Determination of a reasonable threshold of total bilirubin for the diagnosis of hepatitis B virus-associated acute-on-chronic liver failure / 临床肝胆病杂志

Objective To investigate a reasonable threshold of total bilirubin for the diagnosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), and to realize accurate early diagnosis. Methods A retrospective analysis was performed for the clinical data of 1232 patients with HBV-ACLF who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from September 2008 to September 2018, and according to the baseline serum level of total bilirubin (TBil), the patients were divided into group A (TBil 15%) in patients with acute-on-chronic liver failure (ACLF). Although there was a difference in long-term mortality rate between the two groups, there was no significant increase in transplant-free mortality rate after 90 days in either group. Conclusion Under the premise of international normalized ratio ≥1.5, it is not recommended to increase the threshold of TBil to 205.2 μmol/L in the diagnostic criteria for HBV-ACLF, so as to ensure the early diagnosis of more ACLF patients and bring more opportunities for treatment and cure.

Clinical features of patients with acute-on-chronic liver failure and bacterial infection and influencing factors for prognosis / 临床肝胆病杂志

ObjectiveTo investigate the clinical features of infection in patients with acute-on-chronic liver failure (ACLF) and bacterial infection and the influencing factors for 90-day survival rate. MethodsThe patients with ACLF who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to December 2015 were enrolled, and related clinical data were collected and analyzed, including infection time and site, microbial culture, biochemical parameters and inflammatory markers, and 28- and 90-day prognosis after infection. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The life-table method was used to plot survival curves. The indices affecting prognosis in the univariate analysis were further included in the multivariate logistic regression analysis. ResultsA total of 1074 patients with ACLF were admitted, among whom 609 had bacterial infection, and the incidence rate of bacterial infection was 567%. Among these 609 patients, 16 underwent liver transplantation within 90 days and related data statistics were obtained for the remaining 593 patients. As for infection site, among the patients with infection, 70.15% had abdominal infection, 41.15% had pulmonary infection, 11.97% had sepsis, 5.40% had urinary system infection, 4.89% had thoracic infection, and 8.6% had infection at other sites. Among the patients with infection, 64.76% had infection at a single site. The positive rates of microbial culture of ascites, phlegm, urine, and pleural effusion were 22.70%, 52.82%, 40.63%, and 35.71%, respectively. Escherichia coli was the most common bacterium in ascites and accounted for 43.82%; Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii accounted for 22.67%, 2400%, and 22.67%, respectively, in phlegm; Escherichia coli, Klebsiella pneumoniae, and Staphylococcaceae accounted for 33.80%, 29.58%, and 15.49%, respectively, in blood culture. The 90-day survival rate after infection was 38.11% (226/593) in the patients with ACLF, and the multivariate logistic regression analysis showed that age (P=0.006), stage of hepatic encephalopathy (HE) (P＜0001), stage of liver failure (P＜0.001), and acute kidney injury (AKI) (P＜0.001) were independent risk factors for 90-day survival in patients with ACLF and infection. ConclusionThere is a high incidence rate of infection in patients with ACLF. The 90-day survival rate is relatively low, and the presence of AKI, HE stage III or above, and advanced liver failure may indicate poor prognosis.

Clinical features of patients with liver failure and fungal infections and influencing factors for prognosis / 临床肝胆病杂志

Liver failure is severe liver injury due to a variety of causes and has complex and diverse complications. Fungal infection is one of the serious complications of liver failure which often occurs in the advanced stage of liver failure, greatly affects prognosis, and leads to a significant increase in mortality, and therefore, it has become a difficult problem in clinical practice. This article introduces the research advances in high-risk factors, clinical features, diagnostic methods, and prognostic factors in patients with liver failure and fungal infections and provides a theoretical basis for improving the level of clinical diagnosis and treatment, in order to reduce the mortality of such patients and improve their quality of life.

Comparison of the effect of two different surgical approaches for thymoma under thoracoscopy / 中国基层医药

Objective@#To compare the effects of video assisted thoracoscopic surgery(VATS) of intercostal surgery and by subxiphoid surgical treatment for early thymoma, to investigate the feasibility and clinical application value of VATS subxiphoid surgical treatment for thymoma.@*Methods@#From January 2014 to January 2017, 30 thymoma patients who met the diagnostic criteria of the Masaoka stageⅠ~Ⅱ in the People's Hospital of Jingshan County were selected, and were divided into two groups according to the different surgical methods.The observation group (12 patients) received VATS underwent subxiphoid surgery, 18 patients in the control group were treated with VATS intercostal surgery.The operation time, blood loss, drainage time, length of stay, degree of pain, antibacterial time, incidence rate of complication and patients' satisfaction were compared between the two groups.@*Results@#The preoperative general data between the two groups had no statistically significant differences(all P>0.05). The operation time, intraoperative bleeding volume, postoperative drainage time, antibacterial time, postoperative hospitalization time in the observation group were (102.2±26.6)min, (105.9±29.4)mL, (3.8±1.4)d, (6.8±0.3)d, (8.5±1.6)d, respectively, which in the control group were (124.6±35.1)min, (255.6±82.8)mL, (5.2±1.2)d, (9.3±0.8)d, (14.4±1.8)d, respectively, there were statistically significant differences between the two groups(t=1.516, 2.517, 2.857, 4.462, 3.327, all P<0.05). The incidence rate of complications (8.33% vs.16.67%), satisfaction(82% vs.59%) between the two groups had statistically significant differences(χ2=4.013, 4.427, all P<0.05). During the follow-up period, there was no recurrence or metastasis in the two groups.@*Conclusion@#Compared with VATS intercostal surgery, VATS subxiphoid approach for surgical treatment of thymoma can reduce surgical trauma and reduce the incidence of complications, reduce the pain of patients, shorten the hospitalization time, its curative effect is more significant.

The relationship between differentially expressed miR-19b-3p and cognitive function in patients with Alzheimer's disease / 中华行为医学与脑科学杂志

Objective To explore the relationship between differentially expressed miR-19b-3p and cognitive function in patients with Alzheimer's disease (AD).Methods The miRNA expression profiles of patients with AD(AD group,n=30) or healthy elderly people (NC group,n=30) were analyzed by Illumina/Solexa high-throughput sequencing technique.The miRNA lentiviral plasmids were constructed and injected into the model of AD rats.The cognitive function of rats was analyzed with water maze test.The mimics and inhibitors were synthesized and transfected into SH-SY5Y cell lines.The protein expression of β-amyloid precursor protein cleavage enzyme 1 (BACE1) was detected by western blot.Results Compared with the NC group,the expression of miR-146a-5p (log2AD/Control =2.3),miR-195-5p (log2 AD/Control =10.2),miR-20b-5p(log2AD/Control =15.1) in serum of AD group was up-regulated and the expression of miR-19b-3p (log2 AD/Control =-8.0) and miR-125b-3p (log2 AD/Control =-15.3) was down-regulated (P＜ 0.05).Compared with the rats in the AD group((26.50±3.12) s),the rats in the AD+miR-19b-3p group ((15.33±2.78) s) showed significantly shorter escape latencies(P＜0.05).Compared with the NC group,the protein expression of BACE1 in miR-19b-3p mimetic group was decreased and the protein expression of BACE1 in inhibitor group was increased.Conclusion miR-19b-3p may improve the cognitive function of AD patients via regulating the expression of BACE1.

Clinical application of hepatic venous pressure gradient to predict early bleeding after esophageal variceal ligation / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the predictive value of hepatic venous pressure gradient (HVPG) for early bleeding after esophageal variceal ligation (EVL) by analyzing the differences in HVPG in patients with and without post-EVL bleeding.</p><p><b>METHODS</b>The medical records of patients who had been diagnosed with cirrhosis and esophageal varices and who had pre-EVL HVPG measurement data were surveyed. The study population included 105 patients from October 2010 to March 2014. Data of HVPG value, previous treatment history, endoscopic manifestation, and whether bleeding and serious complications occurred within 2 weeks after the ligation procedure were investigated as independent risk factors.</p><p><b>STATISTICAL METHODS</b>included the chi-square test and Wilcoxon test, logistic regression modeling and receiver operating characteristic (ROC) analysis using the SPSS software version 16.</p><p><b>RESULTS</b>Only HVPG value was identified as an independent risk factor of early bleeding after EVL.According to the ROC analysis, the area under the curve (AUC) of HVPG for early bleeding after EVL was 0.866; when HVPG was more than or equal to 16 mmHg, AUC was 0.838. The sensitivity was 90.9% and the specificity was 76.4%.</p><p><b>CONCLUSION</b>HVPG is an independent factor of early bleeding after EVL and when HVPG cut-off value of more than or equal to 16 mmHg is used the predictive ability has certain accuracy and high sensitivity and specificity.</p>

Percutaneous transhepatic variceal embolization with 2-Octyl-Cyanoacrylate versus endoscopic cyanoacrylate injection for treatment of gastric variceal bleeding / 中华消化内镜杂志

Objective To compare the efficacy of a modified percutaneous transhepatic variceal embolization (PTVE) with 2-Octyl-Cyanoacrylate (2-OCA) and endoscopic variceal obturation (EVO) in preventing gastric variceal bleeding.Methods Seventy-seven patients with history of gastric variceal bleeding who underwent either EVO or PTVE were retrospectively reviewed.The rebleeding rate,survival rate and complications were compared between the two groups.Results EVO was performed in 45 patients; PTVE was performed in 32 patients.During the follow-up (19.78 ± 7.70 months in EVO group,vs.21.53 ± 8.56 months in PTVE group),rebleeding occurred in 17 patients (37.78％) of EVO group,and in 4 patients (12.5％) of PTVE group (P =0.028).The cumulative rebleeding free rate for EVO was 75％,59％,and 49％ in 1,2,and 3 years,respectively; 93％,84％,84％ for PTVE (P =0.011).There is no significant different in survival rate and the incidence of complications was similar in two groups.Conclusion Compared with EVO,PTVE with 2-OCA demonstrates advantage as an effective and safe method for gastric varices.

Protective effects of a c-jun N-terminal kinase inhibitor, SP600125, against D-galactosamine/lipopolysaccharide induced acute liver failure in mice / 中华传染病杂志

Objective To investigate the protective effect of c-jun N-terminal kinase (JNK)inhibitor SP600125 against acute liver failure in mice.Methods Fifty-five male C57/BL6 mice were divided into control group (n =30) and SP600125 group (n =25).The animals were given an intraperitoneal injection of D-galactosamine (D-GalN,400 mg/kg body weight)/lipopolysaccharide (LPS,30 μg/kg body weight).The control group and SP600125 group were given 10％ dimethyl sulfoxide (15 mL/kg body weight) or SP600125 (75 mg/kg body weight) subcutaneously 12 h and 1 h before D-GalN/LPS administration,respectively.D GalN/LPS induced mouse JNK activation was detected by immunohistochemistry for phospho JNK (p-JNK).D-GalN/LPS induced mouse liver cell apoptosis was detected by immunohistochemistry for Caspase-3 and TdT-mediated-dUTP nick endlabeling (TUNEL).Serum alanine transaminase (ALT) level was tested to assess liver injury.Survival rate of mice within 24 h after D-GalN/LPS administration was observed.The comparison between groups was done by t test and survival rate was analyzed by Kaplan-Meier method.Results JNK activity in liver tissues,as indicated by observation of p-JNK positive cells by immunohistochemistry,was diminished 4 h after D-GalN/LPS administration in SP600125 group.Reduced Caspase-3 activity was observed 6 h after D-GalN/LPS administration in SP600125 group (as indicated in immunohistochemistry by Caspase-3 positive cells).Mice in SP600125 group showed significantly lower TUNEL-positive cell count than control group (43.0±24.5 vs 194.7±73.8; t=9.743,P=0.000).Serum ALT level 6 h after D-GalN/LPS administration was (24.0±54.7) U/L in SP600125 group,which was significantly lower than that in control group [(1234.4±478.4) U/L; t=4.734,P=0.0015].SP600125 also significantly improved the survival rate within 24 h after D-GalN/LPS administration (4/5 vs 1/10； x2=5.225,P=0.0223).Conclusions JNK inhibitor SP600125 exerts protective effects against D-GalN/LPS induced acute liver failure in mice by suppressing JNK activation and hepatocyte apoptosis.

Efficacy of percutaneous transhepatic variceal embolization with TH glue for large gastric fundal variceal bleeding / 中华消化内镜杂志

Objective To investigate the efficacy of percutaneous transhepatic variceal embolization (PTVE) with Cyanoacrylate (TH glue) in treating large gastric fundal variceal bleeding.Methods PTVE was performed on 24 patients with TH glue injected into the main stem of left gastric vein and its fundic branches.The degree of varices in gastric fundus,rebleeding rate and survival rate after the procedure were compared with those before.Results Varices in gastric fundus were all embolized successfully with TH glue.The diameter of varices was reduced to below 5mm or disappeared in 20 patients (83.3％),and reduced to 5-10mm in the other 4 ( 16.7％ ) During the follow-up period of 3-36 months(mean 16.6 months),the rebleeding rate and mortality were 12.5 ％ ( 3/24 ),and 12.5 ％ (3/24),respectively.One patient died of liver cancer,and two others died of chronic liver failure.Conclusion PTVE with TH glue is of ideal therapeutic effect to block the feeding veins of large gastric fundal varices.

Ultrasound assayed detrusor thickness may predict the bladder outlet obstruction in old men / 中华老年医学杂志

Objective To evaluate the relationship between ultrasound-assayed detrusor thickness and bladder outlet obstruction (BOO) in old men with benign prostatic hyperplasia (BPH).Methods The 106 BPH patients underwent the urodynamic examination on which the diagnosis of BOO was dependent. The obstruction was defined as the Abrams-Griffiths nomogram (A-G index)≥40 and the grade of linear passive urethral resistance relation (LinPURR)≥Ⅱ . When bladder capacity reached 150 ml, the detrusor thickness was measured by abdominal ultrasound. Results Compared with unobstructed group, the maximum flow rate and average flow rate were both lower in obstructed group [(10.1±3.0) ml/s vs. (17.4±3.1) ml/s, (5.5±2.2) ml/s vs. (11.2±2.2) ml/s, t= 10.26and 11.03, both P＜0.01]. And the residual urine volume and maximum detrusor pressure were significantly higher in obstructed group than in unobstructed group [(47.6 ± 24.3) ml vs. (17.0 ±5.6) ml, (39.3±14.4) cm H2Ovs. (26.8±8.0) cm H2O, t=6.32 and 4.07, P＜0.01 or 0.05].Detrusor thickness was positively correlated with maximum detrusor pressure (r= 0.419, P＜0.01),but negatively correlated with maximum flow rate (r =- 0.749, P＜ 0.01 ), mean flow rate (r=-0.853, P＜0.01) and voided volume (r=-0.556, P＜0.01). There was significant difference in detrusor thickness between obstructed group and unobstructed group [(3.0± 0.2) mm vs. (2.5 ±0.2) mm, t= 11.2,P＜0.05]. According to the diagnostic standard of detrusor thickness≥3.0 mm,it had a sensitivity of 90% and a specificity of 84.6%, a positive predictive value of 93.1% and a negative predictive value of 78.6%. Conclusions Detrusor thickness of 3.0 mm or greater has a certain predictive value for BOO in old men.

Establishment of a PCR-product direct sequencing for the detection of HBV YMDD mutation / 中华检验医学杂志

Objective To develop an assay of PCR-produet direct sequencing to detect hepatitis B virus (HBV) YMDD mutation, and compare the results gained by the sequencing and traditional real-time fluorescent PCR assays. Methods Serum samples were collected from 103 patients with chronic hepatitis B. HBV DNA were extracted from sers. YMDD mutation was detected by a commercial real-time PCR assay. Meanwhile, HBV reverse transcriptase-encoding gene was amplified by a nested PCR assay. The PCR products were directly subjected to sequencing at two directions, and the sequencing results were analyzed by NTI program. Using Kappa test, comparison was made between the results of rtM204-site mutations obtained by the direct sequencing and YMDD mutations by the real-time fluorescent PCR. Results The direct sequencing assay proved to be highly effective with bread range of detection in viral load from 500 to 1010copies/ml. And it may simultaneously avoid inhibitory effect caused by high viral load. The coincidence rates between two assays were 100% for YIDD, 97. 1% for YVDD, 76. 2% for YIDD/YVDD coexistence (Kappa = 0. 853, P < 0. 01). Conclusions The direct sequencing assay for HBV drug-resistant mutation detection is highly sensitive with broad dynamic range. It has high coincidence rate with real-time fluorescent PCR assay with advantage of detecting YMDD, YIDD and YVDD mutations simultaneously.

The value of color doppler flow imaging in diagnosing primary bladder cancer / 中国基层医药

Objective To evaluate the diagnostic value of color doppler flow imaging in primary bladder cancer.Methods The imaging characteristics from 39 patients with primary bladder cancer proved by bladder endoscopy and pathological dignosis were investigated and analyzed by means of color doppler flow imaging and pulse doppler,according to TNM staging system.Results The colorful flow signals,such as Vs 25.4～78.7 cm/s,Vd 10.1～34.6 cm/s,and RI 0.56～0.71,were found in the 32 cases in which the diameters of tumors are larger than 1cm.The cases in T1,T2 and T3 plus T4 stage are 7,22,10 and 10 respectively.Conclusion The color doppler flow imaging can increase the accuracy of diagnosing primary bladder cancer It's the first choice for determining bladder tumors.

The expression and activity determination of N protein of Sars-CoV / 解放军医学杂志

Objective To construct an expression vector pGEX-2T/N, and to express the fusion protein consisting of N protein of SARS-CoV in E. coli.Methods The N region gene of SARS-CoV was obtained by RT-PCR. The expression vector PGEX-2T/N was constructed by DNA recombination. The recombinant plasmid was transformed into E. coli BL21(DE3). The expression of the fusion protein was determined by Western blot with anti-SARS-CoV antibody positive blood sera. Results The N region gene of SARS-CoV was obtained. The fusion protein GST-N was soluble. Western blot analysis showed that the reaction of GST-N to anti-SARS-CoV sera was positive. Conclusion The pGEX-2T/N has been constructed and expressed in the form of fusion protein GST-N successfully, and the result lays the foundation for further study of SARS-CoV N protein.