Clinical features of bone mass loss in liver cirrhosis and its association with sarcopenia / 临床肝胆病杂志

ObjectiveTo investigate the influence of sarcopenia on bone mass loss， the risk factors for bone mass loss in liver cirrhosis， and the correlation between body composition and bone mineral density （BMD） by comparing the clinical features of bone mass loss in patients with liver cirrhosis. MethodsA total of 92 patients who were hospitalized and diagnosed with liver cirrhosis in Department of Gastroenterology， The Second Affiliated Hospital of Kunming Medical University， from April to December of 2022 were enrolled， and based on the results of dual-energy X-ray absorptiometry， they were divided into bone mass loss group （osteopenia/osteoporosis） with 57 patients and normal bone mass group with 35 patients. The two groups were compared in terms of general data， laboratory examination， imaging data， and body composition analysis. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the continuity correction chi-square test was used for comparison of categorical data between two groups； Pearson correlation analysis and Spearman correlation analysis were used to investigate correlation； a binary logistic regression analysis was used to investigate the risk factors for bone mass loss in liver cirrhosis. ResultsCompared with the normal bone mass group， the bone mass loss group had significantly higher age （t=-3.597， P<0.05）， proportion of female patients （χ2=8.393， P<0.05）， N-terminal middle molecular fragment of osteocalcin （N-MID） （Z=-3.068， P<0.05）， β isomer of C-terminal telopeptide of type I collagen （β-CTX） （t=-2.784， P<0.05）， and proportion of patients with sarcopenia （χ2=13.884， P<0.05） and significantly lower calcitonin （CT） （Z=-2.340， P<0.05） and L3 skeletal muscle index （L3-SMI） （t=4.621， P<0.05）. Compared with the normal bone mass group， the bone mass loss group had significantly lower total muscle mass （Z=-2.952， P<0.05）， right upper limb muscle mass （Z=-2.929， P<0.05）， left upper limb muscle mass （Z=-2.680， P<0.05）， right lower limb muscle mass （Z=-3.366， P<0.05）， left lower limb muscle mass （Z=-3.374， P<0.05）， presumed bone mass （t=2.842， P<0.05）， body water mass （Z=-2.779， P<0.05）， basal metabolic rate （BMR） （Z=-3.153， P<0.05）， and BMD of L1— L4 and femoral neck （t=9.789， t=10.280， t=10.832， Z=-7.298， t=8.945， all P<0.05）. Total muscle mass， muscle mass of trunk and limbs， presumed bone mass， BMR， and body water mass in body component analysis were positively correlated with L1 — L4 BMD and femoral neck BMD （all P<0.05）， and fat mass was positively correlated with L1 — L4 BMD （all P<0.05）. Sarcopenia （odds ratio ［OR］=8.737， 95% confidence interval ［CI］： 2.237 — 34.129， P=0.002）， age （OR=1.094， 95%CI： 1.019 — 1.175， P=0.013）， and N-MID （OR=1.095， 95%CI： 1.019 — 1.176， P=0.014） were independent risk factors for bone mass loss in patients with liver cirrhosis. ConclusionOld age， female sex， sarcopenia， elevated N-MID， elevated β-CTX， reduction in CT， low muscle mass， low presumed bone mass， low BMR， and low body water mass are the features of bone mass loss in patients with liver cirrhosis， and sarcopenia， age， and N-MID are independent risk factors for bone mass loss in patients with liver cirrhosis. Detailed assessment of body composition changes can help to identify abnormal BMD in patients with liver cirrhosis.

Advances in the pathogenesis, diagnosis, and treatment of renal injury in liver cirrhosis / 临床肝胆病杂志

Patients with decompensated cirrhosis often have a reduction in renal function due to severe hepatic insufficiency which results in reduced inactivation of vasodilators, hemodynamic disorders, immune disorders, and infections, and without timely intervention, patients may gradually develop from early prerenal injury to late renal failure. Patients tend to have a low survival rate and great difficulties in treatment. With the gradual clarification of the classification and diagnostic criteria for kidney injury and the discovery of an increasing number of markers for kidney injury, early diagnosis and localization of kidney injury are of great importance for improving the prognosis of patients. This article analyzes the new advances in the pathogenesis, diagnostic criteria, and treatment of renal injury in cirrhotic patients in recent years, so as to provide help for the clinical diagnosis and treatment of cirrhotic patients with renal injury.

Advances in the risk factors, pathogenesis, and treatment of liver cirrhosis with osteoporosis / 临床肝胆病杂志

Osteoporosis is a common extrahepatic complication of liver cirrhosis, and it not only increases the economic burden of patients, but also brings adverse effects on their quality of life and prognosis. Recent studies have shown that sarcopenia, adiponectin, leptin, irisin, and inflammatory factors are involved in the development of osteoporosis in patients with liver cirrhosis, and commonly used anti-osteoporosis drugs include calcium supplement, vitamin D, and bisphosphonates. This article reviews the advances in the risk factors, pathogenesis, and treatment of liver cirrhosis with osteoporosis and points out that there are still controversies over the influence of some factors on osteoporosis, and further studies are needed to explore related pathogeneses and safe and effective treatment regimens.

Effects of photodynamic therapy combined with torasemide on rat glioma / 国际生物医学工程杂志

Objective To study the effects of photodynamic therapy (PDT) combined with torasemide on rat glioma by detecting the protein expression of matrix metalloproteinase 2 (MMP2),matrix metalloproteinase 9 (MMP9),sodium-potassium-chloride co-transporter 1 (NKCC1) and vascular endothelial growth factor (VEGF).Methods Male Wistar rats with glioma were randomly divided into four groups,includes control group (sham group,n=15),photodynamic therapy group (PDT group,n=15),torasemide group (T group,n=15) and PDT+T group (n=15).The rats were normally fed in the sham group,were received PDT (80 J/cm2) for 10 min in the PDT group,were received intraperitoneal torasemide 5 mg/kg for 3 days in the T group,and received PDT and torasemide treatment in the PDT+T group.After 2 weeks,5 rats were sacrificed from each group.Peritumoral edema tissues were harvested for the detection of wet-dry-weight ratio (W/D),and the protein expression of MMP2,MMP9,NKCC 1 and VEGF by Western Blot,immunohistochemistry and qRT-PCR.The remaining rats were used for survival time assessment.Results Compared with the sham group,the PDT group showed an increase in W/D (5.17±0.42 vs 4.83±0.38),the expression of NKCC1 (0.54±0.21 vs 0.35±0.12) and VEGF (0.68±0.20 vs 0.42±0.15),and survival time ((32.2±2.9) d vs (25.3±2.6) d) (all P＜0.05),and showed an decrease in the expression of MMP2 (2.76±0.42 vs 1.88±0.17) and MMP9 (2.55±0.38 vs 1.46±0.21) (all P＜0.05).Compared with the PDT group,the T group showed decrease in W/D (3.68±1.04),the expression of NKCC1 (0.22±0.10) and VEGF (0.33±0.14),and survival time ((28.7±2.2) d) (all P＜0.05),and showed increase in the expression of MMP2 (2.71 ±0.35) and MMP9 (2.42±0.36) (all P＜0.05).Compared with the PDT group,the PDT+T group showed decrease in W/D (4.52±0.46),and the expression of NKCC1 (0.30±0.16),VEGF (0.44±0.21),MMP2 (1.84±0.23) and MMP9 (1.53±0.24) (all P＜0.05),and showed increase in survival time ((44.5±2.8) d)(P＜0.05).Conclusion PDT combined with torasemide can reduce PDT induced edema,reduce tumor invasiveness,and prolonged the average survival time of rats.

The inhibitory effect of photodynamic therapy and of an anti-VCAM-1 monoclonal antibody on the in vivo growth of C6 glioma xenografts

We investigated the effect of photodynamic therapy (PDT) and of an anti-vascular cell adhesion molecule-1 (VCAM-1) monoclonal antibody on the in vivo growth of C6 glioma. Seven days after inoculation with C6 cells, adult male Wistar rats weighing 280-300 g with MRI-confirmed glioma were randomly assigned to 4 groups (N = 15 per group): PDT + VCAM-1 antibody group; PDT group; VCAM-1 antibody group; control group. Eight days after inoculation, hematoporphyrin monomethyl ether (HMME) was administered as a photosensitizer and PDT was performed at 630 nm (illumination intensity: 360 J/cm²) for 10 min. VCAM-1 antibody (50 µg/mL) was then administered (0.5 mL) through the tail vein every other day from day 8 to day 16. At day 21, 5 rats in each group were sacrificed and cancers were harvested for immunohistochemistry and Western blot assay for the detection of VCAM-1, and TUNEL assay was used to detect apoptosis. Survival and tumor volume were recorded in the remaining 10 rats in each group. In the PDT group, tumor growth was significantly suppressed (67.2 percent) and survival prolonged (89.3 percent), accompanied by an increase in apoptosis (369.5 percent), when compared to control. Furthermore, these changes were more pronounced in the PDT + VCAM-1 antibody group. After PDT, VCAM-1 expression was markedly increased (121.8 percent) and after VCAM-1 monoclonal antibody treatment, VCAM-1 expression was significantly reduced (58.2 percent). PDT in combination with VCAM-1 antibody can significantly inhibit the growth of C6 glioma and prolong survival. This approach may represent a promising strategy in the treatment of glioma.

Effect of Neural Stem Cells Transplantation on Sequela after Traumatic Intracranial Hematoma / 中国康复理论与实践

@#Objective To investigate the curative effect of neural stem cells (NSCs) transplantation on sequela after traumatic intracranial hematoma. Methods 20 patients with sequela after traumatic intracranial hematoma were treated with NSCs transplantation. Cells were engrafted into subarachnoid cavity via lumbar puncture. They were assessed with Functional Independence Measure (FIM) before and half a year after the transplantation. Results The FIM scores were significantly increased after the transplantation (P<0.01).Conclusion NSCs transplantation could promote functional recovery and improve the living quality of patients with sequela after traumatic intracranial hematoma in the aspects of self-care, sphincter control, mobility, locomotion, communication and social adjustment/cooperation.