Diagnostic value of a combined serology-based model for minimal hepatic encephalopathy in patients with compensated cirrhosis / 中华检验医学杂志

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Recommendations on the diagnosis and treatment of anti-neutrophil cytoplasmic antibody associated vasculitis in China / 中华内科杂志

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is a group of systemic small vasculitis characterized by ANCA positive in serum. Three diseases are included in this group of diseases: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). In China, standardized diagnosis and treatment of AAV is still lacking. Based on the evidence and guidelines from China and abroad, the Chinese Rheumatology Association formulated the standardization of diagnosis and treatment of ANCA associated vasculitis. The purpose is to standardize the diagnosis of AAV and disease activity assessment, and recommend the treatment strategies.

Analysis on clinical characteristics of PM/DM combined with thyroid disease / 吉林大学学报(医学版)

Objective: To study the characteristics and clinical appearence of polymyositis (PM ) or dermatomyositis (DM)combined with thyroid diseases,and to analyze the clinical significance.Methods:Total 77 patients first diagnosed as PM or DM were selected.All the patients were divided into four groups according to their thyroid functions,which were normal thyroid function group,low T3 syndrome group,hypothyroidism group, and subclinical hypothyroidism group.Their clinical manifestations,laboratory features,immunological examination results and prognosis were collected and analyzed.Results:In all the PM/DM patients,there were 41 cases with thyroid disfunction, including 17 cases (41.46%)with low T3 syndrome (41.46%).Compared with normal thyroid function group,the patients in hypothyroidism group were more vulnerable to dysphagia and edema (P <0.05);the proportion of proteinuria was also significantly increased (P <0.05).The PM/DM patients with low T3 syndrome were more easier to have higher incidence of death,higher level of C-reactive protein and lower levels of albumin and calciumion as well as higher incidence of edema and pleural effusion (P < 0.05 ).Conclusion:The incidence of PM/DM combined with thyroid disfunction is higher,and low T3 syndrome is most common.The PM/DM patients with hypothyroidism and low T3 syndrome are more likely to suffer the digestive system,lung and kidney injuries.The patients with low T3 syndrome have a higher death rate.

Surgical Treatment of Obstructive Jaundice Caused by Bile Duct Strictures after Hepatic Transcatheter Arterial Chemoembolization / 华中科技大学学报(医学版)

Objective To examine the surgical treatments for obstructive jaundice caused by bile duct strictures after hepat-ic transcatheter arterial chemoembolization(TACE).Methods Clinical data were retrospectively analyzed of 9 patients who de-veloped bile duct strictures among 229 patients after TACE between June 1994 and March 2011 in People’s Hospital of Zhe-jiang Provincial and the Second Affiliated Hospital of Zhejiang University.There were 6 cases of primary liver cancer,and 3 ca-ses of metastatic liver cancer.Obstructive jaundice occurred 5 to 16 months after TACE treatment.The median time was 8 months.Results All the nine patients with bile duct strictures suffered different degrees of obstructive j aundice,which was cured after surgical operations or PTC + stenting in 7 patients and significantly relieved by percutaneous transhepatic cholangic drainage(PTCD)in 2 ones.Two patients with obstructive j aundice after TACE for primary liver cancer were followed up for 3 years,and no recurrence of hepatic carcinoma and bile duct obstruction was found.The other 7 patients were followed up for 3 to 13 months,and they all died of deterioration of primary disease.Conclusion Patients with obstructive jaundice caused by bile duct strictures after TACE benefit from surgical operations or intervention treatment.Different surgical strategies are selected based on the characteristics of primary disease,the site and extent of bile duct stricture.

Changes of expression levels of NK,NKT cells and their receptors in peripheral blood of human and its correlation with rheumatoid arthritis / 中国免疫学杂志

Objective:To explore the changes of NK and NKT cells and the expression levels of their activated, inhibitory receptors in the peripheral blood of patients with newly diagnosed rheumatoid arthritis ( RA), and to reveal the potiential role of NK and NKT cells played in the pathogenesis of RA.Methods:32 patients with new onset RA and 15 healthy controls were recruited.Activated and inhibitory NK and NKT cells in peripheral blood were quantified by flow cytometry.The frequency of spontaneous and stimulated IFN-γ+NK and NKT cells and CD107aγ+NK cells were examined.Finally,the potential relationship between the frequency of NK and NKT cells subsets and clinical indexes were analyzed.Results:The frequencies of NK cells in peripheral blood in RA patients were sig-nificantly lower than those in the controls ( P=0.026 ).The frequencies of NKG2D+, NKP46+activated NK cells and NKG2C+, NKG2D+,NKP46+activated NKT cells in RA patients were significantly higher than those in the controls (P=0.011,P=0.010,and P<0.001,P=0.032,P=0.001,respectively),whereas the frequencies of KIR2DL3+,KIR3DL1+and NKG2A+inhibitory NK cells and KIR2DL3+,NKG2A+inhibitory NKT cells in RA patients were significantly lower (P=0.002,P=0.002,P=0.014,and P=0.027,P=0.002,respectively).Moreover, the frequencies of stimulated IFN-γ+NK cells and IFN-γ+NKT cells, spontaneous and stimulated CD107 aγ+NK cells in RA patients were significantly higher than that in the controls ( P=0.037, P=0.004 and P=0.001, P=0.001, respectively).Furthermore,the frequencies of NK cells,NKG2Aγ+and KIR2DL3γ+inhibitory NK cells were correlated significantly with the values of DAS28 in RA patients (r=0.357,P=0.045;r=0.399,P=0.024;r=0.468,P=0.021,respectively).Conclusion:Lower frequencies of NK cells, higher frequencies of activated NK cells and activated NKT cells, lower frequencies of inhibitory NK cells and inhibitory NKT cells, and higher NK cell activity may induce the autoimmune reaction involved in the pathogenesis of RA.

Evaluation on effectiveness of salmeterol/fluticasone propionate combined with N-acetylcysteine in treatment of chronic obstructive pulmonary disease / 吉林大学学报(医学版)

Objective To explore the effects of salmeterol/fluticasone propionate complicated or combined with N-acetylcysteine on the pulmonary function and arterial blood gas analysis of the patients with chronic obstructive pulmonary disease (COPD), and to evaluate its curative effect.Methods 84 cases of COPD patients were randomly divided into combination treatment group (n=44)and simple treatment group (n=40).The patients in combination treatment group were treated with salmeterol/fluticasone propionate combinated with N-acetylcysteine while the patients in simple treatment group were treated only with salmeterol/fluticasone propionate, both of which were followed up for 6 months.The changes of pulmonary function (FEV1%FVC,FEV1%Pred,PEF daily variation rate:ΔPEF%)and the arterial blood gas analysis indexes (PaO2 and PaCO2 )of the patients in two groups were recorded before treatment, 3 months after treatment, and 6 months after treatment. Results The FEV1%FVC,FEV1%Pred and PaO2 of the patients in combination treatment group and simple treatment group were obviously increased 3 and 6 months after treatment compared with before treatment (P0.05).TheΔPEF% of the patients in two groups had no significant differences between inter-group and intra-group before and after treatment (P > 0.05 ). Conclusion Combination of salmeterol/fluticasone propionate and N-acetylcysteine can obviously improve the pulmonary function and arterial blood gas analysis indexes of the COPD patients, which is superior to the simple application of salmeterol/fluticasone propionate and has definite and lasting curative effect on the treatment of COPD.

Experimental study on cultured bone marrow endothelial progenitor cells transfected with gene of human hypoxia inducible factor-1? in vitro / 吉林大学学报(医学版)

Objective To transfect PCDNA3.0-HIF1-? into the endothelial progenitor cells(EPCs),in order to provide the foundation for exploring myocardial vascular repairing capacity and angiogenesis of the EPCs transfected with HIF gene.Methods The EPCs were separated by the method of density gradient separation in the human bone marrow,and then the cells were inoculated in the fibronectin-packaged petri dishes complete medium with the concentration of 1?106?mL-1,and cultivated for 14 d. The expressions of the endothelial cell-specific components ecNOS and flk-1 were detected with RT-PCR; the cells were stained with acLDL-Dil and FITC-UEA-1; the PCDNA3.0-HIF1-? plasmid was transfected into the EPCs mediated by LipofectamineTM 2000,the transcription of HIF1-? was determined with RT-PCR; the expression of VEGF was detected with enzyme-linked immunosorbent assay (ELISA); the expression of HIF1-? was detected with Western blotting.Results After cultivated for 5 d,some round monocytes transformated into spindled inherent EPCs;7 d later,there were some cell colonies containing dozens of cells;10 d later,there were obvious cell clones; RT-PCR showed ecNOS band in 548 bp,flk-1 band in 819 bp; acLDL-Dil and FITC-UEA-1 double-staining was positive; RT-PCR showed specific band in 383 bp; ELISA showed the content of VEGF in the supernatant of EPCs transfected with HIF1-? was (20.53?2.33) ?g?L-1,and it was (3.96?1.67) ?g?L-1 in the EPCs transfected without HIF1-?,there was significant difference between two groups (P

Effect of basic fibroblast growth factor on sheep bone marrow mesenchymal stem cells proliferation and differentiation in vitro / 吉林大学学报(医学版)

Objective To evaluate the effect of basic fibroblast growth factor(bFGF) on sheep bone marrow mesenchymal stem cells(BMSCs) proliferation and differentiation in vitro.Methods The sheep BMSCs were isolated and expanded in vitro and divided into experimental group and control group.bFGF(2 ?g?L-1) was added into cell culture medium of experimental group.In control group,no bFGF was added.The morphological differences of BMSCs between two group were observed.Growth curves and alkaline phosphatase(ALP) activity were assessed.In order to observe the influence of bFGF on differentiation potential of BMSCs,osteogenic and adipogenic inductions were conducted on BMSCs in two groups.Results Fibroblast colonies appeared 1 week after seeding of the mononuclear cells.2 weeks later,more colonies formed and each colony became larger.The cell number was 2.5 times of the control when the first passage cells grew to confluence and the ALP activity in experimental group was lower than that in control group(P

Targeting therapy of SLE associated thrombocytopenia with labeled antibody in vitro / 吉林大学学报(医学版)

Objective To discuss the feasibility and effect of labeled antibody on targeting therapy of systemic lupus erythematosus(SLE) associated thrombocytopenia.Methods MTX-IVIG conjugate was prepared by indirect and direct cross linking,and the binding ability of it to Fc fragment was detected by indirect immunofluor-escence.The killing activity of the conjugate was detected by MTT method using murine macrophage with Fc receptor and strain U937 of human monocytic leukemia cell as targets.Results Conjugation showed stronger cytotoxicity upon target cells than free MTX,and it showed less cytotoxic effect on Fc receptor negative cells compared with the positive ones.IVIG-HSA-MTX restrained the phagocyte of macrophage.The killing effect of IVIG-HSA-MTX was significantly stronger than that of IVIG-MTX.Conclusion The conjugation can show a highly specific cytotoxicity upon mononuclear-macrophage in vitro.

Study on targeting therapy of idiopathic thrombocytopenic purpura with MTX-labelled antibody in vitro / 吉林大学学报(医学版)

Objective:To conjugate IVIG and MTX to produce a specific cytotoxicity upon phagocytes.Methods :MTX was conjugated with IVIG by indirect conjugating methods. HSA was used as an intermedi-ary to conjugate MTX with IVIG. The indirect immunofluorescence was adopted to test the binding abilityof Fc fragment. MTT assay was used to measure the cytotoxicity of conjugation on phagocytes. Results:Conjugation showed stronger cytotoxicity upon target cells than free MTX,and it showed only less cyto-toxic effect on Fc receptor negative cells compared with the positive ones. The specific cytotoxicity of IVIG-HSA-MTX was significantly stronger than that of MTX. Conclusion: In vitro the conjugation showed ahighly specific cytotoxicity upon phagocytes.