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Objective:To investigate the prognostic value of systemic immune-inflammation index (SII) in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods:The clinical data, including age, gender, complications, laboratory examination results post-admission, SII, model for end-stage liver disease (MELD) score, MELD-Na score, Child-Turcotte Pugh (CTP) score of HBV-ACLF patients treated in Huashan Hospital, Fudan University from January 2016 to August 2021 were retrospectively analyzed. The patients were divided into survival group and death group according to the outcome at 90 days of follow-up.Paired sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis.Pearson correlation was used to analyze the correlation between SII and the prognosis prediction model of HBV-ACLF. The area under the curve (AUC) was used to analyze the clinical efficacies of SII, MELD score, MELD-Na score and CTP score in predicting the prognosis of HBV-ACLF patients, and the optimal cut-off value of SII for predicting the prognosis of HBV-ACLF was calculated. Kaplan-Meier method was used for survival analysis. Results:A total of 140 patients with HBV-ACLF were included. There were 88 patients in the survival group, including 65 males and 23 females, with the age of (47.69±11.96) years. There were 52 cases in the death group, including 40 males and 12 females, with the age of (52.73±12.22) years. The age, aspartate aminotransferase, total bilirubin, serum creatinine, international normalized ratio, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, SII, MELD score, MELD-Na score, CTP score and the incidence of infection in the death group were all significantly higher than those in the survival group, and albumin, lymphocyte count, platelet count, prognostic nutritional index in the death group were all significantly lower than those in the survival group, and the differences were all statistically significant ( t=-2.39, Z=-2.84, t=-4.81, Z=-2.15, Z=-4.91, Z=-3.47, Z=-3.36, Z=-3.83, Z=-4.69, Z=-4.56, Z=-6.31, χ2=24.96, t=3.06, t=3.03, Z=-7.57 and t=4.12, respectively, all P<0.05). Pearson correlation analysis showed that SII was positively correlated with CTP score ( r=0.272 7, P=0.001), MELD score ( r=0.365 8, P<0.001) and MELD-Na score ( r=0.381 1, P<0.001). The AUC of SII was the largest of 0.80, and 0.76 for MELD score, 0.74 for MELD-Na score and 0.73 for CTP score. The optimal cut-off value of SII was 447.49. Kaplan-Meier analysis showed that the 90 days survival rate of patients with SII≥447.49(38.60%(22/57)) was lower than that of SII<447.49 group (79.52%(66/83)), and the difference between the two groups was significant ( χ2=23.80, P<0.001). Conclusions:SII can be used to assess the severity and prognosis of HBV-ACLF patients. SII ≥447.49 indicates poor prognosis.
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The risk of graft loss is relatively high in early stages after pancreatic transplantation so that some patients are placed back on a waiting list for pancreatic transplantation. This review summarized the experiences of two recipients of pancreatic re-transplantation after simultaneous pancreas-kidney transplantation. Both patients could successfully discontinue insulin dosing, blood sugar levels were maintained at a normal level and function of kidney graft improved obviously as compared to pre-transplant levels.
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The First World Consensus Conference on Pancreas Transplantation was initially formulated in 2019 and formally promulgated in 2021.It was composed of 49 jury deliberations regarding the effects of pancreas transplantation on the treatment of diabetics and 110 expert consensus opinions for practicing pancreas transplantation in terms of donor/recipient selections, immunosuppressant regimens, surgical techniques and post-transplant prophylactic strategies.The tenet of this consensus conference is that all types of pancreas transplantation could improve long-term patient survival, the quality-of-life of recipients and optimize the course of chronic complications of diabetes.This review attempted to further interpret the guidelines to improve clinical practicability.
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Objective:To investigate the expression of the zinc finger protein 18 (ZNF18) in the pancreatic ductal adenocarcinoma (PDAC) tissue and analyze its relationship with the clinicopathological features and prognosis.Methods:Cancer tissue specimens from 131 patients with PDAC who were surgically resected and pathologically confirmed at First Affiliated Hospital of Naval Medical University from March 2017 to December 2019 were collected. ZNF18 protein expression in cancer tissue was detected by immunohistochemical staining, and high and low ZNF18 expression groups were divided based on the expression level of ZNF18. . Kaplan-Meier method and Log-Rank test were used to analyze the relationship between ZNF18 expression level and overall survival rate of PDAC patients. Furthermore, the correlation between ZNF18 protein expression level and clinicopathological features was analyzed, and the Cox regression hazards model was applied for the univariate and multivariate analysis of the factors affecting the prognosis of PDAC patients.Results:82 of 131(62.60%) PDAC tissues had high ZNF18 expression, and 49(37.40%) PDAC tissues had low ZNF18 expression; the survival time in the high ZNF18 expression group was significantly higher than that in the low ZNF18 expression group (21.53±0.69 months vs 12.17±1.57 months), and the difference was statistically significant( P<0.001). Low ZNF18 expression in PDAC was associated with lymph node metastasis( P<0.05), but was not correlated with gender, age, tumor location, tumor volume, differentiation degree, TNM stage, nerve invasion, and vascular cancer thrombus. The results of the univariate analysis showed that tumor differentiation degree, TNM stage, lymph node metastasis, and ZNF18 expression were all associated with the prognosis of PDAC patients. The results of the multivariate analysis showed that tumor differentiation degree( HR=0.463, 95% CI 0.279-0.769, P=0.003), lymph node metastasis( HR=2.062, 95% CI 1.247-3.409, P=0.005), and ZNF18 expression( HR=0.416, 95% CI 0.255-0.676, P<0.001) were independent risk factors affecting the prognosis of patients with PDAC. Conclusions:Low ZNF18 expression in PDAC tissues was closely associated with lymph node metastasis and poor prognosis. ZNF18 can be used as an important molecular marker to evaluate the prognostic survival of PDAC patients.
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Objective:To investigate the clinical characteristics and prognosis of Epstein-Barr virus-related diseases in adults.Methods:The clinical data of 59 patients with Epstein-Barr virus-related diseases in Huashan Hospital, Fudan University, Shanghai from January 2017 to August 2019 were analyzed retrospectively. The clinical manifestations of patients with infectious mononucleosis (IM), chronic active Epstein-Barr virus infection (CAEBV) and lymphoma in patients were compared. Patients were divided into acute course group (IM) and chronic course group (CAEBV+ lymphoma), and the results of labratory indications (blood rontine, liver function, imflammatory indications, Epstein-Barr virus DNA, Epstein-Barr virus antibody and T lymphocyte) were compared between two groups. Statistical analysis was performed by Mann-Whitney U test, chi-square test or Fisher exact probability test. Results:Among the 59 patients, 23 cases (39.0%) were diagnosed with IM, 23 cases (39.0%) were lymphoma and 13 cases (22.0%) were CAEBV. The clinical manifestations of patients with Epstein-Barr virus-related diseases were fever (57/59, 96.6%), lymphadenopathy (37/59, 62.7%) and splenomegaly (36/59, 61.0%). There were 17 patients in the chronic course group experienced hemophagocytic lymphohistiocytosis (HLH). The white blood cell counts, hemoglobin levels and platelet counts of patients in the chronic course group (4.07(1.94, 8.35)×10 9/L, 89.5(74.5, 108.0) g/L and 100(37, 161)×10 9/L, respectively) were all lower than those in the acute course group (9.91(6.75, 17.38)×10 9/L, 132.5(118.2, 152.0) g/L and 197(129, 233)×10 9/L, respectively), with statistically significant differences ( U=3.69, 5.22 and 3.61, respectively, all P<0.01). The levels of procalcitonin, C-reactive protein and serum ferritin in the chronic course group (0.45(0.15, 1.13) μg/L, 47.75(17.57, 84.67) mg/L and 2 000(682, 2 002) μg/L, respectively) were all higher than those in the acute course group (0.12(0.07, 0.28) μg/L, 6.39(3.13, 11.38) mg/L and 482(159, 1 271) μg/L, respectively), with statistically significant differences ( U=-2.95, -3.77 and -4.16, respectively, all P<0.01). The counts of CD4 + T lymphocytes, CD8 + T lymphocytes, CD19 + B lymphocytes and natural killer cells in the chronic course group (259.15(101.98, 509.26), 214.69(119.31, 529.47), 46.14(4.44, 135.87) and 81.09(41.53, 118.46)/μL, respectively) were all lower than those in the acute course group (738.88(592.20, 893.94), 1 609.17(920.88, 3 952.34), 144.52(83.65, 215.14) and 309.82(123.78, 590.68)/μL, respectively), with statistically significant differences ( U=3.66, 3.80, 2.90 and 3.40, respectively, all P<0.01), while the CD4 + /CD8 + T lymphocytes ratio in the chronic course group was higher (0.90(0.60, 1.70) vs 0.45(0.10, 1.28))( U=-2.29, P=0.02). Twenty-three patients with IM were all cured, while 10 patients with lymphoma died and 13 received chemotherapy. Seven patients with CAEBV died and six improved. Conclusions:The clinical characteristics of Epstein-Barr virus-related diseases in adults are fever, lymphadenectasis, splenomegaly.Chronic Epstein-Barr virus infection may be associated with HLH. The prognosis of adults with acute Epstein-Barr virus infection is good, while that of long-term chronic Epstein-Barr virus infection is poor.
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Objective:To investigate the clinical characteristics and prognosis of cytomegalovirus (CMV) reactivation in patients with liver failure.Methods:A total of 75 patients diagnosed with liver failure and tested for serum CMV DNA between January 2016 and June 2019 in Huashan Hospital, Fudan University were retrospectively analyzed. According to the CMV DNA test results, the patients were divided into CMV DNA positive group and CMV DNA negative group. The classification of liver failure, the use of glucocorticoids, the proportions of T lymphocyte subsets of the two groups were compared and the prognosis was evaluated. Mann-Whitney U test and chi-square test were used to analyze the data. Results:Of the 75 patients with liver failure, 17 were CMV DNA positive and 58 were CMV DNA negative. Among the 17 CMV DNA positive patients, nine were acute (subacute) liver failure, and 13 were treated with glucocorticoids, which were all significantly higher than those in the CMV negative group (20.7%(12/58) and 20.7%(12/58), respectively). The differences were both statistically significant ( χ2=6.70 and 18.40, respectively, both P<0.05). The proportions of CD3 + T lymphocytes and CD8 + T lymphocytes in the CMV DNA positive group were both higher than those in the CMV DNA negative group, and the proportions of CD4 + T lymphocytes, the ratio of CD4 + /CD8 + T lymphocytes and the proportion of B lymphocytes were all lower than those in the CMV DNA negative group. The differences were all statistically significant ( U=274.50, 165.50, 273.00, 185.00 and 189.00, respectively, all P<0.05). Acute (subacute) liver failure (odds ratio ( OR)=4.3, 95% confidence interval ( CI) 1.3-12.6) and glucocorticoid use ( OR=12.5, 95% CI 3.4-38.3) were risk factors for CMV reactivation in patients with liver failure. The disease improvement rate in the CMV DNA negative group was 56.9% (33/58), and five out of 17 patients improved in the CMV DNA positive group, with a statistically significant difference ( χ2=1.99, P=0.04). Conclusions:The use of glucocorticoids increases the risk of CMV reactivation in patients with liver failure, and CMV reactivation in patients with liver failure presents immune disorders which seriously affect their prognosis. Therefore, it is important to pay attention to CMV DNA monitoring in patients with liver failure using glucocorticoids.
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Objective:To investigate the clinical characteristics and prognosis of the patients with nocardiosis.Methods:From January 2013 to July 2019, 44 patients with nocardiosis in Department of Infectious Diseases, Huashan Hospital, Fudan University in Shanghai were enrolled, and their clinical data were retrospectively analyzed, including baseline characteristics, clinical manifestations, underlying diseases history of glucocorticoid therapy, laboratory data (blood routine examination, procalcitonin, C-reactive protein, lymphocytes subsets, etc.), imaging changes, bacterial strain identification, treatment regimens and outcomes. According to the locations of infection, patients were divided into pulmonary nocardiosis, extrapulmonary single-organ nocardiosis and disseminated nocardiosis. The Mann-Whitney U test was used for comparison between two groups, and the Kruskal-Wallis H test was used for comparison among multiple groups. Results:Among the 44 cases of nocardiosis, 14 cases were pulmonary nocardiosis, 17 cases were extrapulmonary single-organ nocardiosis (including nine cases with central nervous system infection, six cases with skin and soft tissue infection, one case with abdominal abscess and one case with urinary tract infection) and 13 cases were disseminated nocardiosis (including four cases with bloodstream infection, six cases with central nervous system and lung or skin and soft tissue infection, three cases of lung and skin and soft tissue infection). Thirty-four cases had underlying diseases, and 27 cases received glucocorticoid or immunosuppressant treatment. The main symptom of 11 patients in pulmonary nocardiosis group was productive cough, while that of the patients in other two groups was fever. Nocardia species were mainly Nocardia brasiliensis, Nocardia nova and Nocardia farcinicaia. The white blood cell counts and neutrophils proportion were normal or slightly increased in 42 cases, and the platelets were normal or slightly decreased in 41 cases. Erythrocyte sedimentation rate increased in 19 cases, procalcitonin increased in 21 cases, C-reactive protein increased in 34 cases, and ferritin increased in 18 cases. A total of 34 patients were tested for lymphocyte subsets, of which 15 had CD4 + T lymphocytes decreased, 14 had CD8 + T lymphocytes increased, seven had B lymphocytes increased, seven had B lymphocytes decreased, and eight had natural killer cells decreased. The hemoglobin of patients with pulmonary nocardiosis was higher than that of patients with extrapulmonary infection, and the difference was statistically significant ( U=0.095, P=0.025). The imaging manifestations were mainly abscess and inflammatory exudation. Forty cases were cured or improved, one case was still on treatment, and three cases died. Conclusions:The clinical manifestations of nocardiosis involving various organs are non-specific. Standardized treatment could reduce the mortality of nocardiosis.
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Large pathological sections can display tumors and the para-tumor tissues holistically and completely on one slice, which is beneficial to the whole observation and evaluation of tumors and their surrounding microenvironments, thus gaining a comprehensive understanding about the disease. With the gradual realization of digital pathology and advancement in computational pathology, artificial intelligence has made it possible to achieve accurate and individualized diagnosis and treatment of pancreatic tumors by linking up morphologies of different tumor cells and surrounding microenvironments with various types of data including image omics, gene proteomics and clinical data, which is both an opportunity and a challenge for Chinese researchers.
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Objective To investigate the clinicopathological features of undifferentiated pancreatic carcinoma with osteoclast-like giant cells (UOC).Methods Clinical and pathological data of 6 patients with UOC admitted in Navy Medical University affiliated Changhai Hospital from April 2011 to December 2017 were retrospectively analyzed.The expressions of Cam5.2,EMA,CD68,vimentin,lysozyme,E-cad,C-erbB-2,p53,MUC1,MLH1,MSH2,MSH6,Osteoponin and Ki-67 were detected by immunohistochemistry,and Kras gene mutations was measured by fluorescence quantitative PCR method.Results There were two main types of UOC cells.One type was oval or spindle mononuclear tumor cells,and the other was osteoclast-like giant cells scattered among mononuclear cells.Immunohistochemical staining results showed that the epithelial markers like CAM5.2,EMA,E-cad,MLH1,MSH2,MSH6 and Ki-67 of the components of ductal adenocarcinoma in 6 UOC patients were all positively expressed,and the mesenchymal markers like vimentin,CD68,lysozyme and tumor-related markers like Her-2,p53 and MUC1 were all negatively expressed.Vimentin,CD68,lysozyme and Osteoponin were positively expressed in osteoclast-like giant cells,but epithelial markers like Cam5.2,EMA,E-cad,MLH1,MSH2 and MSH6 were negatively expressed.6 UOC patients all had K-ras codon 12 mutation,and the mutant type was GGT ＞ TGT,GGT ＞ GTT,GGT ＞ GCT,and no codon 13 mutation was observed.Conclusions Osteoclast-like giant cells may be reactive multinucleated giant cells rather than neoplastic components.
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Objective To compare the short-term mortality of acute-on-chronic liver failure (ACLF) in patients with chronic hepatitis B following lamivudine versus entecavir antiviral treatment. Methods All chronic hepatitis B patients associated with ACLF were included in this analysis if they were treated with lamivudine or entecavirat the Department of Infectious Diseases, Huashan Hospital, Fudan University, from August 2010 to August 2016. Results A total of 56 patients were included (36 in lamivudine group and 20 in entecavir group). The 7-day, 14-day and 28-day survival rate was 94％, 72％ and 64％ in lamivudine group, and 70％, 65％ and 65％ in entecavir group. Lamivudine group showed significantly lower 7-day mortality than entecavir group, but no significant difference in 14-day and 28-day mortality. Subgroup analysis did not show significant difference in 28-day mortality between the two groups either in model for end-stage liver disease (MELD)≤30 patients or in ACLF grade 0-1 patients. Lamivudine treatment was associated with significantly lower 7-day mortality than entecavir in cirrhosis patients, but no significant difference in 14-day and 28-day mortality. Conclusions Lamivudine treatment is associated with significantly higher 7-day survival rate than entecavir. However, the short-term (within 28 days) mortality of acute on chronic liver failure in chronic hepatitis B patients is similar between lamivudine and entecavir treatment. Lamivudine is also appropriate for the patients with cirrhosis or waiting for liver transplantation.
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Pancreatic cancer (PC) is to blame for the digestive system tumor.Radiology and pathology are vital to PC during the course of diagnosis,treatment and deepening the knowledge of the nature.How to further develop the maximum value of radiology and pathology? In this paper,authors made a systematic and comprehensive exposition on the current diagnosis of PC,challenges and future development in radiology and pathology combined with the current work of PC.
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Objective@#To establish a Cryptococcus neoformans murine pneumonia combined with meningitis model by otoscope guiding intubation method.@*Methods@#Twenty male C57BL/C mice were randomized into two groups, including control group and infection group, with 10 mice in each group. On the experiment day, the mice were intubated by otoscope guiding. The mice in infection group were inoculated with 10 μL of fresh Cryptococcus neoformans suspension through endotracheal tube, while the mice in control group were inoculated with 10 μL of sterile saline. The general conditions were observed and the body masses were measured at 0 h, day 3, day 5, day 7 and day 10 after inoculation in each group. Three mice in each group were sacrificed at 0 h and the rest were sacrificed at day 10. The lungs, livers, spleen and brains from each mouse were aseptically collected for quantitative culture and histopathology to confirm the successful establishment of mouse model.@*Results@#Ten mice were all successfully intubated by otoscope guiding and none of the mice was dead. The concentration of inoculated bacterial solution was 2.0×109 colony-forming units (CFU)/mL. The mice were sacrificed at 0h after incubation and the lungs were collected. The pulmonary bacterial culture at baseline (0 h) was (7.84±0.13) lg CFU/g lung. No mice was dead in two groups from 0 h to day 10. The average pulmonary bacterial load in lung was (8.11±0.81) lg CFU/g at day 10, which increased 16 times comparing with baseline. The average cerebral bacterial load in brain was (4.84±0.21) lg CFU/g at day 10. The histopathologic changes in lung showed lots of Cryptococcus neoformans which invaded in the bronchi, alveoli and alveolar space. The pathology in brain showed focal Cryptococcus neoformans invasion.@*Conclusions@#Establishment of Cryptococcus neoformans murine pneumonia and meningitis model using otoscope guiding intubation method is successful. This method has the advantages of easy operation and high successful rate.
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Objective To analyze the application of clinicopathological features and LEF-1 in the diagnosis of solid pseudopapillary neoplasm of the pancreas (SPN).Methods Clinical and pathological data of 227 cases who were pathologically diagnosed as pancreatic SPN at Changhai Hospital from Jan 2000 to Dec 2015 were collected and analyzed.Immunochemical assay was used to detect the expression of LEF-1 in 132 cases of SPN, and the results were compared with β-catenin, which is most commonly used for diagnosing SPN.Results 81.9% of patients with SPN were female (186/227).Mean age at the onset was 34 years.Mean tumor size was 5.4 cm.48.5% tumors were localized in the pancreatic tail, and 33% in the head.46.3% tumors were cystic and solid, 42.3% were solid, and 11.4% were cystic.There were 2 cases of lymph node metastasis (0.9%), 15 cases of vascular tumor thrombus (6.6%), 14 cases of nerve invasion (6.2%), and 13 cases of adjacent organs invasion (5.7%) based on microscopic observations.Immunochemical analysis showed that 130 of 132 cases with SPN expressed LEF-1 with strong nuclear positivity, and the positivity rate was 98.5%.But no obvious expression of LEF-1 can be seen in normal pancreatic tissue and other pancreatic tumors.The specificity was 100%.The positivity of β-catenin expression in SPN was 96.6%(144/149), and β-catenin was positively expressed in only one case of acinar cell carcinoma.Tumors were completely removed by surgery in 165 cases, and the median follow-up was 51 months.By Oct 31, 2016, 162 patients (98.2%) survived, 5 had liver metastasis, and 1 had recurrence.Conclusions SPN is predominantly encountered in young female patients, and the clinical manifestations are not specific.LEF-1 can be used as a specific marker for the diagnosis and differentiation of SPN, which is more accurate than β-catenin.
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Objective To study interleukin-23 (IL-23) levels in serum and dendritic cells of acute-on-chronic liver failure (ACLF) patients with chronic hepatitis B (CHB) and to explore its relationship with the prognosis.Methods Peripheral blood mononuclear cells and serum were collected from 40 ACLF patients with CHB (including survival group 27 cases and non-survival group 13 cases) and 26 healthy controls.Monocytes were induced to immature dendritic cell in vitro and TNF-α was added to induce dendritic cell maturation.IL-23 mRNA of dendritic cells was detected by real time polymerase chain reaction (PCR), and serum IL-23 level was measured by enzyme-linked immuno sorbent assay (ELISA).Differences among the parameters with normal distribution were compared using t test, those with non-normal distribution were compared using non-parametric Mann-Whitney U-test, and the relationship between two variables was assessed by Spearman′s rank correlation.Results International normalized rate (INR) and model for end-stage liver disense (MELD) scores in non-survival group of ACLF were higher than those in survival group (INR: 2.32 vs 1.64, U=69.00, P=0.002 2;MELD:36 vs 30, U=64.50, P=0.001 4).However, there were no significant differences between two groups at gender, age, alanin aminotransferase (ALT), aspartate aminotrans ferase (AST), bilirubin, creatinine, hepatitis B virus (HBV) DNA, hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg) and serum IL-23.IL-23 mRNA level in dendritic cells at baseline in non-survival group of ACLF was significantly higher than that in survival group (76 vs 43, U=71.50, P=0.002 8).After treatment, serum IL-23 was significantly declined in survival group ([160±75] ng/L vs [91±49] ng/L, t=4.012, P=0.000 2), but not in non-survival group.Significant positive correlation was observed between IL-23 mRNA level in dendritic cells and MELD score at baseline (r=0.7198,P<0.01).Conclusions Persistent high serum IL-23 level suggests poor prognosis in ACLF patients with CHB.IL-23 mRNA expression in dendritic cells has good consistency with MELD score and the patients with high IL-23 mRNA expression has poor outcome.
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Objective To investigate the correlativity between elasticity modulus and pathological severity in chronic pancreatitis (CP).Methods Twenty-one pigs were divided randomly into experimental group (n=18) and control group (n=3) using random number method.The main pancreatic duct (MPD) was incompletely ligated to establish the CP model.In control group, MPD was not ligated.The animals were killed in batches at 4th, 8th and 12th week after surgery.The pancreatic tissue was taken for elasticity modulus test and pathological examination, and the pigs were classified into control, mild, moderate and severe groups based on the severity of fibrosis.Cell density, fat infiltration and extracellular edema were observed and classified into mild and severe.The difference of elasticity modulus among different groups were compared by Variance analysis, the correlation between pancreatic fibrosis and elastic modulus was analyzed with Spearman correlation analysis, and ROC curve was used to evaluate its efficacy of diagnosing CP.Results Sixteen CP models were established successfully expected for 2 deaths (mild, n=7;moderate, n=2 and severe, n=7).All of the control group (n=3) showed normal pancreas.The elasticity modulus of control, mild and moderate to severe group were 0.4268±0.0566, 0.3203±0.0518 and 0.2235±0.0685, respectively.The difference between the groups was statistically significant (F=13.658,P0.05).Conclusions The elasticity modulus can be used to detect the pathological changes of CP, and evaluate the CP pathologic grades.
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BACKGROUND/AIMS: To investigate the role of selected serum microRNA (miRNA) levels as potential noninvasive biomarkers for differentiating S0–S2 (early fibrosis) from S3–S4 (late fibrosis) in patients with a chronic hepatitis B virus (HBV) infection. METHODS: One hundred twenty-three treatment-naive patients with a chronic HBV infection who underwent a liver biopsy were enrolled in this study. The levels of selected miRNAs were measured using a real-time quantitative polymerase chain reaction assay. A logistic regression analysis was performed to assess factors associated with fibrosis progression. Receiver operating characteristic (ROC) curve and discriminant analyses validated these the ability of these predicted variables to discriminate S0–S2 from S3–S4. RESULTS: Serum miR-29, miR-143, miR-223, miR-21, and miR-374 levels were significantly downregulated as fibrosis progressed from S0–S2 to S3–S4 (p < 0.05), but not miR-16. The multivariate logistic regression analysis identified a panel of three miRNAs and platelets that were associated with a high diagnostic accuracy in discriminating S0–S2 from S3–S4, with an area under the curve of 0.936. CONCLUSIONS: The levels of the studied miRNAs, with the exception of miR-16, varied with fibrosis progression. A panel was identified that was capable of discriminating S0–S2 from S3–S4, indicating that serum miRNA levels could serve as a potential noninvasive biomarker of fibrosis progression.
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Humans , Biomarkers , Biopsy , Early Diagnosis , Fibrosis , Hepatitis B virus , Hepatitis B , Hepatitis B, Chronic , Hepatitis , Liver Cirrhosis , Liver , Logistic Models , MicroRNAs , Polymerase Chain Reaction , ROC CurveABSTRACT
Interleukin 23 (IL-23) is a recently discovered cytokine, and growing evidence suggests that IL-23 plays an important role in the development and progression of autoimmune diseases and inflammatory diseases. In recent years, certain research advances in association between IL-23 and liver diseases have been achieved at home and abroad. General features and biological characteristics of IL-23 are described, and its role in the development and progression of diseases such as hepatitis B, hepatitis C, and hepatocellular carcinoma is reviewed here, so that clinicians will have a deeper understanding of the effect of IL-23 in liver diseases and provide optimized therapies for patients with liver diseases.
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<p><b>OBJECTIVE</b>To investigate the diagnostic value of liquid-based cytology test (LCT) in pancreatic lesions sampled by ultrasound-guided fine needle aspiration (EUS-FNA).</p><p><b>METHODS</b>A retrospective analysis of 556 cases of LCT smears sampled by EUS-FNA of pancreatic lesions was performed, and 164 cases had histologic diagnosis with subsequent surgical resection or biopsy and immunohistochemistry. The accuracy of the cytologic diagnosis was assessed using the histologic diagnosis as the gold standard. The discrepant cases were reviewed to identify sources of errors.</p><p><b>RESULTS</b>The satisfactory rate for EUS-FNA was 96.0%(534/556). The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 87.7%(128/146), 13/16, 97.7%(128/131), 41.9%(13/31) and 87.0%(141/162) respectively. The diagnostic accuracy was lower in cystic lesions than that in solid lesions. The LCT sensitivities of adenocarcinoma, lymphoma and neuroendocrine tumors were higher than those of cystic tumors and mesenchymal tumors. False positive diagnosis was mainly due to epithelial abnormalities in inflammatory reaction. False negative diagnosis was mainly due to scanty or lack of tumor cells in the smears, or mild atypia that was insufficient for diagnosis.</p><p><b>CONCLUSIONS</b>EUS-FNA is a valuable tool for the diagnosis of pancreatic lesions. Standardized terminology and nomenclature are helpful to improve the diagnostic accuracy.</p>
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Humans , Adenocarcinoma , Diagnosis , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Inflammation , Neoplasms, Connective and Soft Tissue , Diagnosis , Neuroendocrine Tumors , Diagnosis , Pancreas , Cell Biology , Diagnostic Imaging , Pathology , Pancreatic Neoplasms , Diagnosis , Retrospective Studies , Sensitivity and Specificity , Specimen HandlingABSTRACT
Objective To investigate the frequencies of circulating dendritic cell (DC) subsets and the function of monocyte-derived dendritic cells in patients with hepatitis B-related acute-on-chronic liver failure.Methods Peripheral blood was collected from hepatitis B-related acute-on-chronic liver failure patients (ACLF,n =40) and chronic hepatitis B (CHB,n =40) as well as normal controls (NCs,n =20).Circulating myeloid dendritic cell (Mdc) and plasmic dendritic cell (pDC) frequencies in peripheral blood mononuclear cells (PBMC) were analyzed by flow cytometric analysis.Purified monocytes were isolated by combination of Histopaque-1.077 and CD14 Microbeads.Monocyte-derived dendritic cells (MoDCs) generated in vitro in the presence of interleukin (IL)-4 and granulocyte macrophage colony-stimulating factor upon activation by poly I:C.Costimulatory molecule expression and allostimulatory mixed lymphocyte reaction (AMLR) of MoDCs were detected in patients with hepatitis B-related ACLF.Results The number of circulating mDC decreased only in patients with hepatitis B-related ACLF compared with that in normal controls.However,pDC numbers decreased in both CHB and ACLF patients.We observed a further decrease the pDC numbers in ACLF compared to CHB patients without statistical significance (P ＞ 0.05).MoDC from ACLF patients showed lower expression of costimulatory molecules CD80,CD86 and the mature marker CD83,as well as MHC Ⅱ molecule (HLA-DR) compared to CHB and NC group.Interestingly,MoDC impaired allostimulatory mixed lymphocyte reaction from ACLF patients compared to those in CHB patients and NCs.Conclusions Patients with hepatitis B-related ACLF have a significantly lower expression of surface markers and impaired AMLR of MoDC,as well as decreased number of circulating mDC and pDC,which may be partially related to HBV disease progression in these patients.
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The T helper cell 17 (Th17) has important relationship with liver failure caused by hepatitis B virus (HBV).Some studies found that mature,differentiation and proliferation of Th17 cells have a close relationship with interleukin 23,newly discovered in recent years,which function of immune and regulatory mechanism in chronic hepatitis B patients is still unclear.In our country,the main cause of liver failure is hepatitis viruses (mainly HBV),thus the study of immune pathogenesis that why acute exacerbation or liver failure happens in chronic hepatitis B patients has a realistic meaning for improving the prognosis of chronic hepatitis B.