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Osteoporosis is a common complication of primary biliary cholangitis (PBC) with a relatively high prevalence rate and a high risk of bone fracture.The pathogenesis of osteoporosis remains unknown.This article reviews the latest advances in the pathogenesis and treatment of osteoporosis in PBC.Studies have shown that osteoporosis in PBC has various causes,including increased bone absorption and reduced bone formation due to many factors.Although many drugs have been used in clinical practice,until now,bisphosphonates are still the most effective drugs.Long-term systematic studies are needed in the future to clarify their effects on fracture in PBC patients.
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Primary biliary cholangitis (PBC)is a commonly seen cholestatic liver disease.Currently,ursodeoxy-cholic acid (UDCA)is the only drug approved for the effective treatment of PBC.However,up to 40% of PBC patients had poor response to UDCA.Farnesoid X receptor (FXR)can inhibit the synthesis of bile acid,regulating the transport of bile acid and playing a role in anti-hepatic fibrosis.This article reviewed the role of FXR in treatment of PBC.
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BACKGROUND: Adipokines are secreted by adipose tissue, including a series of cytokines and chemokines. Additionally, adipokines have been found to play certain roles in pro- and anti-inflammatory regulation. OBJECTIVE: To analyze the regulatory effect of various adipokines in the inflammatory process of autoimmune response and immune diseases, thus providing the strategy for controlling and treating autoimmune diseases and searching effective indexes for assessing disease development, incidence of complications and prognosis. METHODS: CNKI and PubMed databases were retrieved for the articles addressing the role of adipokines in autoimmune diseases published from 1986 to 2016 using the keywords of adipokine, autoimmune in English and Chinese, respectively. RESULTS AND CONCLUSION: Adipose tissue plays a critical role in metabolism regulation, and its effect on the immune system has emerged through a series of studies concerning adipokines regulating immune response. Adipokines exert various functions, and regulate metabolism and inflammation. In the development and occurrence of autoimmune diseases, some factors for immune responses remain unclear, and in-depth studies on adipokines will be helpful for lifting the veil of autoimmune diseases.
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At present, liver biopsy is the gold standard for the diagnosis and grading of liver fibrosis, but its limitations have been widely acknowledged. The non-invasive detection methods are needed in clinical practice, and at present, magnetic resonance elastography (MRE) is a hot research topic. This article reviews the advances in the clinical application of MRE in related fields, and studies have shown that MRE has a high diagnostic value due to its high sensitivity and specificity in the diagnosis and grading of liver fibrosis and an area under the receiver operating characteristic curve as high as 0.95. Compared with serological and other imaging diagnostic methods, MRE can determine fibrosis stage more accurately and has good reproducibility and objectivity. MRE can be widely applied in all patients except those with hemochromatosis, with special advantages in the diagnosis for patients with obesity and ascites, and can make up for the disadvantages of other methods. This article points out that MRE may become the best non-invasive method for the assessment of liver fibrosis, especially advanced fibrosis.
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Fatigue is one of the most common symptoms of primary biliary cirrhosis (PBC) and greatly affects patients′ quality of life. The pathogenesis of fatigue in PBC remains unknown and there are no effective therapeutic methods. This article reviews the latest advances in the pathogenesis and treatment of fatigue in PBC. Studies have shown that the causes of fatigue in PBC include various central and peripheral factors, such as the changes in the brain, sleep disorders, depression, autonomic nervous dysfunction, and abnormal muscle metabolism. Modafinil does not have a definite therapeutic effect in fatigue in PBC. The causes and treatment of fatigue in PBC still need in-depth systematic studies.
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BACKGROUND/AIMS: To screen for serum protein/peptide biomarkers of hepatitis B virus (HBV)-associated chronic hepatic lesions in an attempt to profile the progression of HBV-associated chronic hepatic lesions using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) techniques. METHODS: Using SELDI-TOF MS, serum protein/peptide profiles on the CM10 ProteinChip arrays were obtained from a training group including 26 HBV-associated hepatocellular carcinoma patients with liver cirrhosis (LC), 30 HBV-associated LC patients, 85 patients at different stages of liver fibrosis, and 30 asymptomatic HBV carriers. The most valuable SELDI peak for predicting the progression to LC in HBV-infected patients was identified. RESULTS: A SELDI peak of M/Z 5805 with value for predicting LC in HBV-infected patients was found and was identified as a peptide of the C-terminal fraction of the fibrinogen alpha-chain precursor, isoform 1. CONCLUSIONS: The peptide of the C-terminal fraction of the fibrinogen alpha-chain precursor, isoform 1 with M/Z 5805, may be a serological biomarker for progression to LC in HBV-infected patients.
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Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Biomarkers/blood , Carcinoma, Hepatocellular/virology , Disease Progression , Hepatitis B virus , Hepatitis B, Chronic/blood , Liver Cirrhosis/blood , Liver Neoplasms/virology , Protein Array Analysis , Spectrometry, Mass, Matrix-Assisted Laser Desorption-IonizationABSTRACT
Primary biliary cirrhosis (PBC)is an autoimmune disease.Ursodeoxycholic acid (UDCA)is the only safe and effective drug for the treatment of PBC,as proved by randomized controlled clinical trials,so it is advocated as first-line therapy.Alternative therapies are urgently needed for patients with poor response to UDCA.In addition to the efficacy of UDCA,the classification of alternative and adjuvant therapies for UDCA nonresponders and the latest research progress in these therapies are reviewed;the efficacy of existing drugs and treat-ment prospects are evaluated,but more long-term clinical studies are needed to confirm the efficacy of immunosuppressants such as budes-onide and etanercept and other drugs.A number of novel molecular therapies for PBC are also undergoing clinical trials.There is currently no consensus on the medical treatment for patients with poor response to UDCA.Although studies have shown that some drugs can improve liver function and liver biochemistries,there is no definitive evidence that they improve long-term outcome.
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The education goal of 8-year medical students is to develop both clinical competence and to meet the needs of research and development. After the research ability questionnaires, we consider that these students have requirements the cultivation of research ability. We should formalize, organize the designed research training for them as soon as possible to make them become medical personnel with the ability to adapt to international competition as.
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Long educational system is an effective form in training high-level medical talents.Doctor-patient communication skill is one of tbe basic qualifications for 8-year program medical students.Standardized patients can be applied in training and evaluating of the 8-year program medical students'ability to deal with doctor-patient relationship so as to cultivate their communication competence.
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Clinical practice course during the physical diagnosis studying is very important for the medical undergraduate students. It’s a bridge between the medical basic knowledge and clinical work. Several aspects such as moral education,learning attitude,scientific schedule,mas-tering the basic medical knowledge and physical examination,typical case and communicating skill must be emphasized in the clinical practice course.
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Student as standard patient(SSP) was defined as student receiving relative medical training,who was willing to act as a human analogue as a patient and could be used as not only a patient but also a teacher in clinic practice.The results indicates that the using of SSP in the clinical teaching of endocrinology could promote the students'level in practice and in the meanwhile,it could be useful to testing the learning result.
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To improve the knowledge of students and strengthen the teaching effects of internal medicine teaching,the characters,teaching methods and notices of clinical guideline were analysed. Moreover,according to previous teaching experiences,a few unique opinions on it were put forward. The results showed that clinical guideline was one of the most important ways in internal medicine teaching.
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0.05). The marks of the group of CBL in case analysis test and clinical skills test are significantly higher than that of the group of stepwise learning (P
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To improve the quality of clinical practice education,questionnaires were distributed to the medical interns. Corresponding responses were proposed based on humanities quality,quality of clinical practice and its factors,views on after-department examination and training for clinical skill. The result shows most of students realized the importance of clinical practice. After reformation for clinical education,after-department examination could efficiently improve interns’ability to resolve practical problems. Management of teachers,development of students’clinical thinking and ability of communication between doctor and patient should be enhanced .
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<p><b>OBJECTIVE</b>To study the expression of tenascin in normal and fibrotic rat liver.</p><p><b>METHODS</b>Liver fibrosis induced in rat with CCl(4) were divided into three stages: the stage of hepatic injury (4 weeks), early stage of hepatic fibrosis (8 weeks) and later stage of hepatic fibrosis (12 weeks). Tenascin expression in liver tissue was observed by immunohistochemical method and in situ hybridization using digoxigenin-labelled DNA probe.</p><p><b>RESULTS</b>In normal rat liver there was a weak staining for tenascin. In both liver injury stage and early stage of hepatic fibrosis, both mRNA signal and immunostaining for tenascin were significantly increased as compared to that in normal liver. In later stage of hepatic fibrosis, mRNA signal and immunostaining for tenascin were decreased compared with that in early stage of hepatic fibrosis. The cellular source of tenascin in liver mainly restricted in mesenchymal cells.</p><p><b>CONCLUSIONS</b>Tenascin is a component of the extracellular matrix of liver tissue. Plays a role in early matrix organization during liver fibrogenesis.</p>
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Animals , Male , Rats , Carbon Tetrachloride , Disease Models, Animal , Extracellular Matrix Proteins , Genetics , Image Processing, Computer-Assisted , Immunohistochemistry , In Situ Hybridization , Liver Cirrhosis , Metabolism , RNA, Messenger , Rats, Sprague-Dawley , Tenascin , GeneticsABSTRACT
<p><b>OBJECTIVE</b>To improve the diagnosis and management of primary biliary cirrhosis (PBC).</p><p><b>METHODS</b>Clinical data of 22 cases of PBC were reviewed including the clinical manifestation, laboratory test, and the response to therapy.</p><p><b>RESULTS</b>There were 20 female patients with an average of 50 years old in total of 22 PBC patients. The major symptoms were pruritus, fatigue, anorexia, and abdominal discomfort. The major signs included jaundice, hepatomegaly, splenmegaly, and ascites. Very high levels of serum alkaline phosphatase (ALP) and serum gamma glutamyl transpeptidase (GGT), hyperbilirubinemia and hypergammaglobulinemia were also detected in most of the patients. The aminotransferase level was only slightly elevated but the AST/ALT ratio was reversed. It took 8 months (ranging from 2 months to 5 years) to confirm the diagnosis after the clinical manifestation onset. Ursodeoxycholic acid could decrease the serum levels of ALP and bilirubin in 80% of the patients (12/15) and improve the symptom of pruritus and fatigue in 72.7% of the patients (11/15).</p><p><b>CONCLUSIONS</b>PBC mainly affects middle-aged women and the main clinical manifestations are hepatosplenomegaly, jaundice, pruritus, and fatigue. Liver function test typically reveal a cholestatic pattern accompanied by hypergammagloblinemia and a positive antimitochondrial antibody (AMA) including M2 subtype (AMA-M2). Ursodeoxycholic acid could improve the abnormal liver function tests and clinical features in PBC patients</p>
Subject(s)
Female , Humans , Male , Middle Aged , Alkaline Phosphatase , Bilirubin , Cholestasis , Hepatomegaly , Liver Cirrhosis, Biliary , Metabolism , Liver Function Tests , Ursodeoxycholic AcidABSTRACT
Objective To improve the diagnosis and management of primary biliary cirrhosis (PBC). Methods Clincal data of 78 cases of PBC patients were reviewed. The clinical manifestations,the results of laboratory tests,and response to therapy in all the PBC patients were analysed retrospectively. Results Among 78 patients 68 were female. The mean age was 50.4?9.3years at the time when definite diagnosis was made. The major symptoms in these patients were pruritus,fatigability,and jaundice. The major signs included hepatomegaly,splenomegaly,and ascites. Very high levels of serum alkaline phosphatase (ALP) and serum gamma glutamyl transpeptidase (GGT),hyperbilirubinemia,and hypergammaglobulinemia were also detected in most of the patients. The aminotransferase levels were only slightly elevated,but the AST/ALT ratio was reversed. It took 12 months (ranging from 2 months to 10 years) to confirm the diagnosis after the onset of clinical manifestations. Ursodeoxycholic acid reduced the serum levels of ALP and bilirubin in 80% of patients and improved the symptom of pruritus and fatigability in 73.4% of patients. Conclusion PBC mainly affects middle-aged women with hepatosplenomegaly, jaundice,pruritus and fatigability as presenting features. Liver function tests typically revealed a cholestatic pattern accompanied by hypergammaglobulinemia and a positive antimitochondrial antibody (AMA) including M2 subtype (AMA-M2). Ursodeoxycholic acid could improve the abnormal liver function tests and clinical symptoms in PBC patients.
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AIM: To observe the expression of undulin(Un) in liver tissue and to clarify the diagnostic significance of serum Un in experimental rat liver fibrosis. METHODS: Rat liver fibrosis was induced by carbon tetrachloride. The expression of Un in liver tissue was detected by immunohistochemical method. Serum Un levels was measured by enzyme immunoassay.RESULTS: Expression of Un increased in fibrotic liver than normal liver, and it was mainly distributed in portal tract stroma, central veins and fibrotic septa in fibrotic liver. Also, the level of serum Un was significantly higher in fibrotic liver than normal liver.CONCLUSION: These data suggest that Un should be a component of the hepatic extracellar matrix, and its expression could be increased greatly in fibrotic rat liver. Serum Un levels may be used as an indicator in liver fibrosis diagnosis.