***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Several drugs which react with DNA decrease hepatitis B viral ( HBV ) DNA polymerase activity in vitro . Because such an alteration of viral replication , if produced in patients with hepatitis B surface antigen (HBsAg)-positive chronic hepatitis , may lead to elimination of viral infection , we conducted a controlled trial of the use of the intercalating agent , quinacrine hydrochloride , in treatment of HBsAg-positive chronic hepatitis . No patient converted from HBsAg positive to negative during the trial and no consistent effect on HBV DNA polymerase activity was noted . Following treatment , elevated transaminase values and alterations of HBV markers were observed in several patients .  Fluctuations of transaminase values and HBV markers may reflect alterations in host immunity and viral replication . Quinacrine alone is ineffective in therapy of chronic HBV infection . Additional study with intercalating agents , perhaps in conjunction with other drugs , is suggested In a preliminary study , carriers of hepatitis B virus were treated with a preparation of the plant Phyllanthus amarus for 30 days . 22 of 37 ( 59 % ) treated patients had lost hepatitis B surface antigen when tested 15 - 20 days after the end of the treatment compared with only 1 of 23 ( 4 % ) placebo-treated controls . Some subjects have been followed for up to 9 months . In no case has the surface antigen returned . Clinical observation revealed few or no toxic effects . The encouraging results of this preliminary study recommend continued evaluation of this plant and the active principles isolated from it We studied the effect of Sho-saiko-to ( Xiao-Chai-Hu-Tang ) on HBeAg clearance rate ( SN rate ) in fourteen children with chronic hepatitis B virus ( HBV ) infection and with sustained liver disease . Seven of fourteen patients ( 50.0 % ) became HBeAg negative in the average observation period of 0.47 years(0.2 - 0.9 years ) . Four of those seven patients developed anti-HBe . The annual SN rate in the She-saiko-to treated group was apparently higher than the natural annual SN rate ( 22.7 % ) of 22 untreated patients retrospectively review ed from the onset of hepatitis . Sho-saiko-to seemed to promote clearance of HBeAg in children with chronic HBV infection and with sustained liver disease . Sho-saiko-to may be a useful drug for such patients OBJECTIVE To determine whether clinical trials originating in certain countries always have positive results . DATA SOURCES Abstract s of trials from Medline ( January 1966-June 1995 ) . STUDY SELECTION Two separate studies were conducted . The first included trials in which the clinical outcome of a group of subjects receiving acupuncture  was compared to that of a group receiving placebo , no treatment , or a nonacupuncture intervention . In the second study , r and omized or controlled trials of interventions other than  acupuncture  that were published in China , Japan , Russia/USSR , or Taiwan were compared to those published in Engl and . DATA EXTRACTION Blinded review ers determined inclusion and outcome and separately classified each trial by country of origin . DATA SYNTHESIS In the study of acupuncture  trials , 252 of 1085 abstract s met the inclusion criteria . Research conducted in certain countries was uniformly favorable to acupuncture ; all trials originating in China , Japan , Hong Kong , and Taiwan were positive , as were 10 out of 11 of those published in Russia/USSR . In studies that examined interventions other than acupuncture , 405 of 1100 abstract s met the inclusion criteria . Of trials published in Engl and , 75 % gave the test treatment as superior to control . The results for China , Japan , Russia/USSR , and Taiwan were 99 % , 89 % , 97 % , and 95 % , respectively . No trial published in China or Russia/USSR found a test treatment to be ineffective . CONCLUSIONS Some countries publish unusually high proportions of positive results . Publication bias is a possible explanation . Research ers undertaking systematic review s should consider carefully how to manage data from these countries BACKGROUND In patients with chronic hepatitis B , treatment with interferon alfa and the consequent loss of hepatitis B e antigen ( HBeAg ) from the blood leads to a reduction in inflammatory activity , but the clinical benefits of this treatment have not been established . We evaluated whether HBeAg seroconversion induced by interferon alfa improves clinical outcome . METHODS We studied prospect ively a cohort of 103 patients treated with interferon alfa for chronic hepatitis B ; the mean ( + /- SD ) follow-up was 50.0 + /- 19.8 months . Fifty-three untreated patients served as controls . RESULTS After treatment with interferon alfa , 53 of 103 patients no longer had detectable HBeAg or hepatitis B virus DNA , although only 10 patients became seronegative for hepatitis B surface antigen ( HBsAg ) ( Kaplan-Meier estimates of cumulative clearance rates at five years , 56.0 percent for HBeAg and 11.6 percent for HBsAg ) . Of the 53 untreated patients , only 7 spontaneously eliminated HBeAg ( 28.1 percent at five years ) , and all remained positive for HBsAg ( p < 0.001 for the Comparison with the treated patients , by the proportional-hazards model ) . During follow-up , 6 of the 103 treated patients died of liver failure , and 2 needed liver transplantation , all 8 were persistently positive for HBeAg . In another eight treated patients , complications of cirrhosis developed ; all but one of these patients remained positive for HBeAg . Overall survival and survival without clinical complications were significantly longer in patients who were seronegative for HBeAg after therapy with interferon alfa than in those who remained seropositive ( P = 0.004 and P = 0.018 , respectively ) . In a regression analysis , clearance of HBeAg was the strongest predictor of survival . Of the 53 untreated patients , 13 had severe complications ( including 4 deaths and 1 need for liver transplantation ) ; all 13 continued to be HBeAg-positive . CONCLUSIONS In patients with chronic hepatitis B infection , the clearance of HBeAg after treatment with interferon alfa is associated with improved clinical outcomes Sixty-five adult asymptomatic chronic carriers of hepatitis B virus were enrolled to the r and omized controlled efficacy study of Phyllanthus amarus . Thirty-four received Phyllanthus amarus 600 mg per day for 30 days and 31 received placebo in identical capsules . The conversion rate of HBsAg was 6 per cent in the study group at day 30 . When 20 subjects in the Phyllanthus amarus group were given a further 30-day treatment and 22 placebo recipients given Phyllanthus amarus 1,200 mg per day for 30 days , the conversion was observed in 1 ( 5 % ) in the higher dose group . Adverse effects were not observed in all patients receiving the plant . The results indicated that Phyllanthus amarus , whole plant except root , grown in the central part of Thail and , given at the studied dosage and duration , had a very minimal effect on eradication of HBsAg from Thai adult asymptomatic chronic carriers Ninety Chinese hepatitis B surface antigen ( HBsAg ) carrier children , aged 2 - 17 years , positive for hepatitis B e antigen ( HBeAg ) and hepatitis B virus DNA on at least three occasions in 6 months , were r and omized into 3 groups . Thirty children received syrup vitamin B complex as control , 29 received 6 weeks of placebo syrup followed by 16 weeks of recombinant alpha 2b-interferon [ intron A ( rIFN2b ) ] , 5 x 10(6 ) u/m2 subcutaneously thrice weekly ; and 31 received 6 weeks of syrup prednisone ( 0.6 mg/kg tailed to 0.2 mg/kg ) followed by 16 weeks of recombinant alpha 2b-interferon as above . The placebo/prednisone syrup was given on a double-blind basis . At 24 months of follow-up , persistent loss of hepatitis B virus DNA occurred in none of the children in the control group , in one child receiving recombinant alpha 2b-interferon alone , who also seroconverted to anti-HBe and anti-HBs and in five children receiving interferon with steroid priming ( p = 0.0571 compared with controls ) , with four seroconverting to anti-HBe and one also seroconverting to anti-HBs . A rise of transaminases to above twice the upper limit of normal levels during the first 7 months of follow-up occurred in one subject in the control group , four in the group receiving alpha 2b-interferon alone and nine in the group receiving recombinant alpha 2b-interferon with steroid priming ( p = 0.0144 compared with controls ) . Side effects of the steroid were negligible ; those of recombinant alpha 2b-interferon were transient and acceptable . We conclude that 6 weeks of prednisone followed by 16 weeks of recombinant alpha 2b-interferon is of use in inducing persistent loss of hepatitis B virus DNA ( 16.1 per cent ) and e-seroconversion ( 12.9 per cent ) in a proportion of Chinese HBsAg carrier children : the prednisone probably enhances the immunomodulatory effect of recombinant alpha 2b-interferon Fifty percent of healthy hepatitis B surface antigen carriers may have histologically proven chronic hepatitis . Our aim was to study the benefit of interferon-alpha in healthy patients . Twenty-nine hepatitis B surface antigen carriers with normal liver enzymes and with serum hepatitis B virus DNA were r and omized into two groups : Group I ,  14 patients treated with 9 megaunits of interferon alpha-2a thrice weekly for six months , and Group II , 15 control patients .  A liver biopsy was obtained from each patient at study initiation . A second biopsy was available in nine treated patients and six controls . During treatment , a significant increase in alanine amino transferase levels was observed in treated patients as compared with the controls ( P < 0.05 ) . After treatment , transaminase levels decreased to normal values . No differences between treated and control patients were observed in clearance of hepatitis B virus markers . A significant increase in the total histological activity index between base line and final liver biopsies was observed in treated patients ( P < 0.05 ) . It is concluded that interferon alpha treatment may induce a biochemical and histological activation of liver disease . Accordingly , interferon alpha should not be administered to healthy hepatitis B surface antigen carriers , at least with the schedule used in this work Many r and omised controlled trials have been conducted in China to evaluate the effectiveness of traditional Chinese medicine , but much of the information is inaccessible to Western doctors . We estimated the total number of r and omised controlled trials published in China and identified problems in applying such methodology to the evaluation of traditional Chinese medicine , which would serve as preparatory work for systematic review and dissemination of the r and omised evidence for such medicine . We r and omly selected 28 journals using stratified sampling from a total of 100 Chinese journals of traditional Chinese medicine ( 4 national , 10 university , 10 provincial or regional , and 4 specialist journals ) . After special training , eight fifth year medical students ( working in pairs ) h and search ed all the issues of the journals published before 1 January 1997 to identify r and omised controlled trials . Discrepancies were settled by one of the principal investigators ( S-YZ ) . Data on method ological quality of r and omised controlled trials were extracted from 414 full length articles To examine the long‐term effect of interferon ( IFN ) therapy in patients with chronic hepatitis B virus ( HBV ) infection , particularly on survival and hepatocellular carcinoma ( HCC ) prevention , 101 male patients with chronic hepatitis B in a r and omized controlled trial were followed up for 1.1 to 11.5 years after the end of therapy . Of the 101 patients , 34 patients received a  placebo ( control ) , and 67 patients were treated with IFN  ( 31 patients were treated with IFN alone and 36 patients were treated with IFN after prednisolone priming ) . Follow‐up studies included clinical , biochemical , and virological aspects and HCC screening every 3 to 6 months . Twenty‐eight ( 42 % ) of the 67 IFN‐treated patients and 8 ( 24 % ) of the 34 untreated patients seroconverted by the end of the trial . During follow‐up , 22 ( 56 % ) of the 39 patients who did not seroconvert in the treated group and 5 ( 19 % ) of the 26 patients who did not seroconvert in the control group showed a delayed sustained response ( P < .005 ) . The cumulative incidence of sustained response was highest in the steroid priming group ( P = .049 vs. the IFN – alone group;P = .028 vs. the control group ) . HCC was detected in 1 ( 1.5 % ) of the 67 treated patients and 4 ( 12 % ) of the 34 untreated patients ( P = .043 ) . The interval between entry and HCC detection was 3.5 to 8.2 years . The cumulative incidence of HCC development was significantly higher in the control group than in the treated group ( P = .013 ) . In contrast , the cumulative survival rate was higher in the treated group than the control group ( P = .018 ) . Multivariate analysis showed  that IFN therapy , preexisting cirrhos 
    Output:
    
Phyllanthus amarus and Astragalus membranaceus showed no significant antiviral effect compared with placebo .
Analysis of pooling eight r and omised clinical trials with less than three months follow-up did not show a significant benefit of Chinese medicinal herbs on viral markers .
REVIEW ER 'S CONCLUSIONS Based on one low quality trial , the medicinal herb ' Jianpi Wenshen recipe ' may have an antiviral activity in asymptomatic carriers of hepatitis B virus .