Efficacy of vitamin D adjuvant therapy for prevention of spontaneous bacterial peritonitis in patients with decompensated cirrhosis of hepatitis B / 中华临床感染病杂志

Objective:To evaluate the efficacy of vitamin D supplementation for prevention of spontaneous bacterial peritonitis (SBP) in patients with decompensated liver cirrhosis of hepatitis B.Methods:A total of 172 patients with decompensated cirrhosis of hepatitis B admitted in Jinhua Hospital affiliated to Zhejiang University School of Medicine from January to December 2021 were randomly divided into two groups with 86 cases in each group. Patients in both groups received conventional antiviral and symptomatic treatment; while patients in the intervention group received additinal oral vitamin D drops (800 IU/d) for 6 months. After 6 months of treatment, the incidence of SBP and the serum biochemical indexes were compared between two groups. SPSS 21.0 statistical software was used for data analysis.Results:After 6 months of treatment, the incidence of SBP in the intervention group(5.81%, 5/86) was significantly lower than that in control group(30.23%, 26/86)( χ2=19.210, P<0.01). The serum 25-(OH)D level in intervention group was significantly higher than that in the control group ( t=13.425, P=0.018), while the levels of CRP, PCT and IL-6 in intervention group were significantly lower than those in control group ( t=17.312, 10.353 and 12.218, P<0.01 or <0.05). Conclusion:Vitamin D adjuvant therapy can increase serum 25-(OH)D level, decrease serum CRP, PCT and IL-6 levels, and effectively reduce the incidence of SBP in patients with decompensated cirrhosis of hepatitis B.

Roles of multidisciplinary team (MDT) in diagnosis and treatment of suspected cases of corona virus disease 2019 (COVID-19) / 浙江大学学报·医学版

OBJECTIVE@#To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of corona virus disease 2019 (COVID-19).@*METHODS@#The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed.@*RESULTS@#Of the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times per case. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged; there was no cross-infection occurred in suspected patients during the hospitalization; there were no deaths and no medical staff infections.@*CONCLUSIONS@#The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved under MDT mode, particularly for complicated and refractory cases.

Roles of multidisciplinary team in diagnosis and treatment of suspected cases of COVID-19 / 浙江大学学报·医学版

OBJECTIVE@#To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of coronavirus disease 2019 (COVID-19).@*METHODS@#The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Municipal Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed.@*RESULTS@#In the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged. There was no cross-infection occurred in suspected patients during the hospitalization. There were no deaths and no medical staff infections.@*CONCLUSIONS@#The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved with MDT, particularly for complicated cases.

The therapeutic effects of interleukin 10 gene-modified bone marrow-derived dendritic cells in a murine model of liver fibrosis / 中华内科杂志

Objective To investigate the therapeutic effects and mechanisms of interleukin-10 (IL-10) gene-modified dendritic cells (DC-IL-10) in mice with liver fibrosis. Methods DC-IL-10 was constructed in vitro, the phenotype and function of which were evaluated by flow cytometry. BALB/c mice were treated with intraperitoneal injection of carbon tetrachloride(CCl4)to establish liver fibrotic model. DC-IL-10 was administrated via tail vein. Animals were divided into 4 groups including normal dendritic cell (DC) control , liver fibrosis only, negative lentiviral transfection DC (DC-mock) and DC-IL-10. Liver function, cytokine secretion, T lymphocyte differentiation and liver histomorphology were tested. Real-time PCR and western blot were used to analyze the effect of DC-IL-10 on Wnt/β-catenin signaling pathway and its role in liver fibrosis. Results When compared with DC control and DC-mock, the expression of DC-IL-10 surface stimulating molecules (major histocompatibity complex-Ⅱ, CD80, CD86) were significantly decreased (F=14.708, 22.503, 12.595, respectively, all P<0.05), and DC-IL-10 significantly inhibited T lymphocyte proliferation (F=50.295, P<0.05). When compared with liver fibrosis group, serum alanine aminotransferase and aspartate transaminase were decreased in DC-IL-10 treated group (all P<0.05), other parameters including inflammatory factors (tumor necrosis factor α, IL-6, IL-1β) reduced (all P<0.05), the proportion of regulatory T cells (Treg) increased (F=6.742, P<0.05), pathological damage improved, the expression of Wnt3a, α-SMA and β-catenin mRNA and protein significantly reduced in DC-IL-10 treatment group(all P<0.001). Conclusions DC-IL-10 induces elevation of Treg for immune tolerance, as well as inhibition of inflammatory response, block of Wnt/β-catenin signaling pathway, which translates into improvement of liver fibrosis.

Study on effect of transforming growth factor-β1 vaccine on insulin-like growth factor binding protein in liver tissues of rats with liver fibrosis / 中华传染病杂志

Objective To observe the effect of transforming growth factor-β1 (TGF-β1) vaccine on the degree of hepatic fibrosis in rats ,and to explore the effect of TGF-β1 vaccine on the insulin-like growth factor binding protein (IGFBP)3 and IGFBP7 .Methods The hepatic fibrosis rat model was set up by injecting N-nitrosodimethylamine . Among them , 10 rats were injected with TGF-β1 vaccine , and additional 10 rats were set up as healthy control group .Changes in hepatic pathology were observe and the expressions of IGFBP3 and IGFBP7 were detected by the methods of immunohistochemistry , reverse transcription polymerase chain reaction (RT-PCR) and Western blot in rat fibrosis tissues after 6 weeks . Normality test and analysis of variance were conducted .LSD test was conducted if variances were tested homogeneity .Categorical data were analyzed using Fisher exact test . Results Changes in hepatic histology and serum levels of hyaluronic acid and laminin suggested that TGF-β1 vaccine interventions could reduce the extent of hepatic fibrosis in rats .The expressions of IGFBP3 mRNA in control group ,hepatic fibrosis model group and vaccine intervention group were 1 .735 ± 0 .097 ,1 .165 ± 0 .096 and 1 .491 ± 0 .046 ,respectively (t= 4 .575 ,6 .285 and 8 .489 ,respectively ,all P< 0 .05) .The expressions of IGFBP7 in the above three groups were 0 .497 ± 0 .021 ,1 .250 ± 0 .064 and 0 .885 ± 0 .149 ,respectively (t= 5 .161 ,30 .101 and 7 .250 , respectively ,all P < 0 .05 ) . Immunohistochemistry proved that the expressions of IGFBP7 in fibrosis model group and TGF-β1 vaccine group were all significantly higher than control group ;and the expressions of IGFBP3 in fibrosis model group and TGF-β1 vaccine group were all significantly lower than control group .The expressions of IGFBP3 protein in control group , hepatic fibrosis model group and vaccine intervention group were 7 .508 ± 0 .357 ,5 .200 ± 0 .210 and 5 .751 ± 0 .178 ,respectively (t = 7 .622 ,6 .180 and 29 .156 , respectively ,all P < 0 .05) . The expressions of IGFBP7 were 1 .176 ± 0 .051 ,1 .735 ± 0 .115 and 1 .428 ± 0 .056 ,respectively (t = 7 .188 ,4 .827 and 8 .649 ,respectively ,all P< 0 .05) .Conclusion TGF-β1 vaccine can affect the expressions of IGFBP3 and IGFBP7 ,which plays an important role in the formation and development of hepatic fibrosis .

Study on expression and significance of hypoxia inducible factor-1α in liver tissues of rats with liver fibrosis / 中华传染病杂志

Objective To observe the expression and significance of hypoxia inducible factor (HIF)-1α,matrix metalloproteinase(MMP)-9 and transforming growth factor(TGF)-β1 in liver tissues of rats with hepatic fibrosis and the effects of TGF-β1 vaccine on the expressions of HIF-1α,MMP-9 and TGF-β1.Methods The hepatic fibrosis rat model was set up by dimethylnitrosamine (DMN).The rat model was injected with TGF-β1 vaccine.The expressions of HIF-1α,MMP-9 and TGF-β1 were detected by immunohistochemistry in rat fibrosis tissues after 6 weeks.Results The expressions of HIF-1α,MMP-9 and TGF-β1 in fibrosis model group and TGF-β1 vaccine group were all significantly higher than control group(P＜0.01),which was positively correlated with the fibrosis degree(r=0.911,0.814 and 0.836,respectively,P＜0.01).However,the expressions of HIF-1α,MMP-9 and TGF-β1 in TGF-β1 vaccine group were all significantly decreased than fibrosis model group (t=2.62,4.03,3.43;P＜0.01).Conclusion During the development of liver fibrosis,HIF-1α promotes the transcriptions and expressions of MMP-9 and TGF-β1.