DAO level of survivals [14.0 (7.1; 26.5) ng/mL] was significantly lower than the nonsurvivals [58.6 (32.5; 121.3) ng/mL, P < .001]. The plasma DAO level, hepatic encephalopathy, spontaneous bacterial peritonitis and model for end-stage liver disease (MELD) score were independent factors associated with the 1-month mortality for ACHBLF. The cut-off point of 15.2 ng/mL for plasma DAO level with sensitivity of 95.45%, specificity of 62.5%, 22.6 for MELD score with sensitivity of 90.91%, specificity of 67.5%, 0.07 for DAO plus MELD with sensitivity of 87.88%, specificity of 80% were selected to discriminate 1-month morality of ACHBLF. Furthermore, DAO plus MELD score showed high AUROC than MELD score for predicting 1-month (0.916 vs. 0.843, P < .01). CONCLUSIONS: The plasma DAO level plus MELD > 0.07 predicts poor 1-month mortality of ACHBLF.

[The analysis of IL-10 and its methylation in the patients with acute on chronic liver failure].

OBJECTIVE: To investigate the effect of IL-10 and the methylation of its promoter in acute on chronic liver failure (ACLF). METHODS: Patients were divided into three groups: 25 with ACLF, 25 with CHB, 10 healthy controls. Respectively detect the serum level of IL-10 via ELISA, and the methylation of IL-10 promoter via MSP, to analyze the difference among the three groups. RESULTS: Both the ACLF group and the CHB group have significant increase in serum level of IL-10 compared with the control group (P < 0.05); the ACLF group's level is higher than the CHB group, however without statistical significance (P > 0.05). The serum level of IL-10 in ACLF group has no significant relativity with ALT and HBV-DNA( r = -0.022, r = 0.033, respectively; P > 0.05); has positive relativity with TBIL and MELD ( r = 0.566, r = 0.443, respectively; P < 0.05); and negative relativity with PTA (r = -0.581, P < 0.05). The distribution of the methylation of IL-10 promoter in ACLF group is significantly different from the other two. CONCLUSION: The serum level of IL-10 in hepatitis patients is significantly higher and increases with the degree of liver failure. The promoter methylation may be important in the gene inactivation.

Enhanced demethylation of interferon-γ gene promoter in peripheral blood mononuclear cells is associated with acute-on-chronic hepatitis B liver failure.

Acute-on-chronic hepatitis B liver failure (ACHBLF) refers to liver failure occurring in patients with chronic hepatitis B (CHB) related liver diseases. Interferon-γ (IFN-γ) plays an important role in the exacerbation of liver function. However, the exact mechanism, by which IFN-γ mediates ACHBLF, is not fully understood. Forty patients with ACHBLF, fifteen patients with CHB and ten healthy controls were included in this present study. ELISA was performed to measure the level of serum IFN-γ. The methylation status of IFN-γ promoter in peripheral blood mononuclear cells (PBMCs) was determined using methylation-specific PCR. Model for End-stage Liver Disease (MELD) scoring was performed for evaluating the severity of liver failure. The serum level of IFN-γ in patients with ACHBLF or CHB was significantly lower than that in healthy controls, while the serum IFN-γ level in ACHBLF patients was significantly higher than that in CHB patients. In ACHBLF patients, the level of IFN-γ was positively correlated with total bilirubin and MELD score, but negatively correlated with prothrombin time activity. These results suggest the involvement of IFN-γ in the pathogenesis of ACHBLF. Importantly, the degree of methylation of the IFN-γ gene promoter in ACHBLF patients (60%, 24/40) was significantly lower than that in CHB patients (93%, 14/15), but was higher than that in the control group (20%, 2/10). Furthermore, in ACHBLF patients, the serum IFN-γ level was significantly higher in unmethylation group than that in methylation group. In conclusion, enhanced demethylation of IFN-γ gene promoter in PBMCs may be associated with the onset of ACHBLF.

[Study of oxidative stress in chronic hepatitis B patients with elevated serum total bilirubin].

OBJECTIVE: To investigate oxidative stress in chronic hepatitis B (CHB) patients with elevated serum total bilirubin (TBIL). METHODS: 75 CHB patients with elevated serum TBIL were enrolled in the present study. A, B, C, D and E group were defined. Serum Malondialdehyde (MDA), Xanthine Oxidase (XOD), Vitamin C (V(C)) and Vitamin E (V(E)) were determined. The control group contained 11 healthy donors and the carrier group contained 16 Hepatitis B surface antigen (HBsAg) carriers. RESULTS: The concentrations of MDA and XOD were significantly higher in each group of patients than in the control (P < 0.05), while V(C) and V(E) were significantly lower (P < 0.05). The concentration of XOD was significantly higher in the carrier group than in the control (P < 0.05), while MDA, V(C) and V(E) were not significantly different (P > 0.05). The concentrations of MDA and XOD were significantly positively correlated with TBIL (r = 0.670, P < 0.01; r = 0.737, P < 0.01, respectively) in the patients, while V(C) and V(E) were significantly negatively correlated with TBIL (r = -0.463, P < 0.01; r = -0.247, P < 0.05, respectively). The concentration of MDA was significantly different among all the groups in the patients except the comparison between group A and group B. The concentration of XOD was significantly different between group A, B, C and group D, E (P < 0.05). The concentration of V(C) was significantly different between group A and group D, E and between group B, C, D and group E (P < 0.05). The concentration of V(E) was significantly different between group A, B and group E (P < 0.05). CONCLUSION: There was a disturbance between oxidative stress and anti-oxidative ability in CHB patients with elevated serum TBIL. Oxidative stress became more serious along with the increasing of serum TBIL. In HBsAg carriers, oxidative stress level was low. The results suggest antioxidant treatment for CHB patients with elevated serum TBIL may help to improve the effect of therapy.