Application of Global Leadership Initiative on Malnutrition criteria in patients with liver cirrhosis / 中华医学杂志(英文版)

BACKGROUND@#The Global Leadership Initiative on Malnutrition (GLIM) criteria were published to build a global consensus on nutritional diagnosis. Reduced muscle mass is a phenotypic criterion with strong evidence to support its inclusion in the GLIM consensus criteria. However, there is no consensus regarding how to accurately measure and define reduced muscle mass in clinical settings. This study aimed to investigate the optimal reference values of skeletal muscle mass index for diagnosing sarcopenia and GLIM-defined malnutrition, as well as the prevalence of GLIM-defined malnutrition in hospitalized cirrhotic patients.@*METHODS@#This retrospective study was conducted on 1002 adult patients with liver cirrhosis between January 1, 2018, and February 28, 2022, at Beijing You-An Hospital, Capital Medical University. Adult patients with a clinical diagnosis of liver cirrhosis and who underwent an abdominal computed tomography (CT) examination during hospitalization were included in the study. These patients were randomly divided into a modeling group (cohort 1, 667 patients) and a validation group (cohort 2, 335 patients). In cohort 1, optimal cut-off values of skeletal muscle index at the third lumbar skeletal muscle index (L3-SMI) were determined using receiver operating characteristic analyses against in-hospital mortality in different gender groups. Next, patients in cohort 2 were screened for nutritional risk using the Nutritional Risk Screening 2002 (NRS-2002), and malnutrition was diagnosed by GLIM criteria. Additionally, the reference values of reduced muscle mass in GLIM criteria were derived from the L3-SMI values from cohort 1. Multivariate logistic regression analysis was used to analyze the association between GLIM-defined malnutrition and clinical outcomes.@*RESULTS@#The optimal cut-off values of L3-SMI were 39.50 cm 2 /m 2 for male patients and 33.06 cm 2 /m 2 for female patients. Based on the cut-off values, 31.63% (68/215) of the male patients and 23.3% (28/120) of the female patients had CT-determined sarcopenia in cohort 2. The prevalence of GLIM-defined malnutrition in cirrhotic patients was 34.3% (115/335) and GLIM-defined malnutrition was an independent risk factor for in-hospital mortality in patients with liver cirrhosis ( Wald = 6.347, P  = 0.012).@*CONCLUSIONS@#This study provided reference values for skeletal muscle mass index and the prevalence of GLIM-defined malnutrition in hospitalized patients with liver cirrhosis. These reference values will contribute to applying the GLIM criteria in cirrhotic patients.

LONP1 ameliorates liver injury and improves gluconeogenesis dysfunction in acute-on-chronic liver failure / 中华医学杂志(英文版)

BACKGROUND@#Acute-on-chronic liver failure (ACLF) is a severe liver disease with complex pathogenesis. Clinical hypoglycemia is common in patients with ACLF and often predicts a worse prognosis. Accumulating evidence suggests that glucose metabolic disturbance, especially gluconeogenesis dysfunction, plays a critical role in the disease progression of ACLF. Lon protease-1 (LONP1) is a novel mediator of energy and glucose metabolism. However, whether gluconeogenesis is a potential mechanism through which LONP1 modulates ACLF remains unknown.@*METHODS@#In this study, we collected liver tissues from ACLF patients, established an ACLF mouse model with carbon tetrachloride (CCl 4 ), lipopolysaccharide (LPS), and D-galactose (D-gal), and constructed an in vitro hypoxia and hyperammonemia-triggered hepatocyte injury model. LONP1 overexpression and knockdown adenovirus were used to assess the protective effect of LONP1 on liver injury and gluconeogenesis regulation. Liver histopathology, biochemical index, mitochondrial morphology, cell viability and apoptosis, and the expression and activity of key gluconeogenic enzymes were detected to explore the underlying protective mechanisms of LONP1 in ACLF.@*RESULTS@#We found that LONP1 and the expressions of gluconeogenic enzymes were downregulated in clinical ACLF liver tissues. Furthermore, LONP1 overexpression remarkably attenuated liver injury, which was characterized by improved liver histopathological lesions and decreased serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in ACLF mice. Moreover, mitochondrial morphology was improved upon overexpression of LONP1. Meanwhile, the expression and activity of the key gluconeogenic enzymes were restored by LONP1 overexpression. Similarly, the hepatoprotective effect was also observed in the hepatocyte injury model, as evidenced by improved cell viability, reduced cell apoptosis, and improved gluconeogenesis level and activity, while LONP1 knockdown worsened liver injury and gluconeogenesis disorders.@*CONCLUSION@#We demonstrated that gluconeogenesis dysfunction exists in ACLF, and LONP1 could ameliorate liver injury and improve gluconeogenic dysfunction, which would provide a promising therapeutic target for patients with ACLF.

Analysis of uranium concentration in surface water and drinking water in Beijing, China / 中国辐射卫生

Objective To explore the uranium concentration in surface water and drinking water in Beijing, China and the relationship between uranium concentration and gross α activity concentration. Methods Water samples were collected from 16 districts in Beijing. Uranium concentration and gross α activity concentration were measured with WGJ-III trace uranium analyzer and LB6008 six-channel α/β counter using the ultraviolet fluorescence and thick source methods. Results The uranium concentrations in surface water and drinking water were 1.131 and 1.572 μg/L, respectively. The gross α activity concentrations in surface water and drinking water were 0.059 and 0.074 Bq/L, respectively. There were no significant differences in uranium concentration and gross α activity concentration between surface water and drinking water (P > 0.05). The uranium concentration was positively correlated with the gross α activity concentration, with a correlation coefficient of 0.700 (P < 0.05). The gross α activity concentration was determined by the uranium concentration with a determination coefficient of 48%. The committed effective dose of 238U in drinking water was between 3.284 × 10−5 and 1.640 × 10−3 mSv, with an average value of 5.400 × 10−4 mSv. Conclusion The uranium concentration and gross α activity in the surface water and drinking water in Beijing fluctuate and remain in the background range. These values are much lower than the recommended limits of 0.03 mg/L and 0.5 Bq/L stipulated in the GB 5749-2021 Standard for Drinking Water Quality. The annual committed effective dose of 238U through drinking water ingestion is very small.

Analysis of Biomechanical Characteristics of Lower Limbs During Stair Descent in Patients with Hemiplegia / 医用生物力学

Objective To conduct a comparative analysis of the biomechanical characteristics of the lower limbs during stair descent in patients with hemiplegia using different method to provide theoretical references for reducing fall risk during stair descent.Methods Ten healthy subjects and 20 patients with hemiplegia were selected,and their kinematic and dynamic data during stair descent were collected using the Qualisys Motion capture system and the Kistler three-dimensional dynamometer.Their biomechanical characteristics and fall risks were also analyzed.Results Compared with that of healthy subjects and patients that step on the healthy side(SHS),the range of motion(ROM)of the affected side in the lower-limb joints of patients that step on the affected side(SAS)was smaller.SHS reduced the flexion and extension ranges of the healthy side of the knee joint,and the ROM of the affected side in the lower-limb joints of SHS patients was greater than that of SAS patients.The ground reaction force(GRF)curve changes of SAS patients in left and right directions during stair descent were relatively consistent with those of normal subjects.The maximum vertical GRF of the affected side in SAS patients at the moment of landing was 1.05 times the body weight,whereas that of the healthy side was 1.25 times the body weight,which was lower than that of normal subjects(1.5 times the body weight).The maximum vertical GRF of the healthy side in SHS patients at the moment of landing was 1.85 times the body weight,which was higher than that of SAS patients and normal subjects.Conclusions Compared with that of SAS patients,the affected limb side of SHS patients has a greater ROM and vertical GRF at the moment of landing during stair descent,making SHS difficult to master.SAS is most consistent with the biomechanical characteristics during stair descent of patients with hemiplegia.

An analysis of the results of the national assessments of gamma spectrometry of radionuclides, 2014-2021 / 中国辐射卫生

Objective To ensure the accuracy of gamma spectrometer in our laboratory for the analysis of radionuclides in samples and to improve the laboratory personnel’s ability to perform analyses of radionuclides. Methods Our laboratory had continuously participated in the national assessments of gamma spectrometry of radionuclides organized by the Chinese Center for Disease Control and Prevention. The samples were measured by a high-purity germanium gamma spectrometer (GEM-MX7080P4). An analysis was performed on the results of the gamma spectrometry assessments from 2014 to 2021. Results Our laboratory had an overall qualified rate of 100% (8/8) and an overall excellent rate of 39% (3/8) in the gamma spectrometry assessments from 2014 to 2021. The distribution ranges of RD, Z, U, and Urel for 28 measurements involving radionuclides 208Tl, 228Ac, 232Th, 40K, 238U, and 137Cs were −11.82% to 5.97%, −0.59 to 0.30, 0.02 to 0.92, and 4.33% to 10.49%, respectively. Conclusion The methods used in our laboratory for gamma spectrometry of radionuclides are accurate and the testing reports issued by our laboratory are reliable.

Study on the comprehensive effect of splenectomy on liver cirrhosis / 中华肝胆外科杂志

Objective:To study the impact and the mechanism of splenectomy combined with pericardial devascularization on cirrhotic livers.Methods:Serum samples and clinical data were collected preoperatively and postoperatively from 54 patients with cirrhosis who underwent splenectomy combined with pericardial devascularization from May 2013 to Oct 2014 at Beijing You’an Hospital, Capital Medical University. Changes in hepatic arterial and portal venous blood flow, liver function and fibroscan results were analyzed. The levels of nitric oxide (NO), endothelin-1 (ET-1), interleukin-6 (IL-6), hepatocyte growth factor (HGF), transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase 1 (MMP1) were measured.Results:There were 31 males and 23 females, aged(45.48±10.21)years. Free portal vein pressure decreased significantly from (37.0±7.1) cmH 2O (1 cmH 2O=0.098 kPa) to (26.1±5.7) cmH 2O after surgery ( P<0.05). Significant increases in postoperative lumen diameter (4.0±1.0) mm vs (3.1±0.7) mm were observed, accompanied by increase in peak flow velocity and blood flow of the hepatic artery. Significant deductions in lumen diameter (11.9±2.0) mm vs (13.1±1.9) mm, accompanied by reduction of peak flow velocity and blood flow of the portal vein were observed following surgery (all P<0.05). The NO level was significantly elevated immediately after splenectomy and was subsequently remained at high levels. The ET-1 level decreased 2 days after surgery and became fluctuated at low levels. The IL-6 and HGF levels increased significantly 2 days after surgery and decreased gradually after 7 days and 1 month, respectively. The TGF-β1 and the MMP1 levels increased after surgery. The endotoxin level decreased significantly after surgery (all P<0.05). Conclusion:Splenectomy combined with pericardial devascularization induced hepatic blood flow restoration, hepatocyte regeneration and reversal of fibrosis in cirrhotic livers. Splenectomy has a protective effect on cirrhotic liver when combined with pericardial devascularization.

A study on the correlation between serum branched-chain amino acid levels and disease severity in alcoholic liver cirrhosis patients / 中华临床营养杂志

Objective:To characterize the serum branched-chain amino acid (BCAA) and aromatic amino acid profiles in patients with alcoholic liver cirrhosis (ALC).Methods:Forty patients with ALC were recruited into the study group, twenty patients with hepatitis B-induced liver cirrhosis (HBV-LC) and ten healthy subjects (HC) were recruited as controls from August 2017 to August 2019 in Beijing YouAn Hospital, Capital Medical University. The serum concentrations of isoleucine, leucine, valine, phenylalanine and tyrosine were determined by ultra-fast liquid chromatography tandem quadrupole mass spectrometry (LC-MS/MS) and Fischer ratio was also calculated for the three groups.Results:The serum isoleucine concentration in the study group [(23.74±8.81) μmol/L] was significantly lower than that in the HBV-LC group [(30.85±8.70) μmol/L, P = 0.031] and the HC group [(61.51±23.06) μmol/L, P < 0.01]. The serum leucine concentration in the study group [(127.99±38.54) μmol/L] was significantly lower than that in the HC group [(153.70±11.88) μmol/L, P = 0.036] and was not significantly different compared with the HBV-LC group [(126.70±31.00) μmol/L, P = 0.890]. The concentration of valine in the study group was (39.56±10.51) μmol/L, which was significantly lower than that in the HBV-LC group [(124.71±45.00) μmol/L, P < 0.01] and the HC group [(164.23±37.16) μmol/L, P < 0.01]. The concentration of phenylalanine in the study group was (141.19±29.35) μmol/L, which was significantly higher than that in the HBV-LC group [(116.07±21.52) μmol/L, P = 0.001] and the HC group [(80.94±7.16) μmol/L, P < 0.001]. Fischer ratio in the study group was significantly lower (1.17±0.34) than that in the HBV-LC group (2.07±0.66, P < 0.01) and the HC group (3.36±0.50, P < 0.01). Along with liver function deteriorating from Child-Pugh grade A to C, the isoleucine, leucine and valine levels in the study group decreased gradually. Fischer ratios in subgroups with Child-Pugh grade C and B liver function were 1.01±0.22 and 1.15±0.32, respectively, significantly lower than that in Child-Pugh grade A subgroup (1.52±0.38, P = 0.001 and P = 0.008). Conclusions:Serum BCAA levels and Fischer ratio decreased significantly in ALC patients, which were more prominent in patients with Child-Pugh grade B and C liver function. In Child-Pugh grade A patients, the decline of Fischer ratio developed earlier than the decrease of serum albumin. Monitoring of BCAA level changes should be an important component in nutritional intervention in ALC patients.

Interpretation of the European Society for Clinical Nutrition and Metabolism micronutrient guideline (2022) / 中华临床营养杂志

Micronutrient (MN) deficiency is common in many acute and chronic diseases and should be monitored and managed. In February 2022, the European Society for Clinical Nutrition and Metabolism (ESPEN) released the MN guidelines. This guideline aimed to inform the evaluation, monitoring and treatment principles in MN management as part of daily clinical nutrition practice with standardized terminology to avoid confusion. Extensive literature review was conducted covering multiple databases including Medline, PubMed, Cochrane, Google Scholar, and CINAHL databases. For each kind of MN, information was summarized concerning main functions, optimal detection methods, susceptibility to inflammation, potential toxicity and recommended dose for supplementation via enteral or parenteral nutrition. Practical recommendations on MN supplementation and monitoring were provided to manage MN deficiency in high-risk diseases. This review was based on the contents in the guidelines with an emphasis on interpreting the critical issues.

Biomechanical Analysis of Stroke Hemiplegic Patients During Sit-to-Stand Transfer / 医用生物力学

Due to damage to the hemi-advanced central nervous system of stroke hemiplegic patients, their ability of sit-to-stand transfer is impaired, and they are prone to fall during the sit-to-stand transfer. This article describes the characteristics of sit-to-stand transfer for hemiplegic patients at different foot placement from a biomechanical perspective, discusses the correlation between different features, analyzes the reasons for their fall, and describes the application of sit-to-stand transfer training in postoperative rehabilitation of hemiplegic patients， so as to provide references for postoperative rehabilitation of hemiplegic patients.

Biomechanical Characteristics and Sports Risk Analysis on Foot-Ankle Joints of Badminton Players at the Moment of Landing / 医用生物力学

Objective To explore the influence of biomechanical characteristics of badminton players on sports risk at the moment of foot and ankle landing, so as to provide references basis for avoiding the sports risk of high-frequency and high-intensity landing of ankle joint of beginners. Methods Using three-dimensional force measuring platform and motion capture system, the kinematic and dynamic data of 30 badminton beginners (experimental group) and 30 high-level athletes (control group) at the kick-off (1 step) moment during ankle landing were collected. Results The angles of metatarsal flexion and dorsiflexion in experimental group were significantly smaller than those in control group, and the angles of varus and internal rotation in experimental group were significantly larger than those in control group. The left-right forces in experimental group were significantly larger than those in control group, and there was no significant difference in anterior-posterior force and vertical force between experimental group and control group. The valgus and external rotation torque of experimental group were significantly higher than those of control group, and the internal rotation torque of control group was significantly higher than that of experimental group. Conclusions Compared with beginners, the ankle movement of professional athletes has good dynamic stability and flexibility, the cushioning task can be completed with a smaller range of movement and force in left-right direction, and the angle of metatarsal flexion and dorsiflexion of professional athletes is relatively increased. It is also the embodiment of good training effect, so that the buffer time is slightly longer to prevent the impact of sudden landing of the ankle.

Monitoring and analysis of activity concentrations of 7Be and 210Pb in atmospheric aerosol in Beijing from 2017 to 2020 / 中华放射医学与防护杂志

Objective:To monitor and analyze the activity concentrations of 7Be and 210Pb in atmospheric aerosol in Beijing from 2017 to 2020. Methods:Totally 1 074 atmospheric aerosol samples were collected by high flow air sampler (SnowWhite) including 275 in spring, 266 in summer, 262 in autumn and 271 in winter and subjected to analysis by low background high-purity germanium gamma-ray spectrometery (ORTEC) to determine the activity concentrations of 7Be and 210Pb. Results:The activity concentrations of 7Be in atmospheric aerosol were from 0.56 to 14.84 mBq/m 3, with an avearage of 6.84 mBq/m 3, and from 0.01 to 9.37 mBq/m 3 for 210Pb, with an avearage 3.19 mBq/m 3. The differences in activity concentrations of 7Be and 210Pb in atmospheric aerosol among differernt seasons were statistically significant ( F=32.66, 93.93, P<0.05). Activity concentration of 7Be was highest in spring, followed by autumn, and lowest in summer and winter. Activity concentration of 210Pb ranged from winter, autumn, spring to summer in descending order. Conclusions:The activity concentrations of 7Be and 210Pb in atmospheric aerosol in Beijing from 2017 to 2020 fluctated within the range of normal level.

Nutritional assessment and clinical management of patients with acute-on-chronic liver failure / 临床肝胆病杂志

As the most important visceral organ in human body for metabolism, the liver is an important place for the synthesis and storage of nutrients. Patients with acute-on-chronic liver failure suffer from varying degrees of malnutrition due to abnormal metabolism of various nutrients, and malnutrition might accelerate the development and progression of liver diseases and lead to poor prognosis. Therefore, it is of great importance to perform early nutritional assessment and nutritional intervention. Although there are a variety of nutritional assessment methods, there are still defects in the nutritional assessment methods for patients with chronic liver diseases and liver cirrhosis, especially those with acute-on-chronic liver failure. This article elaborates on the nutritional assessment and clinical management of such patients, so as to provide a reference for related issues in clinical practice.

Monitoring and analysis of radioactivity in soils in Beijing during 2017-2018 / 中华放射医学与防护杂志

Objective:To investigate radionuclide content in soil at 19 spots in Beijing, in order to provide scientific basis for the accurate evaluation of the levels of radioactive contamination.Methods:GEM-MX7080P4 HPGe γ spectrometer was used to analyse the activity concentrations of radionuclide 226Ra, 232Th, 40K and 137Cs in all 38 soil samples from 16 districts of Beijing from 2017 to 2018. Results:The mean activity concentration of 226Ra, 232Th and 40K were 23.9 and 24.1 Bq/kg, 31.2 and 31.7 Bq/kg, 600 and 578 Bq/kg respectively for the two consecutive years. The mean activity concentration of 137Cs in the two years was 1.21 Bq/kg, with the highest values of 5.48 and 6.18 Bq/kg, about 4.5 times and 5.1 times the average values in those years. Conclusions:All the result are within the range of the values from previous Beijing municipal and countrywide survey of environmental background, with 137Cs in soil arising almost from the previous nuclear activities or nuclear incidents.

Effect and mechanism of silent information regulator 6 on gluconeogenesis in chronic-on-acute liver failure / 中华肝胆外科杂志

Objective:To investigate the effect and mechanism of silent information regulator 6 (SIRT6) and gluconeogenesis-dependent rate-limiting enzymes in hepatocytes in oxidative stress injury rats and chronic-on-acute (sub-acute) liver failure (ACLF) patients.Methods:From August 2016 to May 2018, 10 patients with ACLF from Beijing Youan Hospital Affiliated to Capital Medical University were included in the ACLF group, and 10 normal donors were included in the normal control group. Level of fasting blood glucose, total bilirubin, albumin, and alanine aminotransferase (ALT) were studied. Sprague Dawley rat hepatocytes were isolated and divided into control group (without any intervention), model group (H 2O 2 intervention for 6 h), mammalian rapamycin target protein (mTOR) activation group (mTOR activation was added to the model group), mTOR inhibition group (mTOR inhibitor was added on the basis of the model group). Protein electrophoresis and polymerase chain reaction was used to detect the relative expression of glucose-6-phosphatase (G6P), phosphoenolpyruvate (PEPCK), SIRT6, and mTOR. Results:The ALT and total bilirubin level in ACLF group were significantly higher than those in the normal control group, and the differences were statistically significant (all P<0.05). In ACLF group, level of SIRT6 (0.15±0.07) μg/L and fasting blood glucose (3.19±0.59) mmol/L were significantly lower than those in the normal control group (0.46±0.15) μg/L and (7.07±2.07) mmol/L, the difference was statistically significant (all P<0.05). The relative expression of PEPCK and G6P protein in liver tissue of ACLF group was significantly lower than that of normal control group. The relative expression of SIRT6, PEPCK, and G6P in the model group were lower than those in the control group, and the differences were statistically significant (all P<0.05). When mTOR is activated, the relative expression of PEPCK, G6P, and SIRT6 was higher than those in the model group, and after mTOR inhibition, the relative expression of PEPCK, G6P, and SIRT6 was lower than in the model group. Conclusion:ACLF, SIRT6 may inhibit gluconeogenesis, and increased the occurrence of hypoglycemia through activating mTOR signaling pathway. Blocking of SIRT6 levels may slow down the progress of ACLF.

Research progress of aspartyl-(asparaginyl) β-hydroxylase in hepatocellular carcinoma / 中华肝胆外科杂志

Hepatocellular carcinoma is characterized by a high rate of incidence,along with significant likelihood of postoperative recurrence and metastatic,whereas its underlying mechanism remains considerably unclear.The overexpression of Aspartyl/Asparaginyl beta-hydroxylase (ASPH,AAH) was initially found in hepatocellular carcinoma and cholangiocarcinoma,signifying its involving in multiple biological behaviors of hepatocellular carcinoma.Here we review recent advances on ASPH in hepatocellular carcinoma,aiming to provide a new theoretical basis for its treatment prospectively.

Preliminary study on metabolic symbiosis of HBV-related liver cancer / 中华实验和临床病毒学杂志

Objective@#To explore the glycolysis and metabolic symbiosis of HBV-related liver cancer, and to lay the foundation for studying the metabolism of liver cancer cells.@*Methods@#10 cases of HBV-related liver cancer patients were collected, IHC detection of metastatic symbiotic markers MCT1, MCT4 for liver cancer and adjacent tissues; choosing HLE liver cancer cell lines, time gradient group use serum-free DMEM medium, divided into 6 h, 12 h, 24 h and 48 h hypoxia cultivating, by western blotting to detect HIF-1α; oxygen concentration gradient group use serum-free DMEM medium, separate culture in three gas incubator with 0.2 % O2, 8% O2 and 19% O2, by western blotting to detect HIF-1α, GLUT1, PKM2, MCT1 and MCT4.@*Results@#The expression of MCT1 in HBV-related liver cancer tissues was significantly higher than that in adjacent tissues; HLE cell have the highest expression of HIF-1α in the hypoxia cultivating of 12 h. HLE cell have the highest expression of HIF-1α and GLUT1 in hypoxia cultivating of 0.2% O2 and the highest expression of PKM2 in hypoxia cultivating of 8% O2. The oxygen concentration was at 19% MCT1/4 expressed highest.@*Conclusions@#Abnormal energy metabolism in HBV-related liver cancer tissues; the HLE cell is not preferentially choose the metabolism of aerobic glycolysis in an oxygen-free environment or in the near-constant oxygen environment. In hypoxia environment, aerobic glycolysis may also be associated with metabolic symbiosis.

Advances in the application of regional citrate anticoagulation for continuous renal replacement therapy in patients with liver failure / 中华肝脏病杂志

Currently, continuous renal replacement therapy (CRRT) is one of the most important means of organ support methods in critical care medicine. Anticoagulation is an essential part of the treatment process due to its prolonged duration. Patients with liver failure often have coagulation dysfunction and heparin anticoagulant can increase the risk of bleeding, but without heparin anticoagulant, coagulation can easily occur. In addition, an increased volumetric load, hemodynamic instability, nursing workload and other problems are major issues. Therefore, regional citrate anticoagulation (RCA) is the main anticoagulant method for CRRT therapy in patients with liver failure. This article reviews the mechanism, indications, advantages and disadvantages of using RCA to CRRT in hepatic failure.

Study on characteristics and prognosis of organ failure in patients with hepatitis B virus-associated acute-on-chronic liver failure / 中华肝脏病杂志

Objective@#To evaluate the incidence, and the characteristics of organ failure in relationship to prognosis in hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) patients using chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score for judgments of clinical treatment and prognosis.@*Methods@#Clinical data of 316 patients who were diagnosed as HBV-ACLF during hospitalization from February 2015 to February 2016 were retrospectively analyzed. Intrahepatic and extrahepatic organ failures were assessed according to CLIF-SOFA score, and the relationship between clinical characteristics and prognosis was analyzed. Continuity variables were analyzed by analysis of variance, or Kruskal-Wallis H test. Comparison of the categorical data were done using χ 2 or Fisher's exact test, and the predictive efficacy of various prognostic scores was compared using the area under the receiver operating characteristic curve (AUROC) and Z-test.@*Results@#Of 316 cases (87.3% men) of HBV-ACLF, the mean age was (45 ± 11) years old. 78.8% of patients with underlying liver disease had hepatitis B virus induced cirrhosis. Mortality rates in patients without liver transplantation at 28 days, 90 days and 180 days were 20.5% (63/307), 36.7% (110/300) and 39.2% (116/296), respectively. According to the CLIF-SOFA score, 89.9% (284 patients) had organ failure at baseline, of which 97.5% had liver failure (Total bilirubin ≥ 12 mg/dl) and only 2.5% had coagulation, kidney, circulation or respiratory failure without liver failure. Besides liver failure, the incidence of extrahepatic organ failure was coagulation (23.1%), kidney (5.7%), brain (3.8%), circulation (1.3%) and respiratory failure (0.3%). With increasing number of organ failure, the mortality rate of two and three or more organ failures were 69.6% and 69.2%, respectively, which was significantly higher than that of single organ failure and non-organ failure patients (27% and 6.9%, respectively; P < 0.001). Liver failure with coagulation failure (International normalized ratio≥2.5 or platelet count≤20×109/L) had worst prognosis with a mortality rate of up to 75% at 90 days.@*Conclusion@#According to the CLIF-SOFA score, the main organ failure in patients with HBV-ACLF in China is liver failure. The mortality rate in patients with two or more organ failures is as high as 70% within 3 months. Therefore, timely manner liver transplantation should be considered.

The mechanism of liver regeneration post-hepatectomy liver failure / 中华肝胆外科杂志

Although the risk of post-hepatectomy liver failure is severe and it affects the prognosis of patients,hepatectomy is the first choice for hepatocellular carcinoma patients.At present,the mechanism of liver regeneration and post-hepatectomy liver failure is unclear.In this paper,we reviewed the liver regeneration for three stages:initiation,proliferation and termination,and also reviewed the mechanism of post-hepatectomy liver failure.

Antioxidant activity of oil in seabuckthorn seed and optimization of its extraction process / 国际中医中药杂志

Objective To optimize the process conditions of the oil extraction ofseabuckthorn oil and to evaluate its antioxidant activity by anti-free radical action.Methods The extraction time and particle size of sea-buckseed oil were optimized by using the response surface software design-expert.Its antio xidant activity was studied through its anti-dpph free radical reaction.Results The best process of seabuckthorn seed oil was extracting time 3 h,material liquid than 1:8,extraction temperature 80 C,about 30 mesh size,the yield is highest at 11.13％.The optimum reaction time was 8 min in control,and with the increase of concentration,seabuckthorn oil antioxidant activity increased,when the addition amount of 4.00 ml sample,clearance rate as high as 77.62％.Conclusions This method is simple and reliable,the extraction rate is high,and the test results show that the oil has obvious anti-oxidative effect,which can be used as whitening and wrinkling products to delay the aging of human body.