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Objective@#To investigate the clinical and laboratory features of patients with liver disease and positive anti-liver/kidney microsomal-1 (anti-LKM-1) antibody, and to provide a reference for clinical diagnosis and differential diagnosis.@*Methods@#The clinical data of patients with positive anti-LKM-1 antibody who were treated in our hospital from 2006 to 2016 were collected, and clinical and laboratory features were analyzed and compared. An analysis was also performed for special cases.@*Results@#The measurement of related autoantibodies was performed for about 100 thousand case-times, and 15 patients were found to have positive anti-LKM-1 antibody. Among the 15 patients, 7 were diagnosed with type 2 autoimmune hepatitis (AIH) with an age of 11.0 ± 9.0 years and were all adolescents with acute onset; 8 were diagnosed with hepatitis C with an age of 51.5 ± 9.0 years, among whom 7 were middle-aged patients and 1 was a child aged 12 years, and all of them had an insidious onset. Compared with the patients with hepatitis C, the AIH patients had significantly higher levels of alanine aminotransferase (1 003.9 ± 904.3 U/L vs 57.0 ± 84.1 U/L, P < 0.05), aspartate aminotransferase (410.7 ± 660.3 U/L vs 34.9 ± 42.9 U/L, P < 0.05), and total bilirubin (98.0 ± 191.0 μmol/L vs 15.4 ± 6.0 μmol/L, P < 0.05). There was a reduction in immunoglobulin G after the treatment with immunosuppressant, compared with the baseline. Of all 8 patients with hepatitis C, 6 received antiviral therapy with interferon and ribavirin, and 5 out of them achieved complete response, among whom 4 had a reduction in the level of anti-LKM-1 antibody after treatment; however, a 12-year-old child developed liver failure after interferon treatment and died eventually.@*Conclusion@#Positive anti-LKM-1 antibody is commonly seen in patients with type 2 AIH or hepatitis C, but there are differences between these two groups of patients in terms of age, disease onset, liver function, and the level of anti-LKM-1 antibody. The hepatitis C patients with a confirmed diagnosis and exclusion of autoimmune hepatitis can achieve good response to interferon under close monitoring, even if anti-LKM-1 antibody is positive. As for adolescent patients with hepatitis C and positive anti-LKM-1 antibody, the possibility of AIH should be excluded.
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ObjectiveTo analyze the clinical characteristics of drug-induced liver injury (DILI) accompanied by autoimmune phenomena and to provide evidence for clinical practice. MethodsAn analysis was performed on the clinical data of 51 patients who were admitted to Beijing You′an Hospital from 2011 to 2013 and diagnosed with DILI. The participants were divided into anti-nuclear antibody (ANA)-positive group and ANA-negative group and, according to the simple scoring system for autoimmune hepatitis (AIH), divided into low-score (sore: 1-4) group and high-score (score≥5) group, respectively. Comparison was made for laboratory parameters ［alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), albumin (Alb), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), prothrombin time (PT), immunoglobulin M(IgM), immunoglobulin A(IgA), immunoglobulin G(IgG)］, length of hospital stay, and recurrence. Comparison of normally distributed continuous data between groups was performed by t test, comparison of non-normally distributed continuous data between groups was made by rank-sum test, and comparison of categorical data between groups was conducted by chi-square test. Results Among the 51 patients, 34 cases were positive for ANA, and 17 cases were negative for ANA; 17 cases were in the high-score group, and 34 cases were in the low-score group. There were no significant differences in ALT, TBil, Alb, ALP, GGT, PT, and IgM between the two groups for both grouping criteria (all P＞0.05). AST and IgG differed significantly between the two groups for both grouping criteria (all P＜0.05). The IgG level and recurrence rate in the high-score group (3.87±1.73 g/L and 10/17) were significantly higher than those in the low-score group (2.75±1.38 g/L and 8/34) (both P＜0.05). ConclusionThe clinical manifestations are similar between patients with DILI alone and those with DILI accompanied by autoimmune phenomena. The simple scoring system for AIH is worthy of clinical application in DILI accompanied by autoimmune phenomena.
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ObjectiveTo investigate the correlation between clinical data and pathological stage in patients with primary biliary cirrhosis (PBC) and to provide guidance for clinical diagnosis and treatment. MethodsThe clinical data of 54 PBC patients were collected for analyzing the correlation between the clinical data and pathological stage. The clinical data included biochemical parameters, immunological markers, and autoantibodies. Biopsy of the liver was used for the pathological staging of PBC. For the continuous data of normal distribution, analysis of variance was applied for comparisons between groups; for continuous data of skewed distribution, Wilcoxon rank sum test was used. For categorical data, chi-square test was used. Correlation analysis was performed by Pearson correlation and logistic regression. ResultsAmong the 54 patients, the male-to-female ratio was 1∶5; the mean age was 48.9±9.3 years; pathological stage Ⅰ was identified in 15 cases, stage Ⅱ in 18 cases, stage Ⅲ in 12 cases, and stage Ⅳ in 9 cases, and patients with stage Ⅳ disease were significantly older than the other patients (P＜0.05). Total bilirubin (TBil), alkaline phosphatase, prothrombin time, IgA, IgG, and SP200 were positively correlated with pathological stage (r=0.592, 0.343, 0.281, 0.388, 0.274, and 0.320, respectively, P＜0.05), while a negative correlation was found between albumin and pathological stage (r=-0.569, P=0.000). Multivariate analysis revealed an independent correlation between TBil level and pathological stage (P=0.039). Patients with the same pathological stage might have different clinical stages, while those with the same clinical stage might have different pathological stages. ConclusionsThe same pathological stage may appear in different clinical stages. TBil level is an independent predictive factor for pathological stage in PBC patients.
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Objective To investigate the physical and mental development of small and appropriate for gestational age preterm infants in their early life. Methods This study recruited 220 preterm infants, who were discharged from our hospital and visited preterm following-up clinic at regular intervals from February 2009 to December 2012. All of those infants were divided into two groups based on whether their birth weight below 10th percentile for their gestational ages or not. Weights, lengths and head circumferences were measured up to seventh month age adjusted by gestational age. Meanwhile, mental tests were conducted by the professional staffs working on the children developmental assessment at their adjusted months of 5th, 6th or 7th. All of physical and mental scores were compared between the two groups. Results The SGA group was statistically less than the AGA group on the Z-score of weights from the ifrst to sixth month adjusted by gestational age (P0.05). The SGA group was statistically less than the AGA group on the Z-score of lengths from the ifrst to iffth month adjusted by gestational age (P0.05). The SGA group was statistically less than the AGA group on the Z-score of head circumferences from the ifrst to seventh month adjusted by gestational age (P<0.05). The SGA babies scored statistically less than the AGA babies with a mean development quotient score of 96.7 and 102.9, respectively (P<0.05). The scores of movement, cognitive, language in the SGA group were statistically less than those in the AGA group(P<0.05). Conclusions Preterm SGA could achieve satisfactory weight catch-up gain, with a decreasing difference from preterm AGA while they were getting older. But the length catch-up growth of preterm SGA seemed unsatisfactory with a big differece from preterm AGA. There was the worst catch-up on head circumference in those preterm SGA, backward in mental development, particularly in their movement, cognitive and language capacity.
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Objective To investigate the influences of pain on early neonatal neurobehavioral development Methods 65 newborn infants admitted to the Neonatal Intensive Care Unit( NICU )of our hospital from October,2009 to March,2010 were randomly chosen as the objects of this study.In light of Neonatal Behavioral Neurological Assessment( NBNA) revised by Professor Bao Xiulan,examinations were carried out before and after pain stimulation,and a statistical analysis of the results of the examinations was conducted.Results The total scores of NBNA before and after the pain stimulation were (36.49±1.73) vs.(34.80±1.79) respectively,demonstrating a significant difference.Specifically,after the pain stimulation,the scores of behavioral ability and active muscle tension decreased,with a very significant difference.However,there was no significant difference in terms of the scores of passive muscle tone,primitive reflexes and common reactions.Conclusions Neonatal pain exerts influences on early neurobehavioral development,particularly on behavioral ability and active muscle tension.The training of neonatal health care professionals in the management of and the intervention in neonatal pain should be strengthened in order to decrease the adverse effects of pain on neonates.
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Objective To explore the responses of antigen-specific T cells stimulated by hepatitis B virus(HBV)-specific proteins in chronic hepatitis B patients accepting antiviral therapy. Methods Seventeen patients with chronic hepatitis B (CHB) accepting antiviral therapy were included in this study. The peripheral blood monocular cell ( PBMC) were separated from the whole blood collected at the three different time of before and one and three months after accepting antiviral therapy. ELISPOT assay was used to detect the frequency and strength of secreting IFN-γ cells of PBMC stimulated by HBsAg, HBcAg and HBeAg. HBV virus loading, HBsAg, HBeAg, ALT and AST in serum were detected at the same time. Results After three months therapy, ALT, TBiL were improved in all patients, and HBV DNA level were dropped and undetectable in 11 cases. The rates of T cell response in patients to HBV specific proteins were 64. 7% , 76. 5% and 82. 4% at the time of before and one and three months after accepting antiviral therapy, respectively. The frequency of responses of antigen-specific T cells stimulated by HBcAg was higher than that stimulated by HBsAg or HBeAg, and the frequency was enhanced after antiviral therapy. The average response magnitude was expressed as spot forming cells (SFC) per million input cells. SFC of T cell responses to HBcAg was also higher than to HBsAg or HBeAg. There was no significant difference in SFC of T cell responses to HBsAg or HBeAg at the time of before and after antiviral therapy, but there were significant difference in SFC of T cell responses to HBcAg at the time of before and after antiviral therapy. SFC of T cell responses to HBcAg was negatively associated with HBV DNA, and no associated with level of ALT in serum. Conclusion The responses of antigen-specific T cells were improved in CHB patients accepting antiviral therapy which associated with the decrease of HBV DNA. It suggested to investigate HBV specific T cell responses was important.
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Objective To understand the level of neonatal pain knowledge and attitudes of neonatal and obstetric department nurses, in order to supply the clinical basis for neonatal pain management. Methods Self-designed questionnaires to fill out on-site were distributed to 107 neonatal and obstetric department nurses (of which 40 were from neonatal department, 67 from obstetric department) for neonatal pain knowledge and attitudes. Results About question of neonatal pain, the average percentage of correct answers in the neonatal group was 75.5%, higher than 66.3% of the obstetric group, in the neonatal group, correct rate of seven questions was more than 80%,while in the obstetric group the correct rate of only one question was more than 80%, and 5 questions correct response rate was significantly lower than that of the neonatal group, the difference was significant. All nursing staff considered it essential or necessary to carry out the nursing knowledge of pain-related training. 95.0%(38/40) of neonatal nurses believed that they could properly assess the extent of neonatal pain, but only 83.6% (56/67) for the obstetric group, the difference between the two groups was significant. 97.5% (39/40) of neonatal nurses believed that they could make the right judgments on neonatal crying, and only 85.1%( 57/67) in the obstetric nurses, the difference between the two groups was significant.Conclusions Neonatal pain has gradually been recognized and paid attention to by the clinical front-line medical staff, they believe that it is necessary to receive training on neonatal pain, knowledge of neonatal pain of neonatal nurses is better than obstetric nurses.
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Objective To investigate the influencing factors of pain and the changes of vital signs in newborn infants. Methods Forty two newborn infants were rated by the behavioral scale of acute pain in newborn infants. The scores of pain were compared among infants with different gender,gestational age,birth weight,birth age,type of puncture and whether by vaginal birth or not. At the same time,the respiration rate,heart rate,blood pressure and oxygen saturation (SO2)were dynami-cally recorded by the multi-function monitor in the process of puncture. Results The average score of pain was 7.6. There was no significant difference among newborn infants with different gender,gestational age,birth weight and type of puncture(P> 0.05),while significant differences among infants with different birth age and whether by vaginal birth or not (P=0.015 and 0.043 respectively). In the process of puncture,the SO2 was significantly decreased,while the respiration rate,heart rate,sys-tolic and diastolic blood pressure were significantly increased. Conclusions Pain is prevalent in newborn infants and accom-panied by obvious changes of vital signs. The means of childbirth and birth age have significant influence on the neonatal pain. It is suggested to pay close attention to the neonatal pain and take effective interventions.
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Objective To study clinical features and mechanism in patients suffered from chronic hepatitis B achieving seroconversion of HBsAg by combination treatment with interferon (IFN) and nucleoside analogue (NA). Methods Thirty-two cases with chronic HBV hepatitis were enrolled into this retrospective study. All of them received combination treatment with IFN and Lamivudine/Adefovir, as well as achieved seroconversion of HBsAg from June, 2001 to May, 2007. All the cases in this study were followed up. Results Generally, serum HBV DNA fell below the detection limit 3 to 6 months after starting combination treatment. Virological breakthrough/relapse or new clinical resistant had not been found in all enrolments after combination treatment, including patients with previous resistant to Lamivudine, although the average length of treatment was over 2 years. The average period of following up after seroconversion of HBsAg was 13.2 months. Two cases transfered back to HBsAg positive, one of them achieved seroconversion of HBsAg again by the anti-virus treatment, and the other one gave up treatment and remained anti-HBe positive and HBeAg negative.The other 30 eases kept at the stage of seroconversion of HBsAg. Seven patients underwent liver biopsy after seroconversion of HBsAg, and 3 of them had taken liver biopsy before combination therapy too. Biopsy specimens were scored for fibrosis and neeroinflammation according to the Knodell histological activity index. Six cases showed HBsAg and HBcAg negative by immunohistochemistry,and only 1 case with HBsAg positive in liver tissue experienced relapse. Inflammation and fibrosis grade of the 3 cases who had taken liver biopsy twice were lowered after HBsAg seroconversion,although the ALT level of 1 case who had turned from G2S4 to GIS2-3 remained abnormal after HBsAg seroconversion. According to the sequence and character of HBsAg seroconversion, there were three models of HBsAg conversion. The sequence of transition was HBV DNA→HBeAg→HBsAg,which was dominant one, accounting for 59%(19/32 cases). HBV DNA negative, and the titer of HBeAg wandering at a low level, after then HBeAg and HBsAg change to negative in the same time,31% (10/32 cases). The titer of HBsAg decreased rapidly after the HBV DNA clearance, and the HBsAg clearance was earlier than HBeAg, 9% (3/32 cases). After 1 year of combination therapy,there were 15 of 21 cases (71.4%) whose titer HBsAg showed less than 100 COI by agent from Roche, and 7 of 11 cases (63.6%) whose titer HBsAg showed less than 250 IU/L by agent from Abbott. The frequency of adverse reaction was similar with that induced by IFN monotherapy, and no new adverse reaction was found. Conclusions Combination therapy and long course treatment might be the key to achieve the HBsAg seroconversion. Those with HBsAg in liver tissue and (or) low serum anti-HBs are more likely to relapse. The titer of HbsAg<100 COI (Roche, Germany) or<250 IU/L (Abbott, USA) after one year treatment may be regarded as a predict index of HBsAg seroconversion.
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Objective To determine the susceptibility of yeasts and to explore the antifungal m echanismof Lisea cubeba oil,so as to provide evidence for the development of antifungal medicinal herbs.Methods The minimuminhibitory concentrations(MIC)of Lisea cubeba oil and fluconazole were determined by broth microdilution method according to the National Com mittee on Clinical Laboratory Standards(NCCLS)reference method for broth dilution antifungal susceptibility testing of yeasts.Ultra-structur al changes of C.krusei were observed by electron microscopy before and after Lisea cubeba oil treatment.Results Five previously identified quality control(QC)strains(Candida albicans,Candida tropical is,Candida glabrata,Candida parapsilosis,Candida krusei)were susceptible to Lisea cubeba oil,their MICs were 14.14?3.64?g /mL,23.22?2.85?g /mL,31.24?2.88?g /mL,76.19?4.40?g /mL,28.30?2.54?g /mL,respectively.After treatmen t with Lisea cubeba oil the mor-phology and ultrastructure of Candida krusei showed obvious changes:their cell wall and cytoplasmic membrane ruptured;intracellar components dissolved;organellae swollen and di ssolved.There were no changes observed in the morphology and ultrastructure of C.krusei treated with fluconazole.Conclusions The data indicate that Lisea cubeba oil has antifungal effect not only on C.albican and other medically important Candida spp.,but also on fluconazole resistant isolates such as C.krusei and thus has great clinical importan ce.The antifungal mechanismof Lisea cubeba oil may be that the structure of cell w all and cell membrane of C.krusei being inhibited.