Risk factors for hepatocellular cancer occurrence in patients with primary biliary cholangitis / 中国肿瘤临床

To investigate the potential risk factors for hepatocellular carcinoma in primary biliary cholangitis (PBC) patients. Methods:The data of 670 PBC inpatients between January 2011 and December 2016 were collected from the database of The First Affiliated Hospital of Zhengzhou University. The potential risk factors were evaluated, and odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed by univariate (unadjusted OR) and multivariate [adjusted OR (AOR)] conditional Logistic regression. Results: In total, 35 PBC patients developed liver carcinoma (5.2%); of these, 4 patients (female) were excluded because of incomplete data for influencing factors and 6 (2 male; 4 female) were excluded as they were diagnosed with hepatocellular carcinoma (HCC) during or before PBC. Therefore, 25 patients were included in the case-control study. Male patients were more likely than female patients to show alcohol in-take, smoking, a family history of malignancy, and serious liver injury (all P<0.05), indicated by the increasing levels of alanine amino-transferase (ALT), aspartate aminotransferase (AST), and gamma glutamyl transferase (GGT) (P<0.05). Conditional Logistic regression analysis revealed that body mass index (BMI) ≥25 kg/m2 (AOR=1.015, 95% CI: 1.001-1.257, P=0.032) and history of alcohol intake (AOR=10.014, 95% CI: 1.009-91.071, P=0.039) were significantly associated with increased odds of HCC development in PBC patients. Conclusions:The risk factors for PBC-associated liver carcinoma include BMI≥25 kg/m2 and history of alcohol intake. In addition to regular monitoring, PBC patients may benefit from alcohol abstinence and body weight control.

Clinical features of autoimmune liver disease complicated by abdominal lymphadenectasis / 临床肝胆病杂志

Objective To investigate the clinical features of autoimmune liver disease (AILD) complicated by abdominal lymphadenectasis (LA),as well as the clinical significance of LA in AILD.Methods A retrospective analysis was performed for the clinical data of 252 patients who were admitted to The First Affiliated Hospital of Dalian Medical University from January 2005 to April 2016,and among these patients,52 had autoimmune hepatitis (AIH),174 had primary biliary cholangitis (PBC),and 26 had AIH-PBC overlap syndrome (AIH-PBC OS).A total of 78 patients underwent follow-up.According to the presence or absence of LA,these patients were divided into LA group with 70 patients and non-LA (NLA) group with 182 patients.As for general information,laboratory markers,imaging findings,and follow-up results,the normally distributed continuous data were expressed as mean ± SD,and the t-test was used for comparison between groups;the non-normally distributed continuous data were expressed as median,and the Wilcoxon rank sum test was used for comparison between groups.The categorical data were expressed as rates,and the chi-square test,the corrected chi-square test,or the Fisher's exact test was used for comparison of these data between groups.Results There were no significant differences between the two groups in age,sex ratio,proportion of patients who were diagnosed due to abnormal liver function found by physical examination,and incidence rates of other autoimmune diseases.The incidence rate of abdominal LA was 22％ (11/52) in the AIH group,26.4％ (46/174) in the PBC group,and 50％ (13/26) in the AIH-PBC OS group,and the AIH-PBC OS group had a significantly higher incidence rate than the AIH group and the PBC group (x2 =7.693,P =0.021).The LA group had significantly higher levels of alkaline phosphatase and gamma-glutamyl transpeptidase (GGT) than the NLA group (Z =2.944 and 3.169,P =0.003 and 0.002).For the patients with PBC,the LA group had a significantly higher level of GGT than the NLA group (Z =2.136,P =0.033);for the patients with AIH-PBC OS,the LA group had a significantly higher level of total bilirubin thau the NLA group (Z =2.121,P =0.035);for the patients with AIH,there were no significant differences in these indices between the LA group and the NLA group.The LA group had a higher incidence rate of abnormal imaging findings than the NLA group (97.1％ vs 81.9％,x2 =9.863,P =0.002).A total of 78 patients were followed up with a median follow-up time of 18 months.Of all patients in the LA group,6 (23.1％) achieved complete remission,7 (26.9％) achieved incomplete response,1 (3.8％) experienced recurrence,and 12 (46.2％) experienced treatment failure;of all patients in the NLA group,21 (40.4％) achieved complete remission,17 (32.7％) achieved incomplete response,7 (13.5％) experienced recurrence,and 7(13.5％) experienced treatment failure;there was a significant difference in the distribution of treatment outcomes between the LA group and the NLA group (Z =2.406,P =0.016).Conclusion Patients with AIH-PBC OS have a higher incidence rate of abdominal LA than those with AIH and PBC,and patients with AILD complicated by LA may have marked cholestasis and liver impairment and poor treatment response,suggesting that LA might be used to determine disease severity and judge prognosis.

Pasta base, cocaína y deterioro psicosocial: Estudio comparativo en una muestra local de usuarios / Pasta base, cocaine and psychosocial deterioration: A comparative study in a local sample of drug users

OBJETIVOS: Comparar el deterioro psicosocial experimentado por los usuarios de pasta base de cocaína (PBC) y clorhidrato de cocaína en función de los datos recolectados en las fichas de admisión de un centro de tratamiento ambulatorio de la ciudad de Buenos Aires. MÉTODO: Se analizaron estadísticamente las diferencias entre ambos grupos de usuarios respecto a la frecuencia de consumo, tenencia de causas penales, nivel educativo alcanzado, cantidad de tratamientos previos al momento de la entrevista de admisión, situación laboral, lugar de residencia y tenencia de obra social. Se calculó la intensidad de la asociación entre estas tres últimas y el resto de las variables, así como la intensidad de asociación entre la sustancia de preferencia y todas las demás variables. RESULTADOS: Se hallaron diferencias estadísticamente significativas entre los usuarios de PBC y cocaína respecto a algunas de las variables seleccionadas. Se observan diferencias semejantes entre los pacientes con empleo y los desempleados, independientemente del tipo de sustancia consumida. CONCLUSIONES: Los resultados permiten inferir un mayor nivel de deterioro psicosocial en los usuarios de PBC en comparación con los consumidores de cocaína. No obstante, esta diferencia es leve y podría atribuirse a ciertas condiciones sociales de exclusión. Además, los resultados permiten cuestionar ciertos prejuicios comunes asociados al consumo de PBC.

Suppressive effects of bezafibrate on proliferation and cytokine production by CD4+T cells from patients with primary biliary cirrhosis / 中国免疫学杂志

Objective:To investigate the effects of bezafibrate (BF) on the activation,proliferation and differentiation of CD4+T cells from primary biliary cirrhosis ( PBC) patients and to elucidate the mechanisms for the immunosuppressive effects of BF and to further provide experience basis for BF target therapy PBC.Methods:PBMCs were isolated from PBC patients then CD 4+T cells were selected by MACS, and stimulated with anti-CD3, anti-CD28, in the presence of different concentration of BF.The cytokines were measured by ELISA,and the activation,proliferation and differentiation of CD4+T cells were analyzed by flow cytometry.Results:(1) BF could inhibit the activation of CD 4+T cells in PBC patients.(2) BF could inhibit the proliferation of CD 4+T cells in PBC patients in a dose-dependent manner (P<0.05).(3)BF could down-regulation IFN-γand IL-17 production of CD4+T cells in a dose-dependent manner ( P<0.05 ).Conclusion: BF could inhibit immune responses of PBC patients by suppressing CD 4+T cells activation;proliferation and cytokine production.

A Comparative Evaluation of the Performances of Anti-MIT3, Anti-gp210, and Anti-sp100 Antibodies for the Diagnosis of Primary Biliary Cirrhosis

BACKGROUND: Anti-mitochondrial antibody (AMA) is a serological hallmark of primary biliary cirrhosis (PBC). AMAs are detected by an immunofluorescence assay (IF), which is subject to errors. We evaluated the diagnostic performances of the AMA ELISA test (the anti-MIT3 antibody) and PBC-associated antinuclear antibody (ANA) tests (the anti-gp210 and anti-sp100 antibodies). METHODS: AMA, anti-gp210, and anti-sp100 were measured in the sera of 130 subjects including patients for whom the AMA test was requested with the clinical suspicion of PBC, patients with other autoimmune diseases, and those undergoing health check-ups. AMA was detected by both IF and ELISA (anti-MIT3 antibodies), and anti-gp210 and anti-sp100 were detected by ELISA. The diagnostic performances of the anti-MIT3, anti-gp210, and anti-sp100 were compared with that of the AMA IF test. Associations between the presence of anti-sp100 or anti-gp210 and the diagnosis and biochemical abnormalities of PBC were investigated. RESULTS: The area under the curve of anti-MIT3 for the diagnosis of PBC was 0.934 (95% confidence interval, 0.877-0.970), and the agreement between anti-MIT3 and AMA IF was 93.8% (kappa, 0.82). The sensitivities of anti-MIT3 and AMA IF were both 100%, and the specificities were 83.1% and 81.4%, respectively, whereas the sensitivities of anti-gp210 and anti-sp100 were 41.7% and 16.7%, and their specificities were 94.9% and 97.5%, respectively. The presence of anti-gp210 was associated with the diagnosis of PBC (P=0.0001), but that of anti-sp100 was not. CONCLUSIONS: The diagnostic performance of anti-MIT3 is comparable to that of AMA IF. Anti-gp210 seems to be complementary to AMA for the diagnosis of PBC.

Comparison of Intensity Modulated Radiation Therapy Dose Calculations with a PBC and AAA Algorithms in the Lung Cancer / 의학물리

The pencil beam convolution (PBC) algorithms in radiation treatment planning system have been widely used to calculate the radiation dose. A new photon dose calculation algorithm, referred to as the anisotropic analytical algorithm (AAA), was released for use by the Varian medical system. The aim of this paper was to investigate the difference in dose calculation between the AAA and PBC algorithm using the intensity modulated radiation therapy (IMRT) plan for lung cancer cases that were inhomogeneous in the low density. We quantitatively analyzed the differences in dose using the eclipse planning system (Varian Medical System, Palo Alto, CA) and I'mRT matirxx (IBA, Schwarzenbruck, Germany) equipment to compare the gamma evaluation. 11 patients with lung cancer at various sites were used in this study. We also used the TLD-100 (LiF) to measure the differences in dose between the calculated dose and measured dose in the Alderson Rando phantom. The maximum, mean, minimum dose for the normal tissue did not change significantly. But the volume of the PTV covered by the 95% isodose curve was decreased by 6% in the lung due to the difference in the algorithms. The difference dose between the calculated dose by the PBC algorithms and AAA algorithms and the measured dose with TLD-100 (LiF) in the Alderson Rando phantom was -4.6% and -2.7% respectively. Based on the results of this study, the treatment plan calculated using the AAA algorithms is more accurate in lung sites with a low density when compared to the treatment plan calculated using the PBC algorithms.

Diagnóstico diferencial en consumidores de pasta base de cocaína (PACO): la admisión de pacientes para un tratamiento posible / Differential diagnosis consumers of pasta base of cocaine: the admission of patients for a possible treatment

En la investigación "Alcances de la aplicación del modelo de reducción de daños al campo asistencial en las adicciones" (Alicia Donghi), ubicamos la siguiente particularidad: ciertos usuarios de sustancias "resistían" con sus cuerpos el Ideal de la ciencia del siglo XXI: la salud, el bienestar. Algunos pacientes adictos se presentaban con niveles de deterioro mental y corporal, debido a la ingesta o la abstinencia de sustancias duras. Nuestra tarea en la función pública y en la atención por obras sociales nos exige el diagnóstico según el DSM-IV. En muchas becas de derivación para internación de usuarios de PBC el rotulo de "Psicosis" abunda, a pesar de haber sido entrevistados bajo efectos"tóxicos" del consumo. Así comenzó nuestra investigación sobre diagnóstico diferencial de psicosis según el psicoanálisis y el DSM-IV, a in de garantizar al consultante la derivación a un dispositivo acorde a su patología de base, para un tratamiento posible.

In the research "Scope of the application of the model of harm reduction to the health care ield in addiction" (Alicia Donghi), are located the following peculiarity: certain users of substances "resisted" with their bodies the Ideal of the science of the 21st century: health, well-being. Some addicted patients presented with levels of mental and physical, deterioration due to the intake or the withdrawal of harsh substances. Our task in the public service and care by social work requires us according to the DSM-IV diagnosis. In many scholarships for placement of PBC users bypass the tagline of "Psycho" abounds, despite having been interviewed under "toxic" effects of consumption. Thus began our research on differential diagnosis of psychosis in psychoanalysis and the DSM-IV, in order to ensure the consultant referral to a device according to their pathology of basis, for a possible treatment.

Non-Hodgkin's lymphoma & primary biliary cirrhosis with Sjogren's syndrome

Sjogren's syndrome (SS) is an autoimmune disease characterized by a lymphocytic infiltration of the salivary and lacrimal glands leading to a progressive destruction of these glands due to the production of autoantibodies. This disorder is either isolated (primary SS) or associated with other systemic diseases (secondary SS). The occurrence of B-cell non-Hodgkin's lymphoma (NHL) represents the major complication in the evolution of SS patients. The risk of developing NHL, which is equivalent for both primary and secondary SS, was estimated to be 44 times greater than that observed in a comparable normal population. NHLs in SS patients occur preferentially in the salivary glands and in other mucosa-associated lymphoid tissues (MALT). However, it can also occur in the lymph nodes or bone marrow. We documented a case of low-grade B-cell lymphoma of MALT in the right eyelid and primary biliary cirrhosis (PBC) of a patient with SS. To the best of our knowledge, this is the first case reported in Korea.

Expression of a recombinant branched chain alpha-oxo acid dehydrogenase complex E2 (BCOADC-E2) in insect cells and its immunoreactivity to autoimmune sera

Preparation of a pure autoantigen by way of recombinant DNA technology has an important value in an accurate diagnosis or prognosis of an autoimmune disease. BCOADC-E2 subunit, a mitochondrial protein, has been known to be the autoantigen of primary biliary cirrhosis (PBC), a chronic autoimmune liver disease, as well as idiopathic dilated cardiomypathy (IDCM), a chronic autoimmune heart disease. Recombinant form of this molecule had been expressed in E. coli but with low yield and severe degradation. Furthermore, sera from IDCM patients failed to recognized BCOADC-E2 molecule produced in prokaryotic expression system. In this study, a recombinant bovine BCOADC-E2 fusion protein has been expressed in insect cells using baculovirus expression system and analyzed anti-BCOADC-E2 reactivity in sera from patients with PBC or with IDCM. Optimal production of the recombinant fusion protein has been achieved at 20 multiplicity of infection (MOI), and the protein was affinity-purified using metal-binding resins. The affinity-purified BCOADC-E2 protein was successfully recognized by sera from PBC patients, but not by sera from IDCM patients suggesting that the different auto-immune response against BCOADC-E2 is needed to be elucidated in terms of epitope recognition.