Clinical and pathological features of children with glycogen storage disease: An analysis of 10 cases / 临床肝胆病杂志

Objective To investigate the clinical and pathological features of children with glycogen storage disease (GSD). Methods A retrospective analysis was performed for ten children with GSD who were admitted to the Third Hospital of Hebei Medical University and The Fifth Medical Center of Chinese PLA General Hospital from January 2002 to January 2022, based on medical history, liver biochemistry, and liver biopsy, and population characteristics, clinical manifestations, biochemical parameters, and liver histopathological characteristics were compared and analyzed. Results All ten children had developmental retardation and a short stature, with the manifestations of abnormal liver function, mild weakness, poor appetite, yellow urine, and yellow eyes, and four children had hepatosplenomegaly. Among the ten children, six had the clinical manifestations of hypoglycemia, and one had bilateral gastrocnemius hypertrophy and positive Gower sign. Two children had positive CMV IgG. Liver histopathological manifestations included diffuse enlargement of hepatocytes, light cytoplasm, and small nucleus in the middle like plant cells, with or without fibrous tissue proliferation. Conclusion Most patients with GSD have developmental retardation and abnormal aminotransferases, and liver pathological examination shows specific pathological features.

Current status and perspectives of the clinical and basic research on concomitant chronic hepatitis B virus infection and nonalcoholic fatty liver disease / 临床肝胆病杂志

Chronic hepatitis B virus infection (CBI) and nonalcoholic fatty liver disease (NAFLD) are the two main etiologies of chronic liver diseases worldwide, and therefore, concomitant CBI and NAFLD (Co-CBI&NAFLD) is relatively common. There are still controversies over the influence of the interaction between CBI and NAFLD, especially NAFLD, on the progression, antiviral response, and outcome of chronic hepatitis B (CHB). Current clinical and basic research on Co-CBI&NAFLD have shown that NAFLD could inhibit HBV DNA replication to a certain degree, manifesting as a relatively low HBV DNA load, and it might increase HBsAg clearance rate in patients with CHB. Prospective or retrospective cohort studies have shown that patients with Co-CBI&NAFLD tend to have more rapid progression of liver fibrosis than those with CHB alone, as well as increased incidence rates of liver cirrhosis and hepatocellular carcinoma. Histologically, Co-CBI&NAFLD has the pathological changes of both CHB and NAFLD, and therefore, it is difficult to identify their own characteristic lesions. At present, the natural history and pathogenesis of Co-CBI&NAFLD remain unclear, and its pathological characteristics have not been fully identified. There is still a lack of high-level evidence-based supporting information on the influence of NAFLD on the course of CHB, especially its impact on antiviral response and disease outcome, and there are also no guidelines for the diagnosis/treatment or management of Co-CBI&NAFLD in China and globally. Solutions to the above issues will definitely deepen the understanding of Co-CBI&NAFLD, standardize and improve clinical diagnosis/treatment or management, and thus reduce the incidence and mortality rates of related end-stage liver diseases.

Effect of low expression of sodium taurocholate cotransporting polypeptide on antiviral response in chronic hepatitis B patients with active inflammation / 中华传染病杂志

Objective:To investigate the relationship between the down-regulation expression of sodium taurocholate cotransporting polypeptide (NTCP) in proliferating hepatocytes and the response to antiviral therapy of chronic hepatitis B (CHB) patients.Methods:Sixty-eight hepatitis B e antigen (HBeAg)-positive CHB patients admitted to the Fifth Medical Center of PLA General Hospital from January 2011 to March 2015 were included. Basic information and laboratory data were collected. Based on the baseline (before antiviral treatment) inflammatory activity (G), the patients were divided into ≤G2 group and >G2 group. Twelve liver puncture tissue samples were selected from each group for NTCP and Ki67 immunofluorescence staining.The proportion of Ki67-positive cells was calculated, and the staining of NTCP was scored. Five pairs of tissue specimens of patients who had hepatitis B virus (HBV) infection were diagnosed with focal nodular hyperplasia (FNH) and underwent nodular resection surgery from March 2014 to March 2017 were collected.Immunohistochemical staining was used to detect the expressions of Ki67, NTCP and hepatitis B surface antigen (HBsAg) in each tissue specimen, and the proportion of staining positive cells or the staining intensity was calculated. Statistical analysis was performed by Mann-Whitney U test, chi-square test or Spearman correlation analysis. Results:The proportion of Ki67-positive cells (6.75%(6.20%, 8.16%))in five liver FNH tissues with HBV infection was significantly higher than that in adjacent non-FNH tissues (0.75%(0.66%, 1.20%)), while the immunohistochemical scores of NTCP and HBsAg (3.00 (1.00, 3.00) and 2.00 (1.00, 2.00), respectively) were both significantly lower than those in adjacent non-FNH tissues (8.00 (8.00, 9.00) and 8.00 (6.00, 8.00), respectively), the differences were all statistically significant ( Z=-2.611, -2.424 and -2.635, respectively, P=0.009, 0.015 and 0.008, respectively). There were 37 patients in >G2 group, and 31 patients in ≤G2 group. After six months of antiviral treatment, CHB patients with persistent inflammation in >G2 group obtained a better virological response, with serum HBV DNA and HBeAg showing a greater decline ((0.71±0.14) lg IU/mL and (0.92±0.13) lg IU/mL, respectively) than those in ≤G2 group ((0.54±0.30) lg IU/mL and (0.49±0.65) lg IU/mL, respectively) ( Z=-3.048 and -2.666, respectively, P=0.002 and 0.008, respectively). The proportion of Ki67-positive cells in the specimens of >G2 group (4.34%(1.84%, 8.77%)) was significantly higher than that of ≤G2 group (0.34%(0, 0.80%)) ( Z=-3.640, P<0.01), and the immunohistochemical staining score of NTCP (1.00 (0, 3.25)) was significantly lower than that of ≤G2 group (6.00 (4.00, 8.00)) ( Z=-3.012, P=0.003). Spearman correlation analysis showed that the NTCP immunohistochemical score was negatively correlated with the proportion of Ki67-positive cells ( r=-0.512, P=0.01). Conclusions:CHB patients with persistent inflammationare often accompanied by more active hepatocyte proliferation and low membrane NTCP expression, which is not conducive to HBV reinfection. It may facilitate these patients to obtain better virological response.

Establishment and preliminary application of serum Golgi protein 73 based noninvasive diagnostic model for compensated stage hepatitis B cirrhosis / 中华肝脏病杂志

Objective@#To establish and evaluate diagnostic efficacy and applicability of serum Golgi protein (GP) 73 based non-invasive diagnostic model with other conventional serological indicators for compensated stage hepatitis B cirrhosis.@*Methods@#666 cases with chronic hepatitis B (CHB) who had visited to the Fifth Medical Center of People’s Liberation Army General Hospital from January 2010 to December 2017 were selected as the study subjects, and were classified according to compensated stage cirrhosis into clinical and pathological diagnosis group based on whether or not the liver histological examination was performed. A diagnostic model of compensated stage hepatitis B cirrhosis in the clinical diagnosis group was established. The current clinically used diagnostic model of liver cirrhosis, aspartate aminotransferase/platelet ratio index (APRI), fibrosis index (FIB)-4 and liver stiffness measurement (LSM) were compared. Eventually, the diagnostic model was verified step by step by pathological diagnosis group.@*Results@#The area under the receiver operating characteristic curve (AUC) of GP73 and APRI, FIB-4, and LSM for cirrhosis patients in the clinical diagnosis group were 0.842, 0.857, 0.864, and 0.832, respectively. The diagnostic efficiency of the four indicators were of similar (P value > 0.05). A diagnostic model of compensated stage hepatitis B cirrhosis (GAPA) using logistic regression analysis was established: LogitP = 1/ [1 + exp (1.614-0.054 × GP73-0.045 × Age + 0.030 × PLT-0.015 × ALP)]. The AUC of the model was as high as 0.940 and the optimal cut-off value were 0.41. The corresponding diagnostic sensitivity and specificity were 0.92 and 0.82, respectively. The diagnostic efficiency was better than that of APRI, FIB-4, LSM and GP73 alone (P < 0.05). The AUC of GAPA was 0.877 in the pathological diagnosis group, which was similar to the diagnostic efficacy of LSM (0.891) and FIB-4 (0.847) (P > 0.1), but still superior to that of APRI (0.811) and GP73 alone (0.780) (P < 0.001).@*Conclusion@#GAPA, a diagnostic model for compensated stage hepatitis B cirrhosis established in this study, has a good diagnostic efficacy in both the clinical and pathological diagnosis group, and has certain auxiliary diagnostic value in the areas where resources are relatively scarce or where LSM has not been developed.

Clinical analysis of 24 cases of multi-segment injury of brachial plexus / 中华显微外科杂志

Objective:To explore the diagnosis and treatment of the multi-segment injury of brachial plexus and provide reference for diagnosis and treatment in clinical practice.Methods:From October, 2012 to January, 2015, 24 patients (21 males and 3 females, aged 7-46, average at 25.06±13.01 years) who suffered multi segments injury of brachial plexus were treated by surgical operations. Time from injury to surgery was 7 days to 7 months, with (2.43±2.15) months in average. The general data, injuries and surgical procedures of the patients were recorded. Muscle strength grading was used to evaluate and analyse the curative effect.Results:Twenty-four cases were followed-up for 3.1-7.2 years, with 4.3 years in average. Of the patients, 58.3% of the injuries were caused by mechanical traction. Combined injuries were counted for 83.3%, of which 62.5% combined with ipsilateral limb fractures, 20.8% (5/24) involved in the root of brachial plexus, 79.2% (19/24) with upper part of the clavicle, 91.6% (22/24) with lower part of the clavicle, 16.7% (4/24) with branches of the brachial plexus and 91.7% (22/24) with injuries of 2 segments, 8.3% (2/24) with injuries of 3 segments. At the last followed-up, 55.0% of the patients achieved better than M 3 in total muscle strength. The excellent and good rate was 70.8% in neurolysis group and 42.9% in multiple segment injury group. Conclusion:The mechanism of multi segments injury of brachial plexus is special, and the actual injury is difficult to be located. For patients with multi segments injury, surgical operation should be carried out as early as possible, and the correct surgical procedure can only be determined after the exploration of all sections of the brachial plexus.

Clinical application of covalently closed circular DNA detection techniques / 临床肝胆病杂志

Covalently closed circular DNA (cccDNA) is the original template for hepatitis B virus (HBV) replication and is the basis of persistent HBV infection. Only when HBV cccDNA is completely eliminated can HBV be eradicated. Therefore, the detection of HBV cccDNA plays an important role in evaluating the antiviral outcome of chronic hepatitis B, assessing HBV clearance, clarifying occult HBV infection, studying the pathogenesis of hepatitis B, and developing new drugs, and HBV cccDNA detection techniques with high sensitivity and specificity are the basis for clinical application. With reference to related reports in literature and our own research work, this article reviews the development and clinical application of HBV cccDNA detection methods in recent years.

A clinical trial on the follow-up of nonalcoholic fatty liver disease: An evaluation of pathological endpoint / 临床肝胆病杂志

Liver biopsy is the “gold standard” for the diagnosis of nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH). Although liver biopsy has several limitations including invasiveness and errors in sampling and evaluation, in clinical trials on NAFLD/NASH follow-up and new drugs, liver histological evaluation is still a main and irreplaceable method for inclusion/exclusion diagnosis and assessment of primary endpoints in cohorts. It often takes 10-20 years for NASH to progress to liver cirrhosis, which is a surrogate endpoint in clinical trials for new drugs, and the NASH Clinical Research Network (NASH-CRN) system is recommended as the histological evaluation system in clinical trials for tracking NAFLD/NASH. The primary endpoint for NASH treatment is usually set as the reversal of NASH without progression of fibrosis; an alternative one is a reduction in NAS score by at least 2 points and a reduction in one or more histological parameters by at least 1 point, without progression of fibrosis, during the full-course treatment. Patients in phase 2b and 3 clinical trials should be monitored for at least 12 months, and if the improvement of fibrosis is set as the main assessment index, they should be monitored for at least 1-2 years and should be followed up for more than 6 months after drug withdrawal. Histological evaluation is affected by various factors. In order to ensure the quality of such evaluation, the length of tissue for liver biopsy should be larger than 2 cm (containing more than 10 portal areas). Staining and section preparation should be performed at the same time, and more than two experts specializing in liver pathology should perform single- or double-blinded review of liver biopsies to avoid evaluation bias.

Role of histological evaluation of the liver in clinical practice and research on nonalcoholic fatty liver disease / 临床肝胆病杂志

Liver biopsy is currently the gold standard for the diagnosis of nonalcoholic fatty liver disease (NAFLD),especially nonalcoholic steatohepatitis (NASH). Although liver biopsy has the limitations such as invasiveness,sampling error,and evaluation error,in clinical tri-als of NAFLD/ NASH and related new drugs,it is still used to evaluate the enrollment of patients into a cohort and primary and/ or secondary endpoints and cannot be replaced by other methods. The histological evaluation systems of NAFLD/ NASH mainly include Brunt system, NASH - CRN scoring system,European SAF/ FLIP scoring algorithm,and pediatric NAFLD histological scoring system,and an appropriate histological scoring system should be selected in clinical practice and research.

The potential use of serum HBV RNA to guide the functional cure of chronic hepatitis B / 中华肝脏病杂志

Hepatitis B virus (HBV) covalently closed circular DNA (cccDNA) in infected hepatocytes is the main cause of off-therapy viral rebound. The half-life of cccDNA is only 33-50 days, so the conversion of newly synthesized rcDNA to cccDNA in the nucleus is essential for the maintenance of cccDNA pool in infected hepatocytes. Though not directly targeting the existing cccDNA, current nucleos(t)ide analogues (NAs) may exhaust the cccDNA reservoir by blocking the rcDNA formation. Indeed, a prolonged consolidation therapy post loss of serum HBV DNA can achieve sustained remission and thus safe drug discontinuation in a small proportion of chronic hepatitis B (CHB) patients. In recent studies, we and others have demonstrated that it is the serum HBV RNA that reflects the cccDNA activity in infected hepatocytes, particularly among the patients on NAs. Here we suggest that instead of measuring serum HBV DNA only, simultaneous measurement of both viral DNA and RNA would improve the accuracy to reflect the cccDNA activity; therefore, the virological response should be redefined as consistent loss (less than the lower limit of detection) of both serum HBV DNA and RNA, which indicates the safety of drug discontinuation. Accumulating evidence has suggested that for the CHB patients with lower serum HBsAg, switch-to or add-on pegylated interferon (Peg-IFN) treatment would result in loss of serum HBsAg in a relatively large proportion of CHB patients. Since serum HBV RNA is an ideal biomarker to reflect the intrahepatic cccDNA activity, for the patients with a serum HBsAg level lower than 1 500 IU/ml after long-term NAs treatment, the serum HBV RNA should be measured. If serum HBV RNA is detected, peg-IFN should be added on; if serum HBV RNA is not detected, NAs treatment should be switched to peg-IFN treatment. We believe the therapy based on serum HBV RNA would make the functional cure of CHB (serum HBsAg loss or even conversion to anti-HBs) more efficient.

Pathological features of liver fibrosis/cirrhosis caused by different factors / 临床肝胆病杂志

Liver fibrosis/cirrhosis is a pathological process which involves increased deposition of extracellular matrix in liver tissues and changes in liver tissue structure induced by the persistent action of various factors causing liver injury. This article introduces the features of liver fibrosis/cirrhosis caused by different factors. Identifying the etiology and evaluating the degree of liver fibrosis/cirrhosis with reference to their histological characteristics are of great importance for clinical diagnosis and treatment.

Comparison of the clinical efficacy between obesity and non-obesity with lumbar spinal stenosis and instability by transforaminal lumbar interbody fusion / 重庆医学

Objective To observe the clinic efficacy of open transforaminal lumbar interbody fusion (TLIF) compared with minimally invasive operation in treating lumbar spinal stenosis and instability among obese and non‐obese patients .Methods A ret‐rospective analysis was performed in these cases of mono‐segmental lumbar spinal stenosis and instability between January 2011 and January 2013 .Perioperative index ,clinical efficacy ,and imaging results were observed and compared between different groups .Re‐sults Thirty‐four obese cases and 105 non‐obese cases were divided into two groups ,including conventional posterior open TLIF and minimally invasive TLIF operation ,to compare the results .Perioperative indexes of obese patients were more than non‐obese patients undergone open TLIF operation way and there was significant difference(P0 .05) .No cases of slippage or breakage of implants were found among all these patients after 6 months of follow up .Postoperative VAS and ODI among these four groups were better than before(P0 .05);undergoing minimally invasive postoperative VAS in obese group and in non‐obese group ,there was not significant difference(P>0 .05) .Conclusion Therefore ,obese may be risk factor in treating lumbar spinal stenosis and instability .

Value of serum osteoprotegerin in noninvasive diagnosis of nonalcoholic steatohepatitis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the correlation of serum osteoprotegerin (OPG) with the progression of nonalcoholic fatty liver disease (NAFLD) and the noninvasive prediction and diagnosis of nonalcoholic steatohepatitis (NASH).</p><p><b>METHODS</b>A total of 136 patients with NAFLD were enrolled, and their tissue samples for liver biopsy and serum samples obtained at 1 week after liver biopsy were collected; 83 healthy subjects without the symptoms of fatty liver disease proved by ultrasound examination were enrolled as controls. The physiological indicators including height, body weight, and waist circumference were measured, and body mass index was calculated. The biochemical parameters including alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST/ALT, alkaline phosphatase, gamma-glutamyl transferase, total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were measured. Double-antibody sandwich enzyme-linked immunosorbent assay was used to determine the serum level of OPG. The rank sum test, chi-square test, t-test, one-way analysis of variance, Spearman correlation analysis, least significant difference test, and receiver operating characteristic (ROC) curve were applied for statistical analysis of various data.</p><p><b>RESULTS</b>Serum OPG level was correlated with AST and TG (P < 0.05), and was highly correlated with hepatocyte fatty degeneration, ballooning degeneration, intralobular inflammation, portal inflammation, and fibrosis degree (P < 0.01). With the increasing NAFLD activity score (NAS), serum OPG level decreased, and there was a highly negative correlation between them (r = -0.928, P < 0.01). Serum OPG level was significantly lower in NASH patients than non-NASH patients. The area under the ROC curve of serum OPG level was 0.963, and according to the Youden index, its optimal sensitivity and specificity were 96.1% and 97.4%, respectively, at an optimal cut-off value of 242.96 ng/L, which suggested a high diagnostic power.</p><p><b>CONCLUSION</b>In NASH patients, serum OPG level decreases significantly. Serum OPG level can be used as an independent predictive factor to evaluate NASH and its severity, as well as a noninvasive diagnostic index for NASH.</p>

Correlation between red blood cell count and liver function status / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the changes in red blood cell count in patients with different liver diseases and the correlation between red blood cell count and degree of liver damage.</p><p><b>METHODS</b>The clinical data of 1427 patients with primary liver cancer, 172 patients with liver cirrhosis, and 185 patients with hepatitis were collected, and the Child-Pugh class was determined for all patients. The differences in red blood cell count between patients with different liver diseases were retrospectively analyzed, and the correlation between red blood cell count and liver function status was investigated. The Mann-Whitney U test, Kruskal-Wallis H test, rank sum test, Spearman rank sum correlation test, and chi-square test were performed for different types of data.</p><p><b>RESULTS</b>Red blood cell count showed significant differences between patients with chronic hepatitis, liver cancer, and liver cirrhosis and was highest in patients with chronic hepatitis and lowest in patients with liver cirrhosis (P < 0.05). In the patients with liver cirrhosis, red blood cell count tended to decrease in patients with a higher Child-Pugh class (P < 0.05).</p><p><b>CONCLUSION</b>For patients with liver cirrhosis, red blood cell count can reflect the degree of liver damage, which may contribute to an improved liver function prediction model for these patients.</p>

Study on the morphological features, pathologic diagnosis and differential diagnosis of well-differentiated hepatocellular carcinoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To analyze the clinicopathologic characteristics of well-differentiated hepatocellular carcinoma (WD-HCC), and to find clues for its pathologic diagnosis and differential diagnosis.</p><p><b>METHODS</b>Seventy-three cases of WD-HCC were studied with clinical data analysis, gross and microscopic examination.</p><p><b>RESULTS</b>Among the 73 cases, the prevalence of HBV (+) and/or HCV (+) was 94.5% (69/73), liver cirrhosis was 80.8% (59/73), increased hepatic cell density was 95.9% (70/73), dilated and irregular hepatic sinus was 89.0% (65/73), prominent trabecularism was 89.0% (65/73), increased cytoplasmic eosinophilia or basophilia was 90.4% (66/73), glandular-like structure was 16.4% (12/73, and fatty degeneration was 42.4% (31/73) .</p><p><b>CONCLUSIONS</b>There are important clinicopathologic features associated with WD-HCC. These features are useful in the differential diagnosis of WD-HCC with dysplastic nodule (DN), focal nodular hyperplasia (FNH) and hepatocellular adenoma.</p>

Clinicopathological analysis of HBV recurrence in post-liver transplantation patients / 中华器官移植杂志

Objective To investigate the clinicopathological characteristics of HBV recurrence after liver transplantation. Methods The retrospective analysis of the clinicopathological changes was performed on 17 patients who had HBV recurrence after liver transplantation in our medical department. Results HBV recurrence happened from 4 to 48 months. Twelve of them which were identified to be YMDD mutation switched to entecavir or added adefovir. Three of them receiving chemotherapy when liver cancer recurred switched to entecavir. Two of them with withdrawal of lamivudine were given lamivudine continuously. Liver function returned to the normal level and HBVDNA was ＜ 102 U/ml after anti-hepatitis B virus. The histological changes in the transplanted livers included hepatocellular degeneration, necrosis and apoptosis, portal infiltrations and fibrosis.With time after recurrence, it was easier to see hepatitis B virus replication in liver cells, incidence of acute rejection, increases of liver fibrosis and the formation of fibrous septa, even pseudolobule.Conclusion In native HBV infection livers, fibrosis occurs more early and develops rapidly. The number of virus is closely related to liver necrosis and inflammation. Early discovery and change to quick and effective treatment of anti-hepatitis B virus in time can improve greatly the prognosis of the patients.

Experimental study of the oriented differentiation of bone marrow derived mesenchymal stem cells into chondrogenic phenotype in a specific culture fluid / 中国组织工程研究

BACKGROUND:To construct tissue engineering cartilage would open up a novel way for the repair of cartilage damage in avoidance of the disadvantages of traditional therapeutic method.OBJECTIVE: To probe the techniques for the isolation of mesenchymal stem cells (MSCs) from bone marrow, as well as the in vitro differentiation into chondrocytic phenotype in a specific culture fluid.DESIGN:A complete randomized experimentSETTING:The Department of Traumatic Orthopedics and Hand Surgery of the First Affiliated Hospital of Guangxi Medical University, and Teaching and Research Faculty of Histology and Embryology of Guangxi Medical University.METHODS: The experiment was carried out at Guangxi Medical University between August 2002 and April 2003. Twenty SD neonatal weaning rats were selected. Bone marrow was aspirated from the bones of rat limbs and was isolated by gradient centrifugation in Percoll, and MSCs could be obtained in combination with adherent screening method, which were then cultured in DMEM-LG with 15% fatal bovine serum (FBS) in the incubator of 37℃ with 5% CO2 for 10-14 days. The passage cells were induced in DMEM-HG with 15% FBS (containing TGF-β1 10 μg/L, 10-7 mol/L dexamethasone, 50 mg/L VitC).MAIN OUTCOME MEASURES :The morphology, growth, as well as proliferation and specific expression of chondrogenic matrix of in vitro cultured MSCs due to specific induction.RESULTS: Totally 20 SD rats were observed and analyzed with no loss SCs grew in visible symmetric colonies, displaying a long-spindle shape,and the morphological characteristics of marrow-derived MSCs had no obvious changes during passage-culture, but its proliferation time was found from a shuttle fibroblastic appearance to polygonal shape, displaying posiHC staining of type Ⅱ collagen of cartilage specific matrix.bronectin adherent screening technique is a convenient, effective and practical method to separate and collect MSCs from rat bone marrows in chondrogenic phenotype when induced by a specific medium and can secrete cartilage specific matrix, and they can be the optimal seed cells for cartilage tissue engineering.

Screening and application of human-derived HBsAg bacteriophage single chain antibody in clinical diagnosis / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To identify human single chain Fv antibody (ScFv) against hepatitis B viral surface antigen.</p><p><b>METHODS</b>The recombinant phages were panned by HBsAg which was coated in a microtiter plate, after five rounds of biopanning, 56 phage clones were identified specific to HBsAg. The specificity of ScFv was evaluated by ELISA and immunohistochemistry, respectively.</p><p><b>RESULTS</b>The data of HB sAg-ScFv DNA digestion and DNA sequencing showed that the ScFv gene is composed of 750 bp. ELISA and immunohistochemistry demonstrated that the human single chain Fv antibody against hepatitis B surface antigen has a specific combination character with hepatitis B surface antigen of different sources and paraffin-embedded patients tissue specimens, it did not react with normal liver tissue and HCV.</p><p><b>CONCLUSIONS</b>The application of HBsAg specific ScFv in immunohistochemistry was successfully achieved.</p>

Clinical and pathological characteristics and pathogenesis of autoimmune hepatitis / 中华实验和临床病毒学杂志

<p><b>BACKGROUND</b>To explore the clinical and pathological characteristics and pathogenesis of autoimmunohepatitis (AIH).</p><p><b>METHODS</b>The serum and liver biopsy specimens and clinical data of 26 cases with patients with AIH were analyzed and scored according to the criteria of International autoimmune hepatitis (IAIHG, 1999). The changes of dendritic cells (DC) in the liver tissues were observed with a panel of DC markers (CD-80/B7-1, CD-86/B7-2, CD-1a and HLA-DR) and immunohistochemistry, and the activation of hepatic stellate cells (HSC) and the expression of TGF-alpha were also detected. Liver tissue specimens from 10 patients with chronic viral hepatitis B and C respectively and 5 normal liver specimens were chosen as controls.</p><p><b>RESULTS</b>Mean aggregate scores of 26 AIH cases, including 21 cases of type B (80.8%) and 5 cases of type C (19.2%), which were 18.6 +/- 1.4 and 19.1 +/- 2.1 respectively. There were significant differences between the type B and type C in the average age levels of serum ALT and AST, and alpha-Glo (P <0.001 or P< 0.01 or P <0.05). Histological features of all the AIH liver tissues showed the lesions of chronic active hepatitis such as interface hepatitis/piecemeal necrosis (100%), obvious lobular inflammation (type B 95.2%, type C 100%), bridging necrosis (57.1% type B, 80.0% type C, P<0.05), rosetting of liver cells (71.4% type B, 100% type C, P<0.01), central lobular confluent necrosis (33.3% type B, 80.0% type C, P<0.001), predominant plasmacytic infiltration (type B 95.2%, type C 20.0%, P<0.001). The rates of increased and concentrated DC in the portal and lobular areas, especially in the active lesions in type B and type C AIH were 85.7% (18/21) and 5/5 respectively. It was found that DC and lymphocytes surrounded the hepatocytes which partly expressed HLA-DR antigen, while there were no or a few HLA-DR positive hepatocytes in controls. Meanwhile, the number of alpha-SMA positive HSC and the expression of TGF- were obviously increased in AIH liver tissues.</p><p><b>CONCLUSIONS</b>Several clinical and pathological features of AIH were identified in this study. As an antigen-presenting cell, DC might play an important role in the pathogenesis of AIH. In China, sub-type B of AIH might be more frequent than sub-type C and there were differences in clinical aspects, serology and pathology between the two types.</p>

CLINICAL AND PATHOLOGICAL CHARACTERISTICS OF NONALCOHOLIC STEATOHEPATITIS / 解放军医学杂志

micro), hepatocyte ballooning degeneration, mild diffuse lobular inflammation and perisinusoidal collagen deposition. Zone 3 accentuation could be detected. Mallory hyaline, vacuolated nuclei in periportal hepatocytes were common. NASH has some clinical and pathological characteristics. The authors hold that combinative consideration of clinics, pathology and laboratory can ensure the diagnosis of NASH, and liver biopsy interpretation continues to be the "gold standard " for diagnosis.

Pathological,epidemiological and prognostic studies in 25946 patients with liver disease with liver needle biopsy / 解放军医学杂志

Objective To study the disease spectrum,the features of clinical pathology,epidemiology and prognosis of liver diseases in Chinese populations from Jan.1980 to Jun.2008.Methods Twenty-five thousand nine hundred and forty-six patients with liver diseases in a wide spectrum of inhabitants(including 1 448 military patients) from 31 provinces or cities of all over mainland China in recent 28 years were involved in the present study for a retrospective study regarding their clinical,pathological and epidemiological features,including laboratory re-examinations and pathological examination.1 322 patients with liver disease(course lasted from 6 months to 18 years) were followed-up by more than 2 liver biopsies to study the outcome of chronic hepatitis B.Results For all the patients involved,the sex ratio of male to female was 3 to 1,with mean age of 32.3?14.4 years ranging from 41 days to 91 years,and the diseases occurred predominantly between the age of 18 to 37 years.Hebei,Henan,Beijing,Shandong and Shanxi provinces(city) ranked at the fore in the endemic distribution of the diseases.The spectrum of liver disease covered more than 100 kinds of liver diseases,of which 73.05% were infectious liver disease.As a whole,the incidence of both infectious and non-infectious,especially the non-infectious liver diseases became more prevalent since 2000.It was shown that the chronic hepatitis B was the most predominant factor which caused liver failure,liver cirrhosis and liver cancer,and chronic hepatitis C was the second factor.Chronic infection pathological changes were found in the liver tissues in 0.26% patients with hepatitis A and 0.51% patients with hepatitis E.For all the 1 322 followed-up patients with chronic hepatitis B,the incidence of liver cirrhosis and hepatocellular carcinoma was respectively 15.36%(203 cases) and 1.06%(14 cases),and the average progressive period for the changes in pathology was 46.37?16.93 months and 60.29?39.15 months,respectively.Meanwhile,the degree of liver fibrosis increased more than one stage in 188 patients(14.22%),decreased more than one stage in 441 patients(33.36%),and no change in 476 patients(30.01%).Conclusions The liver disease spectrum during recent 28 years in Chinese populations has been essentially identified by a retrospective analysis of a large number of clinical pathological data.The clinical features of predominant liver diseases have been illustrated,and the outcome and transition time of chronic hepatitis B has been elucidated in present study.