Efficacy controlled observation on acupuncture and western medicine for gastrointestinal dysmotility in liver cirrhosis / 中国针灸

<p><b>OBJECTIVE</b>To observe the therapeutic effect of acupuncture on gastrointestinal dysmotility in liver cirrhosis.</p><p><b>METHODS</b>Forty cases of gastrointestinal dysmotility in liver cirrhosis were randomized into an acupuncture group and a motilium group, 20 cases in each one. In the acupuncture group, on the basis of the conventional treatment, electroacupuncture was applied at Zusanli (ST 36), Sanyinjiao (SP 6) and Taichong (LR 3) for 30 min, once a day. In the motilium group, on the basis of the conventional treatment, motilium was taken orally 30 min before meals, 10 mg each time, three times a day. The treatment was required for 2 weeks in both groups. The changes in the digestive tract symptom score and liver function Child-Pugh score were observed and the efficacy was assessed.</p><p><b>RESULTS</b>The total effective rate of digestive tract symptoms was 85.0% (17/20) in the acupuncture group and 70.0% (14/20) in the motilium group. The score improvements in abdominal distention, belching and vomiting in the acupuncture group were superior to those in the motilium group (all P < 0.05). In the acupuncture group, the liver function Child-Pugh total score was 8.40 +/- 0.22 before treatment and reduced to 5.36 +/- 0.17 after treatment, in which the scores for ascites, serum bilirubin and albumin were all reduced (all P < 0.05) and the reducing range was increased in tendency with the improvements in digestive tract symptoms. In the motilium group, Child-Pugh score was not changed obviously as compared with that before treatment. CONCLUSION Acupuncture effectively alleviates digestive tract symptoms and improves liver function for the patients of liver cirrhosis, its efficacy on gastrointestinal dysmotility in liver cirrhosis is superior to motilium.</p>

Differential liver histopathological features of chronic HBV infection patients with normal and mildly elevated serum ALT / 中华肝脏病杂志

To study the liver histopathological features that are distinctive between chronic hepatitis B virus (HBV) infection patients who have normal serum alanine aminotransferase (ALT)/asparatate aminotransferase (AST) and those with mildly elevated serum ALT/AST. One-hundred-and-thrity-four chronic HBV infection patients with normal serum ALT/AST and 165 chronic HBV infection patients with mildly elevated serum ALT/AST were included in the study. Liver biopsies were performed and used to assess the histological changes by hematoxylin-eosin and reticular fiber staining; mild to severe scoring for inflammation was made as grade G0-G4 and for fibrosis stage as S0-S4. HBV DNA levels were detected by fluorescent quantitative PCR. HBV serological markers were examined by chemiluminescence. The mildly elevated serum ALT/AST group had more male patients than the normal serum ALT/AST group. In the normal serum ALT/AST group, 50.0% (67/134) of the patients had moderate histological changes and only 3.0% (4/134) had severe changes (G3-4 and/or S3-4). In the mildly elevated ALT/AST group, 65.7% (174/265) of patients had moderate histological changes and 16.2% (43/265) had severe changes (G3-4 and/or S3-4). Hepatic inflammation and fibrosis were significantly more severe in the mildly elevated serum ALT/AST group than in the normal ALT/AST group (x2 = 26.386, P less than 0.01; x2 = 15.299, P less than 0.01). In the normal ALT/AST group, the severity of inflammation and fibrosis were positively correlated with age (rs = 0.620, P less than 0.01; rs = 0.347, P less than 0.01). In the mildly elevated ALT/AST group, the severity of inflammation and fibrosis were negatively correlated with age (rs = -0.807, P less than 0.01; rs = -0.557, P less than 0.01). In both groups, the severity of inflammation and fibrosis were negatively correlated with HBV DNA levels (rs = -0.215, P less than 0.01, rs = -0.527, P less than 0.01, rs = -0.951, P less than 0.01; rs = -0.715, P less than 0.01) and were not positively correlated with HBeAg. The majority of the chronic HBV infection patients with normal serum ALT/AST and those with mildly elevated serum ALT/AST had moderate liver pathological changes. All patients with low HBV DNA levels were closely followed-up, regardless of HBeAg-positive status.

Gene copy number, mRNA transcription and protein expression of PD-1 gene in primary hepatocarcinoma patients / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To study the gene copy number, mRNA transcription and protien expression of programmed cell death 1 (PD-1) gene in primary hepatocellular carcinoma (PHC) patients and normal control individuals (NC) who are anti-HBs positive, and to investigate the variations in PD-1 gene copy numbers and its relationship with PHC.</p><p><b>METHODS</b>Real-time PCR was adopted to detect the PD-1 gene copy numbers and their mRNA expressions in peripheral blood mononuclear cells (PBMCs) from 24 samples of PHC patients and 26 of NC. Protein expression level of PD-1 on CD8+ T was analyzed by flow cytometry.</p><p><b>RESULTS</b>In terms of number of PD-1 gene copy numbers, the percentage of cases of haploid (single) was 34.62% and 4.17% in PHC group and control group respectively while the percentage of cases of diploid (double) was 61.54% and 95.83% respectively. The difference between the two was statistically significant (chi2 = 7.639, P = 0.006). The rate of cases with double PD-1 gene copy numbers was found to be higher in patients with PHC than in control group. It was also found that the average expression of PD-1 mRNA was 2.35E-03 in control group and 1.23E-03 in PHC group. The expression level was significant lower in PHC group than that in control group when compared by using Mann-whitey technic (U = 153, P = 0.009). Furthermore, the frequency of PD-1 protein expression on CD8+ T cells was 3.72 +/- 0.32 in control group and 16.13 +/- 1.68 in PHC group. The level of PD-1 mRNA expression was higher in PHC and significant differences was shown between two groups (t = -7.073, P = 0.000).</p><p><b>CONCLUSIONS</b>Our study suggests that the variation in PD-1 gene copy number may trigger primary hepatocellular carcinoma to HBV carriers. The relationship between the variation of PD-1 gene copy numbers and its association with primary hepatocellular carcinoma is worth further focus.</p>

Reference value of brachial-ankle pulse wave velocity for the eastern Chinese population and potential influencing factors

The present study was conducted to obtain reference values for brachial-ankle pulse wave velocity (baPWV) and to evaluate influencing factors of baPWV according to gender. Using automatic devices, baPWV was measured simultaneously in 2095 subjects. A total of 647 healthy subjects, none of whom presented atherosclerotic risk factors, were analyzed in the present study. Two different statistical methods were used to obtain reference values for baPWV according to subject gender and age. The association between baPWV value and gender, as well as other features, were analyzed. For male subjects, multiple stepwise analysis showed that age, systolic blood pressure (SBP), heart rate (HR), and plasma levels of triglycerides (TG) were independent predictors of baPWV. For female subjects, age, SBP, HR, and plasma levels of uric acid (UA) were independent predictors of baPWV. In male subjects, the upper limits of baPWV values were 1497.43/1425.00, 1518.67/1513.25, 1715.97/1726.50, 1925.20/1971.90, and 2310.18/2115.00 cm/s, obtained using two different statistical methods for the age ranges of 30-39, 40-49, 50-59, 60-69, and 70 and older, respectively. For females, the upper limits of baPWV values were 1426.70/1411.13, 1559.15/1498.95, 1733.50/1739.00, 1958.63/1973.78, and 2720.80/2577.00 cm/s for the age ranges of 30-39, 40-49, 50-59, 60-69, and 70 and older, respectively. Aging is the most important influencing factor for baPWV value and its effect is more prominent in females. The reference values of baPWV according to age and gender may be useful for the clinical diagnosis and preventive therapy of cardiovascular diseases.

Risk factors for cerebral microbleeds and its effect on cognitive function in patients with ischemic cerebrovascular disease / 中国脑血管病杂志

Objectives: To investigate the occurrence and risk factors of cerebral microbleeds on the cognitive function in patients with ischemic cerebrovascular disease and to investigate the effect of cerebral microbleeds on the cognitive function in patients with ischemic cerebrovascular disease. Methods: A total of 160 patients with ischemic cerebrovascular disease were divided into cerebral microbleed group (n =30) and control group (n = 130) according to MR T2 *-weighted gradient echo sequences. The demographic data of the patients, conventional risk factors, sites of microbleed, types of cerebral infarction, severity of white matter changes, and numbers of lacunar infarction were recorded in detail. The Montreal Cognitive Assessment was conducted in both groups. All the data were processed using SPSS 16.0 software. Results: Circled digit oneThe mean age of the microbleed group was older than that in the non-microbleed group (75 ±9 vs. 66 ±6, P = 0.000) ; the degree of white matter changes was higher (6.7 ±2.4 vs. 3.5 ±1. 8, P =0.003) ; and the numbers of lacunar infarction were larger (5.0 ±2. 3 vs. 2. 1 ±1.3, P= 0.000). Circled digit twoThe logistic regression analysis showed that the high blood cholesterol, the degree of white matter change ( WMC ) , and the numbers of lacunar infarction were the independent risk factors for CMB (OR =3. 880, 95% CI:0. 086 -0. 994; OR = 11.735, 95% CI; 1.340 -2.930; OR = 10. 160, 95% CI: 1.241 -2.475). Circled digit threeThere was no significant difference in the cognitive function scores between the two groups ( P > 0. 05 ). Circled digit fourThere was significant difference in the executive ability between the two groups (P =0.010). Conclusions: Circled digit oneCerebral microbleeds are closely associated with leukoaraiosis and lacunar infarction; Circled digit twothe patients with ischemic cerebrovascular disease accompanied by microbleeds has obvious executive dysfunction ; Circled digit threecontrolling the risk factors for microbleeds has a certain role for the control of the occurrence and development of cognitive impairment in patients with ischemic cerebrovascular disease.

Study on the copy numbers and mRNA expression levels of the programmed death-1 gene in chronic hepatitis B patients / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the copy numbers and mRNA expression levels of the Programmed Death-1 gene in chronic hepatitis B patients and to analyze the differences of the copy numbers and mRNA expression levels of the gene in patients with different clinical outcomes.</p><p><b>METHODS</b>Real time PCR was adopted to detect the PD-1 gene copy numbers and their mRNA expressions in peripheral blood mononuclear cells (PBMCs) from 27 samples from healthy donors in Control group, 31 samples from chronic asymptomatic HBV carriers (ASC, n=31), 19 samples from chronic severe hepatitis B patients (CSH, n=19) and 29 samples from Primary hepatitis B Virus-related hepatocarcinoma (PHC, n=29). The differences and relationship of copy numbers and their mRNA expression levels among those groups were compared and analyzed by adopting Chi-square test and Rank sum test.</p><p><b>RESULTS</b>PD-1 gene copy number deviated from 0 copy to 3 copies among all the 106 samples. In control group, ASC group, CSH group and PHC group, the percentages of cases of haploid (single) were 37.0%, 35.5%, 26.3% and 6.9%, respectively, the percentages of cases of diploid (double) were 55.5%, 58.0%, 63.2% and 82.8%, respectively, and the percentages of cases of triploid (triple) were 3.7%, 6.5%, 10.5% and 10.3%, respectively. The percentage of cases of polyploid (diploid and triploid) in control group, ASC group, CSH group and PHC group were 59.3%, 64.5%, 73.7% and 93.1%, respectively. The different distribution of PD-1 gene copy number of polyploid was significant in total samples (x2=9.583, P<0.05). Compared with Control Group and ASC group, the percentage of cases of polyploid in PHC group was lower with the x2 equals to 8.985 and 7.215 respectively and both with P less than 0.05. The difference between the two groups was statistically significant. The mean PD-1 gene copy numbers for these four groups were 1.59+/-0.63, 1.70+/-0.52, 1.84+/-0.60 and 2.00+/-0.37 while the median were 0.002 54, 0.002 72, 0.002 55 and 0.001 33 respectively. Except the control group, there was a uptrend in the other three groups while PD-1 gene mRNA expression presented a downtrend. The mean of PD-1 gene copy numbers of 2 and their mRNA expression levels were 19.59, 32.57 and 33.22 for PHC, CSH and ASC groups among which PHC group had the lowest value, there was significant differences found in the comparison with F=5.395 and P<0.05.</p><p><b>CONCLUSION</b>PD-1 gene copy numbers and their mRNA expression levels were different in chronic HBV infected patients with different transformation. It is valuable to follow up the patients with more than 1 copy number of PD-1 gene in long term.</p>

Relationship between liver pathological characteristics and serum HBeAg and HBV DNA in 1057 patients with chronic hepatitis B / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To study the relationship between liver pathological changes and serum HBeAg and HBV DNA in 1057 patients with chronic hepatitis B.</p><p><b>METHODS</b>Liver puncture biopsy for histopathological examinations were performed in 1057 patients with chronic hepatitis B. The quantitative analysis of serum HBV DNA by fluorogenic quantitative PCR and HBeAg by chemoluminescence were also conducted.</p><p><b>RESULTS</b>The inflammatory grade and fibrosis stage were higher in HBeAg-negative patients (G4 and S4 were 7.83% and 12.17% respectively) than in HBeAg-positive patients (G4 and S4 were 3.39% and 5.44% respectively). The inflammatory grade and fibrosis stage were higher in HBeAg-positive patients with low-level HBV DNA (G3G4 was 45.64% and S3S4 was 30.20% for HBV DNA104-105), whereas they were higher in HBeAg-negative patients with high-level HBV DNA (G3G4 was 54.55% for HBV DNA106-107 and S3S4 was 42.85% for HBV DNA108-109).</p><p><b>CONCLUSION</b>There were some correlation between the liver pathological changes and serum HBeAg and HBV DNA levels in patients with chronic hepatitis B. It is important to perform the liver pathological examination and antiviral therapy as early as possible in patients with HBeAg-negative chronic hepatitis B.</p>

Liver histopathological features of chronic HBV carriers and inactive HBsAg carriers / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the liver histopathological features of chronic HBV carriers and inactive HBsAg carriers.</p><p><b>METHODS</b>Liver biopsies were performed on 189 chronic HBV carriers and 30 inactive HBsAg carriers (219 cases in total). All of them had a normal serum ALT value; they were then followed-up for more than 6 months. HBsAg and HBcAg were detected by immunohistochemistry. The circulating HBV DNA loads and serologic markers of HBV were examined at the same time. Grades of liver necrosis/inflammation and fibrosis were compared between the patients regarding their HBV DNA positivity or negativity. The relationships between the HBeAg positivity and degrees of liver histological changes were evaluated. The grades of liver necrosis/inflammation and fibrosis were compared between three age groups: younger than 18 years, 18-40, and older than 40 years.</p><p><b>RESULTS</b>Two hundred eight carriers of the total 219 (95.0%) had histological liver changes. Fifty percent (104/208) of them had mild histological changes (G0-1/S0-1), while more severe changes (G3-4 and/or S3-4) were found in 18 out of the 208. There were no significant differences in the grades of liver necrosis/inflammation and fibrosis between the chronic HBV carriers and the inactive HBsAg carriers. Among the serologic HBV DNA positive carriers, hepatic fibrosis was more severe in the HBeAg negative group than in the positive group (chi2 = 9.551, P = 0.008), but no differences of the necrosis/inflammation grades were seen between the two groups. The rate of severe fibrosis (S3-4) was 21.1% in those carriers older than 40 years but was 7.7% in patients younger than 18 years. However, no statistically significant differences in degrees of liver inflammation and fibrosis were found among the three age groups. HBcAg positive rate was 100% in the liver tissues of all the chronic HBV carriers, but only in 33.3% in the inactive HBsAg carriers.</p><p><b>CONCLUSIONS</b>The majority of our HBV carriers have liver inflammation and fibrosis. More severe histological changes were found in 8.65% of them. Liver fibrosis existed in the carriers with negative HBeAg and in those older than 40 years. HBcAg was found in hepatic tissues while their serological HBV DNA was negative.</p>

Clinical trial of sequential antiviral therapy for patients with chronic hepatitis B in China / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To establish a sequential antiviral regime and evaluate its efficacy in patients with chronic hepatitis B using a controlled trial.</p><p><b>METHODS</b>Seventy-four patients with chronic hepatitis B were divided into 3 groups: 30 cases were enrolled in the sequential antiviral group in which patients received eight-week treatment with thymosin alpha1 (1.6 mg/time, subcutaneous injection, 2 times/week), six-month treatment with interferon (500 MU/ times, muscle inject, every other day) begun in the fifth week of the therapeutic course, and lamivudine treatment (100 mg/days) begun 2 months later after HBeAg seroconversion or just after the withdrawal of interferon to more than eighteen months. Fourteen cases were enrolled in combination group in which patients received six-month treatment with interferon and thymosin alpha1 simultaneously in the same manner as in sequential antiviral group. Thirty cases were enrolled in lamivudine group in which patients received more than eighteen-month treatment with lamivudine.</p><p><b>RESULTS</b>The temporary rates of HBeAg seroconversion and normalization of alanine aminotransferase (effective rate) in sequential antiviral group, combination group and lamivudine group were 76.7%, 78.6% and 13.3%, respectively. The effective rates of sequential group and combination group were very similar, and significantly higher than that of lamivudine group (P less than 0.01). Long-term efficacy rates were 76.7%, 57.1% and 16.7% among the three groups, respectively. The long-term effective rate of sequential group was relatively higher. The rate of liver damage sensitive period in sequential antiviral group and combination group was 47.7%. The time of onset was from 2 to 8 weeks after the treatment begun, earlier than that from 6 to 8 weeks after the beginning of interferon alone in the literature.</p><p><b>CONCLUSION</b>Sequential antiviral therapy had much higher rates of long-term HBeAg seroconversion, undetectable HBV DNA and normalization of alanine aminotransferase with good cost-effectiveness. Its mechanism to promote the antiviral effect might be dependent on the immunoregulatory action of thymosin alpha1 in the earlier period and the specific inhibition of HBV DNA replication by lamivudine in the later period of the therapeutic course.</p>