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The common causes of non-cirrhotic sinusoidal hypertension were intrahepatic diseases that involves sinusoidal or perisinusoidal space, with sinusoidal obstruction syndrome being a common etiology, which was mainly caused by chemotherapy or radiotherapy prior to hematopoietic stem cell transplantation and pyrrolizidine alkaloid herbal therapy; defibrotide was the only approved drug for this disease. The other causes included nodular regenerative hyperplasia, which were mainly diagnosed by liver pathophysiology; treatment remains largely targeted at the individual sequalae of portal hypertension and respective potential causes.
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Noninvasive methods for the evaluation of liver fibrosis have been widely validated with liver biopsy as the gold standard. This article elaborates on the application of various imaging methods in the evaluation of liver fibrosis and their prospects in evaluating the reversal of liver fibrosis. Transient elastography is the main imaging method for evaluating the reversal of liver fibrosis and can show the improvement in liver fibrosis via liver stiffness measurement, but the association between the reduction in liver stiffness measurement and the improvement of liver fibrosis remains unclear.
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Objective@#To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression.@*Methods@#Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment.@*Results@#A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness.@*Conclusion@#This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.
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Liver fibrosis/cirrhosis is the outcome of the progression of chronic hepatitis B and is associated with liver events and long-term prognosis. Effective antiviral therapy can delay or even reverse disease progression. Therefore, assessment of liver fibrosis degree before and during treatment is of great importance in initiating antiviral therapy, developing therapeutic regimens, and monitoring antiviral effects and complications. The semi-quantitative histological scoring system is widely acknowledged in the assessment of liver fibrosis degree and is an important basis for the initiation of antiviral therapy for hepatitis B, as well as a method commonly used for efficacy surveillance. Morphological and structural quantitative methods provide objective histological assessment of liver fibrosis and may cover the shortage of conventional semi-quantitative scoring system. Non-invasive methods for the assessment of liver fibrosis may reduce but not completely substitute liver histological examinations; a consensus has not been reached on their cut-off values to make decisions to initiate antiviral therapy, but such non-invasive methods can provide rich information on therapeutic effect and long-term prognosis.
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Objective To evaluate the value of transient elastography (TE) for predicting severity of liver fibrosis in patients with chronic hepatitis B (CHB).Methods A total of 969 patients with CHB was enrolled and recruited for analysis,which had been received TE scan,including 258 patients of liver biopsy,and 117 patients of gastric endoscopy.Results A total of 35 patients was excluded from analysis due to TE failure or unreliable TE.Liver stiffness measurement (LSM) was independently influenced by bilirubin,AST,liver fibrosis and inflammation,ultrasonic score and albumin.TE predicted Child-Pugh C,B/C,liver fibrosis S4,≥S3 and ≥ S2 with respective area under receiver operating characteristics curves (AUROC)0.907 (95% CI 0.886-0.928 ),0.920 ( 95% CI 0.899-0.940 ),0.871 ( 95% CI 0.819-0.923 ),0.852(95%CI0.805-0.899) and 0.807(95% CI0.749-0.865),respectively.While LSM ＜32.2 kPa excluded Child-Pugh C with 99.4% probability,LSM ≥35.3 kPa determined Child-Pugh B/C with positive predictive value (PPV) 0.820.For compensated CHB,cut-offs of LSM 23.3,15.2 and 10.8 kPa diagnosed cirrhosis,liver fibrosis ≥S3 and ≥S2 with positive likelihood ratio nearly 10.0 and PPV 0.692,0.882 and 0.980,respectively; and cut-offs 8.8 kPa,6.6 kPa excluded cirrhosis,liver fibrosis ≥ S3 with negative likelihood ration nearly 0.1 and negative predictive value 0.977 and 0.903,respectively.Correlation coefficient between LSM and grades of esophageal varices was only 0.180,and AUROC for TE predicting EV was of no clinical value.ConclusionTE relatively make accurate prediction in the severity of liver fibrosis and classification of Child-Pugh.Patients with LSM ≥ 10.8 kPa should be considered for receiving antivirus treatment.
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The author explained the necessary of clinical case teaching for infectious disease teaching in clinical technical skill training,shortage of disease species and practice effect. Then,the author propounded his experience on how to practice the infectious disease clinical cases teaching,which included clinical cases selection,cases discuss and students’ clinical skill training.
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Objective To prepare the coating of dexamethasone-eluting intravascular stent and observe the features of its delayed release in vitro.Methods Spray painting and dipping coating were used respectively to prepare stent coating,and then high performance liquid chromatography(HPLC)was used to detect the drug loading.The stents prepared by dipping coating were set in a flow of 50 ml PBS buffer at a velocity of 20 ml/min,and 0.5 ml buffer was collected at 6 h and 1,2,4,6,8,10,12,15 d respectively with another 0.5 ml fresh PBS being added immediately.The drug content of the 0.5 ml buffer was detected by HPLC for drug sustained release in vitro.Results The drug loading of stents prepared by spray painting was(24.26?5.23)?g,while that stents prepared by dipping coating for 4 d was(93.15?7.83)?g.Drugs were released slowly and the release rate reached 84% at 15 d.Conclusion The dipping coating-prepared stents have evident effect of sustained release.
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<p><b>OBJECTIVE</b>To discuss the diagnostic value of ultrasonic examination in patients with early liver cirrhosis and the relation with different stages of liver fibrosis.</p><p><b>METHODS</b>In the series, 263 patients with chronic hepatitis B were under taken liver biopsy and ultrasonic examination of type B for determination of liver cirrhosis images, width of the main portal vein and the splenic vein, tumefaction of the spleen. Data were analysed statistically.</p><p><b>RESULTS</b>Sixties of 263 patients were diagnosed as early liver cirrhosis. The diagnostic sensitivity, specificity, misdiagnostic rate, missed diagnostic rate, and Jonden's index of ultrasonic examination for early liver cirrhosis were 52.5%, 88.3%, 11.7%, 47.5%, and 0.508, respectively. The width of the main portal vein with liver fibrosis of S1, S2, S3, and S4 were 10.93 mm +/- 1.25 mm, 11.35 mm +/- 1.06 mm,11.29 mm +/- 1.52 mm, and 11.4 8mm +/- 1.25 mm, respectively with statistic difference between S4 and S1 (P=0.03). The width of the spleen vein of S1, S2, S3, and S4 were 6.518 mm +/- 2.033 mm, 7.190 mm +/- 1.569 mm, 7.444 mm +/- 1.805 mm and 8.406 mm +/- 2.227 mm, respectively with statistic difference between S4 and S2 (P=0.035). The incidence of tumefaction of the spleen was increased with the degree of liver fibrosis.</p><p><b>CONCLUSIONS</b>The diagnostic sensitivity of ultrasonic examination for early liver cirrhosis is low. The width of the main portal vein, the spleen vein and the incidence of tumefaction of the spleen are related with the degree of liver fibrosis. The regeneration node of liver cirrhosis may contribute to the development of portal hypertension.</p>
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Hepatitis B, Chronic , Liver Cirrhosis , Diagnostic Imaging , Pathology , Portal Vein , Diagnostic Imaging , Pathology , Sensitivity and Specificity , Splenic Vein , Diagnostic Imaging , Pathology , Ultrasonography, Doppler, Color , MethodsABSTRACT
Objective To observe the effects of Jianpi Xiaopi extract on gastric secretion of experimental SD rats with spleen deficiency. Methods Animal model of spleen deficiency was established by using Rhubarb decoction. The gastric secretion was determined by titration method, and the gastrin in plasma was measured by radioimmunoassay. Results Compared with those in spleen deficiency group, the levels of the total acidity and the output of total acid were higher in the middle dose group treated with Jianpi Xiaopi extract ( P
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Triage is one of the important taches for the wounded whom is cured effectively under the condition to limited medical resource in public health emergency events.It is a decision based on doctrine rather than expediency.By the view of ethics,the article considered three doctrines: fairness,benthamism and scientific decision-making,which assures that the outcome of wartime triage at the sea is speedy and exact.