Integrated care model and point of care diagnostics facilitate Hepatitis C treatment among patients receiving opioid agonist therapy: a retrospective review of medical records.

BACKGROUND: Hepatitis C virus (HCV) is common among individuals in opioid agonist therapy (OAT). HCV treatment has previously been unavailable for most HCV positive OAT patients in Finland. The removal of treatment restrictions and attempts to reach HCV elimination goals have increased the number of OAT patients needing HCV treatment. The objectives of this study were 1) to characterize Finnish HCV positive OAT patients and evaluate their eligibility for HCV treatment at addiction service units, and 2) to retrospectively review the outcomes of treated patients. METHODS: The study focused on HCV positive OAT patients (n = 235). Demographics and clinical parameters were retrospectively reviewed using the patients' medical records. The eligibility of providing HCV treatment to patients at addiction service units were evaluated based on patients' clinical characteristics, such as liver function and patterns of substance use. The outcomes of patients receiving HCV treatment were reviewed. RESULTS: Of HCV antibody positive OAT patients, 75% had chronic HCV. Of 103 HCV patients screened for liver fibrosis either with Fibroscan or APRI (aspartate aminotransferase to platelet ratio index), 83 patients (81%) had no indication of severe liver damage. Point of care (POC) HCV tests were used for 46 patients to lower the threshold of attending laboratory testing. All patients preferred POC testing to conventional blood testing. Twenty patients had received HCV treatment, 19 completed the treatment and achieved sustained virologic response (SVR) at the end of the treatment. Of the 18 patients available for evaluation of SVR at 12 weeks after the treatment (SVR12), 17 achieved SVR12. CONCLUSIONS: The integrated model consisting of HCV diagnostics and treatment at the addiction service unit was successfully implemented within normal OAT practice.

Retrospective, Registry-based, Cohort Investigation of Clinical Outcomes in Patients with Cutaneous Squamous Cell Carcinoma and Basal Cell Carcinoma in Finland.

Most cases of keratinocyte cancer can be treated effectively with surgery. However, survival is reduced in patients with advanced disease. This retrospective cohort study evaluated overall survival of patients with invasive keratinocyte cancers, and high-risk features for progression of the disease and mortality in Finnish patients in a real-world setting. A total of 43,143 patients with keratinocyte cancer types of basal cell carcinoma and 10,380 with cutaneous squamous cell carcinoma were identified nationwide. More detailed patient records were available for a subset of patients (basal cell carcinoma n = 5,020 and cutaneous squamous cell carcinoma n = 1,482) from a regional database. Fifty percent of patients with advanced cutaneous squamous cell carcinoma died approximately 4.5 years after diagnosis. Multivariable models suggested that risk factors for keratinocyte cancer progression were male sex, presence of comorbidities, immunosuppression, and pre-cancerous lesions, while risk factors for disease-specific mortality were advanced disease stage with immunosuppression, other malignancies, and consecutive surgical excisions. These results suggest that identifying patient and tumour factors associated with poor disease outcome could be important when determining appropriate treatment and follow-up; however, further studies are necessary.

Liver Fat, Adipose Tissue, and Body Composition Changes After Switching from a Protease Inhibitor or Efavirenz to Raltegravir.

Integrase inhibitors appear to increase body weight, but paradoxically some data indicate that raltegravir (RAL) may decrease liver fat. Our objective was to study the effects of switching from a protease inhibitor (PI) or efavirenz (EFV) to RAL on liver fat, body composition, and metabolic parameters among people living with HIV (PLWH) with high risk for nonalcoholic fatty liver disease (NAFLD). We randomized overweight PLWH with signs of metabolic syndrome to switch a PI or EFV to RAL (n = 19) or to continue unchanged antiretroviral therapy (control, n = 24) for 24 weeks. Liver fat was measured by magnetic resonance spectroscopy (MRS), body composition by magnetic resonance imaging, and bioimpedance analysis; subcutaneous fat biopsies were obtained. Median (interquartile range) liver fat content was normal in RAL 2.3% (1.1-6.0) and control 3.1% (1.6-7.3) group at baseline. Liver fat and visceral adipose tissue remained unchanged during the study. Body weight [from 85.9 kg (76.1-97.7) to 89.3 (78.7-98.7), p = 0.019], body fat mass [from 20.3 kg (14.6-29.7) to 22.7 (17.0-29.7), p = 0.015], and subcutaneous adipose tissue (SAT) volume [from 3979 mL (2068-6468) to 4043 (2206-6433), p = 0.048] increased, yet, adipocyte size [from 564 pL (437-733) to 478 (423-587), p = 0.019] decreased in RAL but remained unchanged in control group. Circulating lipids and inflammatory markers improved in RAL compared to control group. The median liver fat measured by MRS was unexpectedly within normal range in this relatively small study population with presumably high risk for NAFLD contradicting high prevalence of NAFLD reported with other methods. Despite weight gain, increase in SAT together with decreased adipocyte size and reduced inflammation may reflect improved adipose tissue function. Clinical Trial Registration number: NCT03374358.

Tubular cell damage may be the earliest sign of renal extrahepatic manifestation caused by Hepatitis C.

Chronic kidney disease (CKD) is one of the most well-known extrahepatic manifestations caused by hepatitis C infection (HCV). CKD is typically discovered at a late stage. HCV-nephropathy may show different histopathologic patterns, as both glomerular and tubulointerstitial damage have been described. Identification of patients with early renal manifestations would be beneficial to provide treatment and avoid progression to CKD. The observational prospective single-center HCVKID study assessed the prevalence of early renal manifestations in patients with chronic HCV and compared these patients with HCV-negative healthy controls cross-sectionally. HCV-positive patients with and without renal manifestations were also compared to define biomarkers suitable for identifying early manifestations in standard clinical practice. Tubular proteinuria as judged by urine α 1-microglobulin was the most common early renal manifestation found in 11% in HCV-positive patients, followed by hematuria in 8%. Kidney filtration was statistically significantly lower among HCV-positive patients with renal manifestation according to any calculation method. There were no significant differences in duration of infection or stage of liver fibrosis between patients with or without renal manifestations. Tubular cell damage may be the earliest sign of renal dysfunction caused by HCV. Complement activation also correlates with the dysfunction, indicating of contribution to HCV-induced renal manifestations even in their early phase.

Impact of Anti-Dementia Medication on the Risk of Death and Causes of Death in Alzheimer's Disease.

BACKGROUND: The Finnish population offers many advantages for evaluating the impact of anti-dementia medication on mortality in Alzheimer's disease (AD) due to broad range of individual-level data collected in national health and social care registries and the fact that Finland has one of the highest mortality rates for dementia globally. OBJECTIVE: The aim of this study was to investigate the association of anti-dementia medication with 2-year risk of death and all-cause mortality in patients with AD. METHODS: This was a retrospective, non-interventional registry study based on individual-level data using Finnish national health and social care registries. An incident cohort of 9,204 AD patients (first AD diagnosis in 2012) was formed from a population of 316,470 individuals ≥74 years of age. The main outcome measure was overall 2-year risk of death. Statistical modelling was used to assess mortality (Kaplan-Meier) and adjusted hazard ratios (HR) (Cox proportional hazard model). RESULTS: Early start of anti-dementia medication (treatment started ≤3 months from AD diagnosis) reduced significantly the risk of all-cause death compared to AD patients who had late medication initiation (defined as treatment started >3 months from AD diagnosis/no medication; HR, 0.51; 95% confidence interval (CI), 0.46-0.57). Dementia was the most common recorded cause of death in both groups. CONCLUSION: This study places importance on early diagnosis of AD and subsequent early initiation of drug treatment in decreasing 2-year risk of death.

Synthesis and melt processing of cellulose esters for preparation of thermoforming materials and extended drug release tablets.

Using softwood pulp as the starting material, the synthesis of regioselectively substituted mixed cellulose esters with varying degree of substitution and ratio of short/long chains was successfully completed. The structures of the cellulose esters were characterised. The impact of the structural changes and the degree of substitution of the cellulose esters on thermal properties and processability were investigated. The study shows that the sequential esterification is a promising modification route for cellulose to improve its thermal processability and mechanical properties without the use of external processing aids such as plasticisers. In particular, the hexanoate group in the C6 position on the cellulose backbone acts as an internal plasticiser and improves thermal processability and increases the strength and stiffness of the cellulose ester. The properties of sequentially esterified cellulose promote its practical use in plastics, coatings, films and drug delivery. Sequentially esterified cellulose hexanoate-acetate was used successfully in a coating formulation for the preparation of tablets and showed a stable extended release profile for three water-insoluble drugs in this context. The pH of the release medium had no notable effect on the release properties.

Using a low melting solvent mixture to extract value from wood biomass.

Green chemistry, sustainability and eco-efficiency are guiding the development of the next generation of industrial chemical processes. The use of non-edible lignocellulosic biomass as a source of chemicals and fuels has recently raised interest due to the need for an alternative to fossil resources. Valorisation mainly focuses on cellulose, which has been used for various industrial scale applications for decades. However, creating an economically more viable value chain would require the exploitation of the other main components, hemicellulose and lignin. Here, we present a new low melting mixture composition based in boric acid and choline chloride, and demonstrate its efficiency in the fractionation of wood-based biomass for the production of non-condensed lignin, suitable for further use in the search for sustainable industrial applications, and for the selective conversion of hemicelluloses into valuable platform chemicals.

Chemical modification of cellulosic fibers for better convertibility in packaging applications.

Cellulose fiber has been modified by mechanical and chemical means in order to improve paper properties, which respond to moisture and temperature. When the cellulose is first refined and then etherified using hydroxypropylation under dry conditions, the paper sheets prepared from the hydroxypropylated cellulose show improved elongation. When the level of hydroxypropylation is high enough, the paper sheets also become transparent. Additionally, the effect of cellulose activation using different mechanical methods has been compared by esterification reactions. It is shown that removal of water is the most crucial step for the esterification reactions while other methods have a lesser impact. The paper sheets prepared from the esterified cellulose fibers show an increase in contact angles and high hydrophobicity.

(E)-1-(4-Amino-phen-yl)ethanone oxime.

In the mol-ecule of the title compound, C(8)H(10)N(2)O, the oxime group is oriented at a dihedral angle of 5.58 (3)° with respect to the benzene ring. In the crystal structure, inter-molecular O-H⋯N and N-H⋯O hydrogen bonds link the mol-ecules, forming a three-dimensional network.

Two isomers of Pd2(S2NC7H4)4.

The dichloromethane solvates of the isomers tetrakis(mu-1,3-benzothiazole-2-thiolato)-kappa(4)N:S;kappa(4)S:N-dipalladium(II)(Pd-Pd), (I), and tetrakis(mu-1,3-benzothiazole-2-thiolato)-kappa(6)N:S;kappa(2)S:N-dipalladium(II)(Pd-Pd), (II), both [Pd2(C7H4NS2)4] x CH2Cl2, have been synthesized in the presence of (o-isopropylphenyl)diphenylphosphane and (o-methylphenyl)diphenylphosphane. Both isomers form a lantern-type structure, where isomer (I) displays a regular and symmetric coordination and isomer (II) an asymmetric and distorted structure. In (I), sitting on an centre of inversion, two 1,3-benzothiazole-2-thiolate units are bonded by a Pd-N bond to one Pd atom and by a Pd-S bond to the other Pd atom, and the other two benzothiazolethiolate units are bonded to the same Pd atoms by, respectively, a Pd-S and a Pd-N bond. In (II), three benzothiazolethiolate units are bonded by a Pd-N bond to one Pd atom and by a Pd-S bond to the other Pd atom, and the fourth benzothiazolethiolate unit is bonded to the same Pd atoms by, respectively, a Pd-S bond and a Pd-N bond.

Biodegradabilities of some chain oils in groundwater as determined by the respirometric BOD OxiTop method.

The respirometric BOD OxiTop method was used to monitor the biodegradation of different chain oils (mineral, rapeseed and tall oils) over 28 days in groundwater, as well as in standard conditions described by OECD 301 F. The aim of the study was to gather more information about the biodegradability of forestry oils in groundwater, as well as about the suitability of the automatic OxiTop method for biodegradation measurements. The BOD OxiTop method proved to be a precise and reliable technique for determining the biodegradations of different oils. Some comparative studies were also made using a traditional IR method in order to clarify the total oil concentrations. The results show that if biodegradation only is to be monitored, the OxiTop method is preferable. This is due to the influence of other reactions aside from biodegradation on total hydrocarbon concentrations when using the IR method.