Comparison of Exosomes Derived from Fibroblasts and Mesenchymal Stem Cells for the Treatment of Acute Wound Healing / 中山大学学报(医学科学版)

ObjectiveTo compare the therapeutical effect of exosomes derived from fibroblasts and mesenchymal stem cells on acute wound healing. MethodsPrimary human dermal fibroblasts （hDF） were isolated， cultured and identified. Human bone marrow mesenchymal stem cell exosomes （hMSC-EXO） and hDF exosomes （hDF-EXO） were extracted by ultracentrifuga tion. After 24 h of coincubation with hDF-EXO or hMSC-EXO， hDFs proliferation and migratory capacity were evaluated by cell counting kit-8 （CCK8） assay and scratch test. Full-thickness cutaneous wounds were created on 8-week-old female C57BL/6 mice， and topically applied with PBS （control）， hDF-EXO or hMSC-EXO. Wounds were measured at day 0， 2， 4， 7， and the uptake of exosomes in wound was observed at day 1. Quantitative PCR （qPCR） analysis was performed to detect the mRNA expression levels of TNF-α， IL-6， IL-1β， IL-10 in wound at day 1. HE staining was conducted to analyze the histological structure of wounds at day 7， while immunofluorescence staining was used to examine expression of PDGFR-α、α-SMA、Ki67. ResultshDF exhibited certain fibrolast-like characteristics with respect to expression of cell surface markers and specific proteins. hDF-EXO and hMSC-EXO presented exosomal morphology， size， and markers， and both concentrations were not statistically different （P>0.05）； CCK8 assay showed that both exosomes promoted hDF cell viability， compared with the negative control （P<0.01）， and hDF-EXO group had greater cell viability than hMSC-EXO group （P<0.01）. Scratch test indicated that hDF-EXO induced a significant increase in scratch healing rate versus the negative control （P<0.01）， hMSC-EXO （P<0.05）. In vivo experiments showed wound tissues took up exosomes at day 1. qPCR detected TNF-α， IL-6， IL-1β expression levels in wound at day 1 were lower in exosomes group than in the control group， and were the lowest in hMSC-EXO group （all P<0.01）. Wound areas were measured smaller at day 7 in exosomes group than in the control group （all P<0.01） and hDF-EXO group had better closure than hMSC-EXO group （P<0.05）. HE staining revealed that compared with control group， scar， incomplete epidermis and few collagen deposition remained in the hMSC-EXO group， whereas hDF-EXO group showed re-epithelialization， continuous neo-epidermis and regenerated dermis. Immunofluorescence staining suggested that the number of fibroblasts， myofibroblasts， proliferating cells was higher in both exosomes group than that in the control group， especially the highest in hDF-EXO group. ConclusionOur study shows both exosomes accelerate wound healing， whereas hDF-EXO is more effective in promoting fibroblasts proliferation， migration， transition to myofibroblasts， and hMSC-EXO may play a role in inhibiting inflammatory reaction during early stage of wound healing.

Recompensation of complications in patients with hepatitis B virus-related decompensated cirrhosis treated with entecavir antiviral therapy / 中华肝脏病杂志

Objective: To analyze the occurrence of recompensation conditions in patients with chronic hepatitis B virus-related decompensated cirrhosis after entecavir antiviral therapy. Methods: Patients with hepatitis B virus-related decompensated cirrhosis with ascites as the initial manifestation were prospectively enrolled. Patients who received entecavir treatment for 120 weeks and were followed up every 24 weeks (including clinical endpoint events, hematological and imaging indicators, and others) were calculated for recompensation rates according to the Baveno VII criteria. Measurement data were compared using the Student t-test or Mann-Whitney U test between groups. Categorical data were compared by the χ (2) test or Fisher's exact probability method between groups. Results: 283 of the 320 enrolled cases completed the 120-week follow-up, and 92.2% (261/283) achieved a virological response (HBV DNA 20 IU/ml). Child-Pugh and MELD scores were significantly improved after treatment (8.33 ± 1.90 vs. 5.77 ± 1.37, t = 12.70, P < 0.001; 13.37 ± 4.44 vs. 10.45 ± 4.58, t = 5.963, P < 0.001). During the 120-week follow-up period, 14 cases died, two received liver transplants, 19 developed hepatocellular cancer, 11 developed gastroesophageal variceal bleeding, and four developed hepatic encephalopathy. 60.4% (171/283) (no decompensation events occurred for 12 months) and 56.2% (159/283) (no decompensation events occurred for 12 months and improved liver function) of the patients had achieved clinical recompensation within 120 weeks. Patients with baseline MELD scores > 15 after active antiviral therapy achieved higher recompensation than patients with baseline MELD scores ≤15 [50/74 (67.6%) vs. 109/209 (52.2%), χ (2) = 5.275, P = 0.029]. Conclusion: Antiviral therapy can significantly improve the prognosis of patients with hepatitis B virus-related decompensated cirrhosis. The majority of patients (56.2%) had achieved recompensation. Patients with severe disease did not have a lower probability of recompensation at baseline than other patients.

Value of ultrasonic S-Detect technique in diagnosis of breast masses / 南方医科大学学报

OBJECTIVE@#To evaluate the value of ultrasound S-Detect in the diagnosis of breast masses.@*METHODS@#A total of 85 breast masses in 62 female patients were diagnosed by S-Detect technique and conventional ultrasound. The diagnostic efficacy of conventional ultrasound and S-Detect technique was analyzed and compared with postoperative pathological results as the gold standard.@*RESULTS@#When operated by junior physicians, the diagnostic efficacy of conventional ultrasound was significantly lower than that of S-Detect technique (P < 0.05), but this difference was not observed in moderately experienced and senior physicians (P>0.05). S-Detect technique was positively correlated with the diagnostic results of senior physicians (r=0.97). Using S-Detect technique, the diagnostic efficacy did not differ significantly between the long axis section and its vertical section (P>0.05). Routine ultrasound showed a better diagnostic efficacy than S-Detect for breast masses with a diameter below 20 mm (P < 0.05), but for larger breast masses, its diagnostic efficacy was significantly lower than that of SDetect (P < 0.05).@*CONCLUSION@#S-Detect can be used in differential diagnosis of benign and malignant breast masses, and its diagnostic efficiency can be comparable with that of BI-RADS classification for moderately experienced and senior physicians, but its diagnostic efficacy can be low for breast masses less than 20 mm in diameter.

Predictive value of the Chinese group on the study of severe hepatitis B-acute-on-chronic liver failure score in the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure / 中华医学杂志(英文版)

BACKGROUND@#As a large, prospective, multicenter study-based prognostic score for hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), the Chinese group on the study of severe hepatitis B-acute-on-chronic liver failure score (COSSH-ACLFs), has been approved by some foreign scholars; however, its predictive value needs to be verified. This study investigated the predictive value of COSSH-ACLFs for short-term prognosis in Chinese patients with HBV-ACLF.@*METHODS@#This retrospective cohort study included 751 patients with HBV-ACLF admitted to the Fifth Medical Center of Chinese PLA General Hospital between January 2011 and December 2014. Spearman method was used to assess the correlation of COSSH-ACLFs with classical scores. Different COX multivariate regression models were used to confirm the relationship between COSSH-ACLFs and short-term prognosis in patients with HBV-ACLF, and stratified analysis was used to further verify the stability of this relationship. We compared the predictive powers of COSSH-ACLFs and other classical scores using area under the receiver operating characteristic curve (AUROC) and Z-test.@*RESULTS@#A total of 975 patients with HBV-ACLF were screened, and 751 were analyzed (623 male and 128 female). COSSH-ACLFs was the highest in patients with end-stage ACLF, followed by those with middle- and early-stage ACLF (H = 211.8, P < 0.001). In the fully adjusted model, COX multivariate regression analysis revealed that COSSH-ACLFs (as a continuous variable) was independently and positively correlated with mortality risk in patients with HBV-ACLF at 28 days (hazard ratio [HR]: 1.37 [1.22, 1.53], P < 0.001) and 90 days (HR: 1.43 [1.29, 1.58], P < 0.001). The same trend could be observed in the crude model and minimally adjusted model. The AUROCs of COSSH-ACLFs for 28-day and 90-day prognoses in patients with HBV-ACLF were 0.807 and 0.792, respectively, indicating a stronger predictive accuracy than those of classic models.@*CONCLUSIONS@#COSSH-ACLFs, with a superior predictive accuracy compared with other classical scores, can strongly predict short-term prognosis in Chinese patients with HBV-ACLF.

Predictive value of the Chinese group on the study of severe hepatitis B-acute-on-chronic liver failure score in the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure / 中华医学杂志(英文版)

Background@#As a large, prospective, multicenter study-based prognostic score for hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), the Chinese group on the study of severe hepatitis B-acute-on-chronic liver failure score (COSSH-ACLFs), has been approved by some foreign scholars; however, its predictive value needs to be verified. This study investigated the predictive value of COSSH-ACLFs for short-term prognosis in Chinese patients with HBV-ACLF.@*Methods@#This retrospective cohort study included 751 patients with HBV-ACLF admitted to the Fifth Medical Center of Chinese PLA General Hospital between January 2011 and December 2014. Spearman method was used to assess the correlation of COSSHACLFs with classical scores. Different COX multivariate regression models were used to confirm the relationship between COSSHACLFs and short-term prognosis in patients with HBV-ACLF, and stratified analysis was used to further verify the stability of this relationship. We compared the predictive powers of COSSH-ACLFs and other classical scores using area under the receiver operating characteristic curve (AUROC) and Z-test.@*Results@#A total of 975 patients with HBV-ACLF were screened, and 751 were analyzed (623 male and 128 female). COSSH-ACLFs was the highest in patients with end-stage ACLF, followed by those with middle- and early-stage ACLF (H = 211.8, P < 0.001). In the fully adjusted model, COX multivariate regression analysis revealed that COSSH-ACLFs (as a continuous variable) was independently and positively correlated with mortality risk in patients with HBV-ACLF at 28 days (hazard ratio [HR]: 1.37 [1.22, 1.53], P < 0.001) and 90 days (HR: 1.43 [1.29, 1.58], P < 0.001). The same trend could be observed in the crude model and minimally adjusted model. The AUROCs of COSSH-ACLFs for 28-day and 90-day prognoses in patients with HBV-ACLF were 0.807 and 0.792, respectively, indicating a stronger predictive accuracy than those of classic models.@*Conclusions@#COSSH-ACLFs, with a superior predictive accuracy compared with other classical scores, can strongly predict shortterm prognosis in Chinese patients with HBV-ACLF.

Relation between serum levels of high mobility group box 1 and hepatitis B virus-related acute-on-chronic liver failure / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the levels of high mobility group box 1 protein (HMGB1) in serum of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) and investigate its potential relation to the clinical features of these patients.</p><p><b>METHODS</b>Sixty patients with HBV-related ACLF, 30 patients with chronic hepatitis B (CHB), and 24 healthy individuals (controls) were enrolled in the study. Markers of liver function, such as aspartate aminotransferase (AST), were measured by routine biochemical methods. Imaging studies, such as abdominal computed tomography or magnetic resonance imaging, were used for disease staging. Serum levels of HMGB1 were measured by ELISA. Deaths within the 2-month follow-up after serum collection were used for the survival analysis. Patients who developed peritonitis, pneumonia, or other bacterial and fungal infections during the 2-month follow-up after serum collection were classified as the infected group. Pairwise comparisons were carried out by t-test, and multiple comparisons were carried out by analysis of variance.</p><p><b>RESULTS</b>Patients with HBV-related ACLF had significantly higher serum levels of HMGB1 than CHB patients or controls (P = 0.003). Among the patients with HBV-related ACLF, those in the late stage (n = 20) had significantly higher levels of HMGB1 than those in the early stage (n = 20) (P = 0.005). The serum levels of HMGB1 correlated well with AST level in patients with HBV-related ACLF (P = 0.006). In addition, patients with HBV-related ACLF who developed infection or died during follow-up also had significantly higher levels of HMGB1 (P = 0.028 or P = 0.017, respectively).</p><p><b>CONCLUSION</b>Enhanced serum level of HMGB1 is associated with development of HBV-related ACLF in CHB patients. The strong correlation between HMGB1 and AST levels suggest that HMGB1 may be useful as a prognostic marker for development of ACLF.</p>

Orthogonal design based optimization of a mouse model of acute liver failure induced by D-galactosamine and lipopolysaccharide / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To apply an orthogonal design optimization strategy to a mouse model of acute liver failure induced by D-galactosamine (D-GalN) and lipopolysaccharide (LPS) exposure.</p><p><b>METHODS</b>A four-level orthogonal array design (L16(45)) was constructed to test factors with potential impact on successful establishment of the model (D-GalN and LPS dosages, and dilution rate of the D-GalN/LPS mixture). The mortality rate of mice within 24 hours of D-GalN/LPS administration was determined by the Kaplan-Meier method. The model outcome was verified by changes in serum alanine transferase level, liver histology, and hepatocyte apoptosis.</p><p><b>RESULTS</b>The orthogonal array identified the optimal model technique as intraperitoneal injection of a combination of D-GalN and LPS at dosages of 350 mg/kg and 30 mug/kg, respectively, and using a dilution rate of 3. The dosages tested had no effect on survival. The typical signs of liver failure appeared at 6 hrs after administration of the D-GalN/LPS combination.</p><p><b>CONCLUSION</b>The orthogonal design optimization strategy provided a procedure for establishing a mouse model of acute liver failure induced by D-GalN and LPS that showed appropriate disease outcome and survival, and which will serve to improve future experimental research of acute liver failure.</p>

Comparison of four prognostic models and a new Logistic regression model to predict short-term prognosis of acute-on-chronic hepatitis B liver failure / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute-on-chronic hepatitis B liver failure (ACLF-HBV) is a clinically severe disease associated with major life-threatening complications including hepatic encephalopathy and hepatorenal syndrome. The aim of this study was to evaluate the short-term prognostic predictability of the model for end-stage liver disease (MELD), MELD-based indices, and their dynamic changes in patients with ACLF-HBV, and to establish a new model for predicting the prognosis of ACLF-HBV.</p><p><b>METHODS</b>A total of 172 patients with ACLF-HBV who stayed in the hospital for more than 2 weeks were retrospectively recruited. The predictive accuracy of MELD, MELD-based indices, and their dynamic change (D) were compared using the area under the receiver operating characteristic curve method. The associations between mortality and patient characteristics were studied by univariate and multivariate analyses.</p><p><b>RESULTS</b>The 3-month mortality was 43.6%. The largest concordance (c) statistic predicting 3-month mortality was the MELD score at the end of 2 weeks of admission (0.8), followed by the MELD: sodium ratio (MESO) (0.796) and integrated MELD (iMELD) (0.758) scores, DMELD (0.752), DMESO (0.729), and MELD plus sodium (MELD-Na) (0.728) scores. In multivariate Logistic regression analysis, the independent factors predicting prognosis were hepatic encephalopathy (OR = 3.466), serum creatinine, international normalized ratio (INR), and total bilirubin at the end of 2 weeks of admission (OR = 10.302, 6.063, 5.208, respectively), and cholinesterase on admission (OR = 0.255). This regression model had a greater prognostic value (c = 0.85, 95%CI 0.791 - 0.909) compared to the MELD score at the end of 2 weeks of admission (Z = 4.9851, P = 0.0256).</p><p><b>CONCLUSIONS</b>MELD score at the end of 2 weeks of admission is a useful predictor for 3-month mortality in ACLF-HBV patients. Hepatic encephalopathy, serum creatinine, international normalized ratio, and total bilirubin at the end of 2 weeks of admission and cholinesterase on admission are independent predictors of 3-month mortality.</p>

Distribution and clinical significance of HBV genotypes in patients with HBV infection in 30 regions of China / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To explore the distribution and clinical significance of HBV genotypes in patients with HBV infection in China.</p><p><b>METHOD</b>Serum samples were collected from 2922 patients with HBV infection. HBV genotyping was performed with type-specific primers polymerase chain reaction, and the virological and biochemical markers were detected, which differences in the genotypes distribution between various regions and liver function and virological markers between various HBV genotyping were analyzed.</p><p><b>RESULT</b>The genotype B, C, B + C, D of 2922 patients with HBV infection accounted for 15.9%, 83.5%, 0.41%, 0.21% respectively. In Northern China, genotype C was most prevalent, accounting for 90% of all cases, while it was less common in Southern China; genotype C was present in Zhejiang and Jiangsu provinces, but genotype B was comparatively more common in Guangdong, Hunan, Hubei, and Jiangxi provinces. B, C genotype HBV infection patients in the sex difference was not statistically significant; B genotypes compared with C genotype HBV infection patients, the average age of is less (P < 0.001); HBeAg positive rate of C genotype HBV infection patients are higher than that of B genotype (P = 0.023); Viral load of genotype C HBV infection patients is higher than that of genotype B (P = 0.038); Cholinesterase and Albumin levels of genotype C HBV infection patients are lower than that of genotype B (P values were 0.016, <0.001).</p><p><b>CONCLUSION</b>There were HBV genotype B, C, B + C and D in Chinese patients with HBV infection, with genotype B and C being the major ones. Mainly in northern regions of genotype C, C genotype significantly reduced the southern region, some of the southern region dominated by B genotype. Genotype C HBV infection patients are older, and their HBeAg-positive rate is higher, and their liver damage is more severe, but their viral load is less.</p>

Study on gene delivery via the bile duct to rat liver using naked DNA particles / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of gene delivery to the right lateral lobe of the rat liver via a branch of the bile duct using naked DNA.</p><p><b>METHODS</b>We evaluated regional gene delivery to the right lateral lobe of the rat liver via a branch of the bile duct, using naked DNA, including pGL3, pCMV beta and Cy3 labeled CMV beta.</p><p><b>RESULTS</b>Gene expression was observed in right lateral lobe of both the damaged and the normal rats liver. The gene delivery efficiency was similar in two groups (P > 0.05). Gene expression was found in the right lateral lobe of damaged and normal livers. Fluorescence was observed in the region of the portal triads, and occasionally, in the lobule.</p><p><b>CONCLUSION</b>Retrograde infusion of naked DNA via the bile duct is an effective way to deliver genes to in both damaged and normal rat liver.</p>

Association between HBV genotype and chronic/severe liver disease with HBV infection in Chinese patients / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To explore the association between HBV genotype and chronic/severe liver disease with HBV infection in Chinese patients.</p><p><b>METHODS</b>Serum samples were collected from 2922 patients with HBV infection. HBV genotyping was performed with type-specific primers polymerase chain reaction, and the virological and biochemical markers were detected, which differences in the genotypes between various clinical types of HBV infection and liver function and virological markers between various HBV genotyping were analyzed.</p><p><b>RESULTS</b>The genotype B, C, BC combinations, D of 2922 patients with HBV infection accounted for 15.9%, 83.5%, 0.41%, 0.21% respectively. The ratio of genotype B in acute hepatitis group was higher (P = 0.003), which the ratio of genotype C in the cirrhosis group and the hepatocellular carcinoma group was higher (P = 0.000, 0.000). The difference in ratio of genotype C was not statistically significant between acute-on-chronic liver failure group and chronic hepatitis group. HBeAg-positive rate, viral load and liver function markers of B, C genotype group in acute hepatitis group and chronic hepatitis group were not significant different. HBeAg-positive rates of genotype C in acute-on-chronic liver failure group, cirrhosis group, hepatocellular carcinoma group were higher than that of genotype B (P = 0.000, 0.024, 0.003). Viral load of genotype C in hepatocellular carcinoma group was higher than that of genotype B (P = 0.025). Cholinesterase levels of genotype C in the acute-on-chronic liver failure group and the hepatocellular carcinoma group was lower than that of genotype B (P = 0.0004, 0.02).</p><p><b>CONCLUSION</b>There were HBV genotype B, C, B/C combinations and D in Chinese patients with HBV infection, with genotype B and C being the major ones. Compared with HBV genotype B, genotype C in Chinese patients with HBV infection was more likely to chronic infection, evolved to cirrhosis and hepatocellular carcinoma, but genotype difference was not observed in occurrence of acute-on-chronic liver failure. Genotype was not significant effect in acute and chronic hepatitis B, but HBeAg-positive rate/viral load was higher and liver damage was more severe in severe and end-stage genotype C HBV infection patients.</p>

Lamivudine and entecavir significantly improved the prognosis of early-to-mid stage hepatitis B related acute on chronic liver failure / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To clinically study the antiviral effects of lamivudine and entecavir on patients with early-to-mid stage Hepatitis B related acute on chronic liver failure (HBV-ACLF). METHODS; A prospective, randomized, open and parallel controlled clinical trial was designed to observe the antiviral effects of nucleoside analogues on patients with early-to-mid stage HBV-ACLF. Three groups were set for controlled study, i. e. basic treatment group, lamivudine plus basic treatment group and entecavir plus basic treatment group.</p><p><b>RESULTS</b>One month after treatment, the improvement rates of lamivudine group and entecavir group were 58.85% and 59.15% respectively, significantly higher than that of basic treatment group which was 34.84% (Chi(2) = 9.8323, P = 0.043). By the end of six months, the cumulative survival rates of patients with the antiviral treatments, i.e., lamivudine, entecavir, were 65.8%, 60.1%, significantly higher than that (42%) without the antiviral treatment (P = 0.045, P = 0.04 respectively). The cumulative survival rate in patients with a MELD score < 30 was higher than that with a MELD score over 30 (Chi(2) = 3.920, P = 0.048). For the patients with pretreatment HBV DNA > or = 10(7), the cumulative survival rate in patients with entecavir treatments group was higher than that of patients in basic treatment group (Chi(2) = 5. 014 P= 0.025). According to the Ordinal Regression analysis, antiviral therapy by using either lamivudine or entecavia could significantly increase the improvement rate of patients with early-to-mid stage HBV-ACLF. But severe complications, including hepatorenal syndrome, electrolyte imbalance and hepatic encephalopathy, medical history of liver cirrhosis, and pretreatment HBV DNA > or = 10(7) had significant impacts on prognosis of this group patients.</p><p><b>CONCLUSIONS</b>Antiviral therapy by using either lamivudine or entecavia could significantly increase the survival rate of patients with early-to-mid stage HBV-ACLF.</p>

The short-term efficacy of nucleoside analogue on the treatment of acute-on-chronic liver failure / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To discuss the short-term efficacy of nucleoside analogue on the treatment of hepatitis B virus induced acute-on-chronic liver failure (HBV-ACLF).</p><p><b>METHODS</b>348 patients with HBV-ACLF in our hospital from January 2006 to June 2008 were selected. According to the stages of patient's condition and whether or not with nucleoside analogue administration, The patients were divided into early stage therapy group, early stage control group, middle stage therapy group and middle stage control group. Groups were compared on the basis of stages. The clinical data were analyzed using chisquare test and independent-Samples T Test.</p><p><b>RESULTS</b>After 2 weeks of therapy no significant difference found between the therapy group and the control group. the total bilirubin (TBil) and alanine transaminase (ALT) showed no significant difference between the middle stage therapy group and the control group in 4 weeks of therapy. However significant differences existed in the HBV DNA negative rate, PTA, the model for end-stage liver disease (MELD) score and the improvement rate between the two groups (P<0.05, P<0.01). Only the 4 week survival rate and HBV DNA negative rate showed significant difference in patients who received anti-virus therapy on the early stage as compared to the control group.</p><p><b>CONCLUSION</b>Anti-virus therapy with nucleoside analogue is an effective way for the treatment of those patients with HBV-ACLF and can increase the survival rate.</p>

Analysis of prognostic factors for patients with acute-on-chronic liver failure / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To analyze the prognostic factors for patients with acute-on-chronic liver failure, and to build a scoring system for assessment of the prognosis of liver failure.</p><p><b>METHODS</b>480 patients with acute-on-chronic liver failure in our hospital from January 2006 to June 2008 were enrolled in this study. The patients were divided into improved group and deteriorated group. The clinical data were analyzed by using chi square test, independent-Samples T Test and Binary logistic regression.</p><p><b>RESULTS</b>The factors that significantly affected the prognosis of Acute-on-chronic Liver Failure included age, hepatitis or liver cirrhosis, Staging, Hyponatremias, alpha-fetoprotein (AFP), the prothrombin time activity (PTA), total bilirubin (TBil), creatinine (Cr), albumin (ALB) and Hepatic encephalopathy, ascites, alimentary tract hemorrhage (P less than 0.05, P less than 0.01). PTA, Hyponatremias, hepatitis or liver cirrhosis, Hepatic encephalopathy and alimentary tract hemorrhage were independent risk factors of prognosis.</p><p><b>CONCLUSION</b>PTA, Hyponatremias, hepatitis or liver cirrhosis, Hepatic encephalopathy and alimentary tract hemorrhage are important to build a scoring system to assess the prognosis of Acute-on-chronic Liver Failure and may be useful to guide clinical treatment.</p>

Rescue of dendritic cells malfunction and loading with HBV proteins in patients with chronic hepatitis B in vitro / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate dendritic cell (DC) malfunctions in patients with chronic hepatitis B (CHB) and try some means to restore the function in vitro.</p><p><b>METHODS</b>Twelve CHB patients and 10 healthy people were enrolled in the study. Phenotype analysis and allogeneic mixed lymphocyte reaction (AMLR) assay of DC from these subjects were made. Enzyme-linked ELISpot method for detecting IFN-gamma-producing CD8 (+) T cells were used to evaluate the efficacy of DC loaded in vitro with HBsAg or HBcAg.</p><p><b>RESULTS</b>DC from patients had a lower expression of co-stimulatory molecules and impaired AMLR capacity, but was restored partially by cytokine cocktail in vitro. Mature DC loaded with HBsAg or HBcAg showed a greater capacity for IFN-gamma-production than immature DC.</p><p><b>CONCLUSION</b>Malfunction of DC from CHB patients may be rescued by a cocktail of cytokines, and therapeutic DC vaccines loaded with HBV protein might be helpful to treat CHB patients.</p>

Relativity analysis of chronic hepatitis B virus genotype and clinical pathology / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To explore the relationship between chronic hepatitis B virus genotypes and clinical pathology.</p><p><b>METHODS</b>HBV genotype was determined in 92 cases with chronic hepatitis B patients and the relationship between HBV genotypes and clinical, serological and histological data of the patients was analyzed.</p><p><b>RESULTS</b>Sixteen cases were infected with HBV genotype B (17.4%), 71 with genotype C (77.2%), 3 with HBV classified as genotype B+C (3.2%) and in 2 (2.2%) cases HBV genotype was not confirmed. ALT level and HBV DNA load log value were (82.6+/-82) U/L, (84.7+/-71.5) U/L and (5.8+/-1.4), (5.9+/-1.5) respectively in genotypes B and C patients, in 8 cases of genotype C group liver cirrhosis was diagnosed, but no statistical significance was seen.</p><p><b>CONCLUSION</b>No significant differences in clinical, serological or histological data were detected between genotypes B and C patients.</p>

Etiological analysis of 1977 patients with acute liver failure, subacute liver failure and acute-on-chronic liver failure / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the etiology of 1977 patients from northern China with acute (ALF), sub-acute (SALF) or acute-on-chronic liver (ACLF) failures.</p><p><b>METHOD</b>The age, gender, etiology, pathogenesis, and prognosis of the 1977 patients with liver failures were retrospectively analyzed.</p><p><b>RESULTS</b>Of the 1977 cases, the three most common causes of ALF were HEV (33.96%) or HBV (13.21%) infections or those caused by medicines (9.43%). The three predominant causes of SALF were medicines (31.53%), HEV (16.22%) or HBV (9.91%) infections, but those of the ACLF were HBV (90.29%) infection, alcoholic hepatopathy (2.65%), and HBV super infected with HEV (2.26%) infections. 90.09% (1781) patients were infected by hepatotropic viruses. Of these 1781 patients, the most common cause of their liver failures was HBV infection (92.93%). In these HBV infected patients, 77.10% were from 26 to 55 years old. From 2005 to 2007, there were 39 patients with alcoholic liver failure. In the past two years, there were 23 patients with drug induced liver failure. The improvement rate of the 1977 patients after their treatments was 35.56%. The improvement rate of HEV infected liver failure was higher than drug induced liver failure (P less than 0.05); no statistical significance was found between other groups (P more than 0.05).</p><p><b>CONCLUSION</b>Different types of liver failure have different predominant causes. HBV infection is the most common cause in our 1977 patients. In the past two years, the number of drug induced liver failures and alcoholic liver failures have been increasing.</p>

Comparison and analysis of two international diagnostic criteria for the diagnosis of 230 cases with drug-induced liver injury / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To compare and analyze the accuracy of two diagnostic criteria of drug-induced liver injuries.</p><p><b>METHODS</b>230 cases of drug-induced liver injury diagnosed clinically in the 302 hospital of PLA were retrospectively studied. The drugs which induced liver injuries were summarized and analyzed. Danan's international consensus criteria and Maria's diagnostic scale were applied to diagnose these 230 cases again and then the differences of diagnostic results were analyzed and compared.</p><p><b>RESULTS</b>The drugs which induced liver injuries in the 230 patients were arranged in order of their usage frequencies: traditional Chinese herbs and the like, antibiotics, antipyretic analgesics, antituberculosis medicines, cardiovascular drugs, over-the-counter health stuff, psychopharmaceuticals, dermatological agents, drug for diabetes, tapazol, and others. Based on the 230 adult inpatients with drug-induced liver injury, according to Danan's international consensus criteria, 149 cases (64.8%), 71 (30.9%) and 10 (4.3%) were classified as drug-related, indeterminate and drug-unrelated respectively; according to Maria's diagnostic scale, not one was a definite drug-induced liver injury, 55 cases (23.9%) were probable, while 126 (54.8%), 33 (14.3%) and 16 (7.0%) were possible, unlikely and excluded respectively.</p><p><b>CONCLUSION</b>The accordance rate of Danan's international consensus criteria and clinical diagnosis was higher than that of Maria's diagnostic scale. Neverthelessìthe current diagnostic methods for drug-induced liver injury need to be revised for clinical practice.</p>

Ultrasonic Characteristics of Urinary Calculus in Infants with History of Feeding Melamine Contaminated Milk Powder / 实用儿科临床杂志

Objective To summarize the ultrasonic characteristics of urinary calculus in infants who had history of feeding melamine contaminated milk powder.Methods A total of 163 children[aged(19.4?10.9)months] with urolithiasis,who had feeding melamine contaminated milk powder,were retrospectively analyzed using ultrasonography.Twenty children [aged(16.7?9.9)months] with urolit-hiasis,who had no feeding history of melamine contaminated milk powder,were chosen as controls.Ultrasonic characteristics were compared between the 2 groups.Results For melamine calculus cases,sporadic spot or hyperechic mass with different size and shape in the collecting system,partly without acoustic shadow,was found in 65 cases;dense echo and luminous belt with obscured acoustic shadow under a band without echo was found in 48 ureteral calculus cases;irregular strong echo mass or small spot with thick acoustic shadows without side lobe artifact in the dark liquid areas was found in 8 cases with bladder calculus.There was significant difference in morphology of the calculus(P0.05).Conclusions The unique ultrasonic characteristics in infants with melamine calculus had become a very useful tool to diagnose the pediatric urinary melamine calculus.J Appl Clin Pediatr,2009,24(1):67-69