Systematic review of qualitative studies on the decision dilemma of blood glucose management during pregnancy in patients with gestational diabetes mellitus / 中国实用护理杂志

Objective:To systematically evaluate the qualitative studies on the decision dilemma of blood glucose management during pregnancy in patients with gestational diabetes mellitus, so as to provide reference for the subsequent formulation of intervention strategies.Methods:The qualitative studies on the decision dilemma of blood glucose management during pregnancy in patients with gestational diabetes mellitus in the Cochrane Library, CINAHL, EMbase, PubMed, PsycINFO, ProQuest, Web of Science, China National Knowledge Internet, Wanfang, VIP and Chinese Biomedical Database were searched from inception to May 2022. The JBI Critical Appraisal Tool for qualitative studies in Australia (2016) was used to evaluate the literature quality, and research results were summarized and integrated by integrating methods.Results:A total of 13 studies were included, 56 themes were extracted, and they were summarized into 9 categories, forming 3 integrated results as following, lack of personalized and professional information on blood glucose management, worring about the influence of blood glucose management on the health of mothers and children, conflict between daily life and blood glucose management plan.Conclusions:Health care workers should provide gestational diabetes mellitus patients with adequate personalized professional information support on blood glucose management to facilitate scientific decision-making during pregnancy, and also analyze the benefits and risks of different decisions for patients to help them make the best decision and strengthen their external support system to help them implement blood glucose management decisions.

The early diagnosis and treatment of atypical autoimmune liver disease should be taken seriously / 临床肝胆病杂志

Autoimmune liver disease is a group of diseases mainly caused by autoimmune abnormalities, including autoimmune hepatitis dominated by hepatocellular injury, primary biliary cholangitis and primary sclerosing cholangitis dominated by bile duct injury, and overlap syndrome with the main features of the above two diseases. Recently, IgG4-related hepatobiliary diseases have also been included in this category, and without timely diagnosis and treatment, it can progress to liver cirrhosis and even liver failure. Different autoimmune liver diseases have their own features, and with the popularization of the knowledge on autoimmune liver diseases, physicians have gradually increased their understanding of such diseases and can achieve the early diagnosis and timely treatment of most typical autoimmune liver diseases. However, some patients may have atypical manifestations or laboratory markers, which may easily delay the diagnosis, and therefore, it is of great importance to identify atypical autoimmune liver disease and give timely diagnosis and treatment as soon as possible.

Review and prospect of the development in the field of autoimmune liver diseases in China over the last 20 years / 临床肝胆病杂志

Through big data, this paper reviews the national research projects and the academic papers published in China and globally in the field of autoimmune liver diseases in China from 2001 to 2020, revealing the development trend in the past two decades. This paper also introduces the updates of the newly issued guidelines for the diagnosis and treatment of autoimmune liver diseases, and reviews the development of autoantibody detection technology and analyzes its progress.

Percutaneous transhepatic one-step biliary fistulation lithotomy combined with laparoscopic cholecystectomy for choledocholithiasis with gall stones / 中华普通外科杂志

Objective:To evaluate the clinical value of percutaneous transhepatic one-step biliary fistulation(PTOBF)lithotomy plus laparoscopic cholecystectomy(LC) in the treatment of choledocholithiasis combined with cholecystolithiasis.Methods:From Jul 2012 to Jun 2018, 44 patients with cholecystolithiasis and choledocholithiasis were treated by PTOBF + LC ( n=20) vs laparoscopic common bile duct exploration(LCBDE)+ LC( n=24). Results:The success rate of one-step operation in both groups was 100%.The average intra-operative hemorrhage and the average hospital stay after operation were higher in LCBDE+ LC group (all P<0.05). The post-operative complication rate of PTOBF lithotomy + LC group was 10.0% (2/20), recurrence rate of observation period was 10.0% (2/20), while that of LCBDE+ LC group was 8.3% (2/24), and 12.5% (3/24), the difference was not statistically significant (all P>0.05). Conclusion:PTOBF lithotomy combined with LC is a safe, effective and feasible minimally invasive method for the treatment of choledocholithiasis combined with gall stones.

Culture and identification of dermal mesenchymal stem cells from skin lesions of patients with psoriasis and analysis of HES1 and CXCL6 expression in these cells / 中华皮肤科杂志

Objective:To culture and identify dermal mesenchymal stem cells (DMSCs) in skin lesions of patients with psoriasis, and to determine the expression of hairy and enhancer of split-1 (HES1) and chemokine ligand 6 (CXCL6) in DMSCs.Methods:DMSCs were isolated from skin lesions of 15 patients with psoriasis and normal skin tissues of 18 healthy controls, and then subjected to culture. Cell phenotypes were identified by flow cytometry, and mRNA and protein expression of HES1 and CXCL6 was determined by real-time fluorescence-based quantitative PCR (RT-PCR) and Western blot analysis respectively. Comparisons were performed between 2 groups by using t test. Results:There was no difference in the morphology of DMSCs between the psoriasis group and control group. The mRNA expression of HES1 and CXCL6 in the psoriasis group was 3.56 and 3.44 times that in the control group respectively, and there was a significant difference between the two groups (both P < 0.05) . The protein expression of HES1 and CXCL6 in DMSCs was significantly higher in the psoriasis group than in the control group (both P < 0.05) . Conclusion:The high expression of HES1 and CXCL6 in DMSCs from lesions may be involved in the occurrence of psoriasis.

A preliminary clinical study comparing percutaneous transhepatic choledochoscopy lithotomy with laparoscopic choledocholithotomy for choledocholithiasis / 中华肝胆外科杂志

Objective:To compare the clinical efficacy of percutaneous transhepatic choledochoscope lithotomy (PTCSL) with laparoscopic choledocholithotomy (LD) in treatment of choledocholithiasis.Methods:Data of 132 patients with choledocholithiasis treated at the First Affiliated Hospital of Guangzhou Medical University from July 2012 to December 2018 were retrospectively analyzed. There were 75 males and 57 females, with an average age of 62.7 years. For 76 patients underwent PTCSL (the PTCSL group) and 56 underwent LD (the LD group). The data of the patients the success rate of lithotomy, stone residual rate, operation time, postoperative complications and stone recurrence, chronic cholangitis, and acute cholangitis 1 month after operation were compared between the two groups.Results:The ratio of upper abdominal operation history and biliary tract infection in the PTCSL group was higher than that in the LD group, and the difference was statistically significant (both P<0.05). In the PTCSL group, the calculi were successfully removed in 64 patients in one treatment session, while residual calculi were removed through subsequent sinus choledochoscopy in 9 patients. In the remaining 3 patients, the residual calculi were removed with LD or laparotomy operations. Postoperative complications occurred in 14 patients (19.2%, 14/73). In the LD group, the calculi were successfully removed in one session in 46 patients while in 8 patients the residual calculi were removed by choledochoscopy (1 patient still had residual calculi after choledochoscopy). The remaining 2 patients underwent open surgery due to anatomical difficulties. Postoperative complications occurred in 11 patients (20.4%, 11/54). There were no significant differences between the two groups in the one-off stone removal rate, postoperative stone residual rate, final stone removal rate and postoperative complication rate (all P>0.05). The operation time of the PTCSL group was (156±60) min, which was significantly shorter than the LD group (203±59) min ( P<0.05). There was no significant difference between the two groups in the incidence of postoperative chronic cholangitis and recurrence rate of calculi (both P>0.05). The incidence of acute cholangitis in the PTSCL group was significantly higher than that in the LD group ( P<0.05). Conclusion:PTCSL was as safe and effective as LD, with fewer complications and faster recovery. It is especially suitable for patients with previous upper abdominal surgery, recurrence of calculi and repeated biliary tract infection.

The ultrasonic navigation technique in percutaneous transhepatic one-step biliary fistulation with rigid cholangioscopic lithotripsy for complicated hepatolithiasis / 中华肝胆外科杂志

Objective To study the efficacy and safety of percutaneous transhepatic one-step biliary fistulation (PTOBF) with rigid cholangioscopic lithotripsy for treatment of complicated hepatolithiasis under the ultrasonic navigation technique.Methods In this retrospective study,PTOBF lithotripsy surgery was performed in 94 patients with hepatolithiasis under general anesthesia with tracheal intubation,and with percutaneous transhepatic puncture of targeted bile duct under ultrasonic navigation in The First Affiliated Hospital of Guangzhou Medical University.Biliary expanders were used along a guidewire to expand the sinus gradually until 14Fr to establish a fistulous channel.Lithotripsy was then performed through the channel by rigid cholangioscopy.The operation-related data were collected and analyzed,including puncture and fistula establishment success ratio,complication rate,intraoperative blood loss,residual and recurrence hepatolithiasis rates.Results 94 patients (total 122 patient-times) underwent PTOBF lithotripsy.There was no perioperative mortality.The overall puncture success rate was 100％,and the fistula/puncture rate was 97.5％ (119/122).In 118 patients success was achieved in 2 time (96.7％).The complication rate was 9.6％ (9/94).The average intraoperation blood loss were (24.9 ± 21.3)ml.The residual calculus rate after therapy was 13.8％ (13/94).All patients were followed-up for a period that ranged between 18 and 30 months.The recurrence rate was 14.9％ (14/94).Conclusions Ultrasonic navigation technique plays an important role in bile duct puncture,sinus expansion and rigid cholangioscopic lithotripsy for treatment of complicated hepatolithiasis.PTOBF lithotripsy is a safe and effective procedure,which provides a new way in mini-invasive treatment for hepatolithiasis.It is worth generalizing.

Role of intestinal flora in the development/progression and treatment of autoimmune liver diseases / 临床肝胆病杂志

Overgrowth of intestinal bacteria, change in intestinal flora, translocation between bacteria and their products, and bile acid metabolism are the important pathways for the development and progression of liver diseases. Hepatocytes are persistently exposed to intestinal metabolites and various antigens and antibodies via the portal vein system, and the constituents or metabolites of some intestinal bacteria can activate the autoimmune mechanism targeting hepatocytes through several mechanisms, including molecular mimicry. Therefore, intestinal flora plays an important role in the development/progression and treatment of autoimmune liver diseases, including autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis. This article reviews the related research advances in recent years.

An analysis of the serological characteristics of anti-mitochondrial M2 subtype in patients with drug-induced liver injury and primary biliary cholangitis / 中华肝脏病杂志

Objective@#To analyze the serological characteristics of anti-mitochondrial antibody M2 subtype (AMA-M2) in patients with drug-induced liver injury (DILI) and primary biliary cholangitis (PBC), in order to provide reference for clinical differential diagnosis.@*Methods@#Laboratory data of 2802 DILI cases who visited the hospital between January 2011 and December 2017 were retrospectively collected. AMA-M2 positive patients were analyzed with respect to laboratorical findings, and serum data of 120 patients with primary biliary cholangitis (PBC) at the same period was taken as a control. A chi-square test was used for group comparisons. One-way ANOVA and rank sum tests was used for ALT, AST, ALP, GGT and three groups of immunoglobulin M.@*Results@#Among 2802 DILI patients, AMA-M2 positive rate was 5.1% (144/2 802), 77.1% (111/144) was DILI alone, 22.2% (32/144) was DILI with PBC, and 0.7% (1/144) was DILI with Sjogren's syndrome. An AMA-M2 level in DILI alone group was mostly mild and moderate than the PBC group and the DILI combined with the PBC group. There was significant difference between the two groups (P < 0.05).There was no significant difference in AMA-M2 levels between DILI group combined with PBC group and PBC group (P > 0.05). ALT and AST levels of DILI alone group and DILI combined with PBC were (585.92 ± 653.04) U/L, (501.45 ± 512.67) U/L and (373.47 ± 502.60) U/L, (335.97 ± 513.96) U/L, respectively, which were significantly higher than PBC group [(106.33 + 134.08) U/L, (112.59 + 152.20) U/L]. There were statistically significant differences between the two groups (P < 0.05).The ALP level of DILI alone group was (152.58 + 81.46) U/L, which was lower than PBC group (237.86 + 215.09). The difference was statistically significant (P < 0.05). The level of immunoglobulin M in the DILI alone group was (1.76 ± 1.16) g/L, which was lower than PBC group (4.74 ± 5.74) g/L and the DILI combined with the PBC group (3.31 ± 1.68) g/L. There was significant difference between the two groups. During follow-up, 2.7% of patients with DILI had cirrhosis, 42.3% had lower AMA-M2 titer, 14.4% had lower AMA-M2 titer, 13.5% had higher AMA-M2 titer and five cases developed PBC.@*Conclusion@#AMA-M2 is not only positive in patients with PBC, but also low-to-medium or even high-level AMA-M2 may be detected in DILI patients. For AMA-M2-positive DILI patients, it is necessary to identify whether they are associated with PBC. Secondly, the levels of ALT, AST and ALP should be analyzed, and the patients should be on regular follow up for early and timely detection of drug-induced PBC.

One stage percutaneous transhepatic rigid choledochoscope lithotomy (PTCSL) vs ERCP plus EST for choledocholithiasis / 中华普通外科杂志

Objective To investigate the curative effect on patients with choledocholithiasis by percutaneous transhepatic rigid choledochoscope lithotomy (PTCSL) vs endoscopic retrograde cholangiopancreatography (ERCP) plus EST.Methods From Jan 2010 to Dec 2015,92 cases of choledocholithiasis were treated by one-stage PTCSL (n =23) vs ERCP (n =69).The curative effects and postoperative complications in two groups were observed and analyzed.Results In PTCSL group,the complete stone clearance at one-time achieved in all 23 cases (100％).While in ERCP group stone clearance was achieved in 72.46％ cases at first attempt and the final clearance rate was 82.60％,leaving 12 cases with residual stones and among those 12 cases 5 cases were converted to surgical operation.The average intra-operative hemorrhage in two groups was (20.6 ± 4.6) ml vs (3.0 ± 0.3) ml,and the average hospital stay after operation was 6.8 d and 7 d respectively.The post-operative complications (30.43％) and stone recurrence (13.04％) were similar in the two groups.Conclusions PTCSL is safe,effective,and more suitable to patients with large stones and those with a history of biliary surgeries.

Clinical features of autoimmune hepatitis in children: An analysis of 10 cases / 临床肝胆病杂志

ObjectiveTo investigate the clinical features and treatment outcome of children with autoimmune hepatitis (AIH). MethodsA retrospective analysis was performed for the clinical data, liver pathology, treatment outcome, and follow-up data of 10 children with AIH who were treated in Beijing YouAn Hospital, Capital Medical University, from December 2008 to December 2017. ResultsThe children were aged 3-16 years (median 10 years), and girls accounted for 70%. Of all patients, 5 had type 1 AIH, and 5 had type 2 AIH; 3 (30%) had an acute onset, 2 (20%) had a subacute onset, and 5 (50%) had a chronic onset. Elevation of aminotransferases was found in 8 children (80%), and elevations of bilirubin, gamma-glutamyl transpeptidase, and immunoglobulin G were found in 7 children (70%), 7 children (70%), and 6 children (60%), respectively. Among the 7 children who underwent liver biopsy, 3 had grade ≥3 liver inflammation, 4 had stage ≥3 liver fibrosis, 5 had interface hepatitis, 5 had plasma cell infiltration, 4 had rosette-like annulation of hepatocytes, and 7 had lymphocyte infiltration. One child died, and one was lost to follow-up; among the other 8 children, 6 had good response, 1 experienced recurrence, and one had poor response. 4 patients with type 2 AIH were treated with glucocorticoids combined with azathioprine, the disease was effectively controlled. ConclusionChildren with AIH have diverse clinical manifestations, and some children have serious conditions. Most patients with type 2 AIH need the treatment of glucocorticoids combined with azathioprine.

Clinical value of anti-liver/kidney microsomal-1 antibody in patients with liver disease / 中华肝脏病杂志

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.

Characteristics of IgH-CDR3 repertoire of peripheral B cells in a patient with primary biliary cholangitis: a preliminary study using high-throughput sequencing / 中华肝脏病杂志

Objective@#To analyze the characteristics of immunoglobulin heavy chain complementarity-determining region (IgH-CDR3) repertoire of peripheral B cells in a patient with primary biliary cholangitis (PBC) and to investigate the diversity of the immune system.@*Methods@#Arm-PCR was used to amplify the IgH-CDR3 region of circulating B cells isolated from a PBC patient, and high-throughput sequencing was used to analyze the amplified product. The characteristics of immune repertoire were analyzed by bioinformatics.@*Results@#In total, 329219 sequence reads were generated from the sample, with 325540 total CDR3 sequences and 72774 distinct CDR3 sequences, and the D50 of IGH-CDR3 was 7.7. The dominant CDR3 length of the sample was 45 nt (9.6%); the N addition with the highest frequency ranged from 13 to 14 nt (5.25%); the J trimming with the highest frequency was 0 nt (12.7%); the three most frequent V alleles were V4-59 (9.5%), V3-23 (8.1%), and V1-69 (6.4%).@*Conclusion@#The diversity of IgH-CDR3 repertoire is relatively low in this patient with PBC, with several B-cell clonal expansions. The specificity needs to be further verified after increasing the sample size.

Prognostic evaluation of primary biliary cirrhosis and its value in guiding therapeutic regimens / 临床肝胆病杂志

Prognostic evaluation of patients with primary biliary cirrhosis (PBC) and how to improve the prognosis have attracted much attention. Further therapeutic regimens for PBC patients with poor prognosis has become the direction of clinical and scientific studies. This article summarizes the association between baseline indices and prognosis and prognostic evaluation of patients undergoing ursodeoxycholic acid (UDCA) treatment, introduces the current status of UDCA combined with budesonide, fibrates, and obeticholic acid for patients with poor response to UDCA and the drugs being developed, and analyzes the influencing factors for prognosis and efficacy of UDCA. It is pointed out that prognosis and efficacy should be evaluated before and during UDCA treatment, and that therapeutic regimens should be adjusted in time to improve prognosis.

Risk factors for occurrence of post-sustained virologic response hepatocellular carcinoma in chronic hepatitis C ;patients / 中华传染病杂志

Objective To investigate the risk factors and predictive model for the occurrence of post-sustained virologic response (SVR)hepatocellular carcinoma in chronic hepatitis C (CHC)patients. Methods A total of 203 CHC patients hospitalized at the First Affiliated Hospital of Zhengzhou University from January 2006 to December 2014 who received antiviral therapy and achieved SVR were collected,including 11 post-SVR HCC cases.Risk factors for post-SVR HCC were estimated by Cox′s proportional hazards regression model.Cutoff value predicting risk of post-SVR HCC was determined by receiver operating characteristic curve.Results In Cox′s model,the risk of post-SVR HCC increased by 9.4-fold in patients with initial diagnosis as compensated cirrhosis compared to those with initial diagnosis as CHC.Increase in post-SVR albumin by per 1 g/L was associated with reduced risk by 20% for the occurrence of post-SVR HCC.Cut-off value of post-SVR albumin for the prediction of HCC was determined as ≤ 36.0 g/L with an area under the curve (AUC)of 0.809.A predictive model for post-SVR HCC was created based on initial diagnosis as compensated cirrhosis and post-SVR albumin ≤36.0 g/L with an AUC of 0.871 .The sensitivity,specificity and negative predictive value of the model were 0. 818,0.896 and 0.989,respectively.Conclusions Initial diagnosis as compensated cirrhosis combines with post-SVR albumin ≤36.0 g/L are risk factors for post-SVR HCC with ideal prediction value for the occurrence of post-SVR HCC in CHC patients.

Drug-induced liver injury accompanied by autoimmune phenomena: an analysis of clinical characteristics / 临床肝胆病杂志

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.

Correlation between clinical data and pathological stage in patients with primary biliary cirrhosis: a study of 54 cases / 临床肝胆病杂志

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.

The function of AMPK activation on apoptosis induced by CD437 in cancer cell / 肿瘤研究与临床

Objective To observe the effects of AMPK activation on cancer cell apoptosis and to investigate the underlying mechanism and its significance to cancer therapy.Methods Human cervical cancer HeLa-S3 cells were divided into six groups:DMSO control,5 μmol/L CD437,CD437+Compound C,CD437+AICAR,Compound C,AICAR.Apoptosis rates in every groups induced by CD437 and other factors were determined by FACS and confirmed with clave Caspase-3 expression by Western blot analysis.Finally,apoptosis rates were detected in HeLa-S3 cells induced by the above factors after wt-LKB1 reintroduction by plasmid transfection.Results FACS results showed that treatment with 5 μmol/L CD437 for 8 hours could induce Hela-S3 cells apoptosis by (87.42±5.95) ％.Co-incubation with 20 μmol/L compound C enhanced apoptotic effect of CD437 by (86.42±5.95) ％,while co-incubation with 2 mmol/L AICAR markedly reduced cell apoptosis induced by CD437 [(51.04±8.26) ％] (P ＜ 0.05).Re-introduction of wt-LKB1 by plasmid transfection attenuated the protective effect of AICAR in CD437 induced apoptosis.Conclusion Endogeneous AMPK activation exerts a protective effect in HeLa-S3 ceils.This effect could be attenuated by re-introduction of wt-LKB1.

Differential characteristics of AMA-M2 autoantibody in primary biliary cirrhosis and non-PBC patients / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To explore the differential characteristics of the AMA-M2 autoantibody in patients with primary biliary cirrhosis (PBC) and non-PBC patients.</p><p><b>METHODS</b>Patients with abnormal liver function at the Capital Medical University affiliated to Beijing You-an Hospital were enrolled in this study between January 2011 and December 2013. Serum levels of ANA, AMA and AMA-M2 were detected by indirect fluorescence assay and enzyme-linked immunosorbent assay. The patients' clinical data was obtained for retrospective analysis. Statistical analyses were performed using the SPSS 16.0 software. Enumeration data have been presented as numbers and percentages, and were analyzed using the chi-square test and one-way ANOVA test.</p><p><b>RESULTS</b>Of the 5315 patients with abnormal liver function, 15.3% (811/5315) were AMA-M2 positive patients; among those 811 patients, 78.4% (636) had PBC, 4.4% (36) had PBC overlapping with autoimmune hepatitis (AIH), 4.4% (36) had drug-induced liver injury, 6.5% (53) had hepatitis B, 3.3% (27) had hepatitis C, 0.6% (5) had hepatitis E, 0.9% (7) had alcoholic liver disease, 0.5% (4) had non-alcoholic fatty liver, 0.8% (6) had primary hepatic carcinoma, and 0.1% (1) had infectious mononucleosis. Serum AMA-M2 level was significantly higher in the PBC patients (vs. other groups, P less than 0.001) with the exception of the patients with PBC/AIH overlap syndrome. Among the 811 patients with AMA-M2 positivity, 88.5% (718) showed AMA positivity and 91.1% (739) showed ANA positivity. Serum alanine transferase (ALT) and aspartate transferase (AST) levels were significantly higher in the drag-induced liver injury patients (527.74+/-684.65 U/L, 490.60+/-716.89 U/L) and the hepatitis E patients (1015.94 ± 165.55 U/L, 665.4 ± 297.14 U/L) than in the PBC patients (96.02 ± 115.56 U/L, 94.82 ± 83.32 U/L) (ALT: F =8.041, P < 0.001, P < 0.001; AST: F =8.066, P < 0.001, P < 0.001). Serum alkaline phosphatase (ALP; 265.16 ± 179.08 U/L) and glutamyl transferase (GGT; 332.02 ± 279.29 U/L) were significantly higher in the PBC patients than in the hepatitis B patients (135.35 ± 123.17 U/L, 140.27 ± 229.24 U/L) and the hepatitis C patients (85.65 ± 27.77 U/L, 92.70 ± 125.72 U/L) (ALP: F=3.911, P =0.01, P=0.001; GGT: F=4.081, P <0.001, P < 0.001). The serum IgM level was significantly higher in the PBC patients (4.60 ± 2.67 g/L) than in the patients with drug-induced liver injury (1.76 ± 1.15 g/L), hepatitis B (2.02 ± 1.41 g/L), hepatitis C (1.48 ± 0.92 g/L), hepatitis E (1.40 ± 0.68 g/L), alcoholic liver disease (1.57 ± 1.07 g/L), non-alcoholic fatty liver (1.05 ± 0.72 g/L), and primary hepatic carcinoma (2.64 ± 2.26 g/L) (F=16.83, P < 0.001, P < 0.001, Probability value < 0.001, Probability value < 0.05, Probability value < 0.01, Probability value < 0.05 respectively).</p><p><b>CONCLUSION</b>Although detection of serum AMA-M2 is an important feature of PBC diagnostic testing,there is a high ratio of serum AMA-M2 detected in patients with drug-induced liver injury, hepatitis B, C and E, alcoholic liver disease, non-alcoholic fatty liver,and primary hepatic carcinoma. The AMA-M2 positive non-PBC patients still require close observation to watch for future development of PBC.</p>

Study on short-term and long-term effects of PTCSL on hepatolithiasis / 实用医学杂志

Objective To explore the short-term and long-term effects ofapplication of Percutaneous Transhepatic Cholangioscopic Lithotripsy on the treatment of hepatolithiasis. Methods Eighty-threecases of hepatolithiasis were treated with the PTCSL and the other 87cases were treated with the Laparoscopic exploration lithotomy.The general clinical parameters , curative effect in the near future and long-term curative effect were anlyzed. Results No significant differences were found between the two groups in the general clinical parameters (P>0.05). The operation time,intraoperative blood transfusion volume and intraoperatve blood soss in group A were significantly shorter than those in group B(P0.05). No patients died in each group. The results of complications showed thatthe incidence of residual calculi of group A was significantly lower than that of group B (P<0.01). Conclusions Compared with the model of Laparoscopic exploration lithotomy, the PTCSL was more safe, minimally invasive and effective. The short-term efficacy of the model of PTCSL was better than that of the model of Laparoscopic exploration lithotomy.