Relationship between metastasis or recurrence of hepatocellular carcinoma and hepatitis B virus DNA or double mutation at 1762/1764 in the basic core promoter / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the relationship between metastasis or recurrence of hepatocellular carcinoma (HCC) and hepatitis B virus (HBV) DNA load or the presence of double mutation at 1762/1764 in the basic core promoter (BCP).</p><p><b>METHODS</b>One-hundred-and-fifty-seven patients with HCC were included in the study. Events of tumor metastasis or recurrence were recorded during 120 weeks of clinical follow-up after treatment by surgery or transarterial chemoembolization (TACE). The 1-year follow-up included monthly alpha fetoprotein (AFP) measurement and abdominal ultrasonography (US), as well as helical computed tomographic (CT) scan performed every 3 months. Follow-up beyond 1-year (surveillance) included AFP measurement and abdominal US every 2 months and helical CT scan every 6 months. Suspected metastasis or recurrence was investigated by hepatic angiography and confirmed according to the combined imaging findings. Serum HBV DNA level was measured by real-time PCR. HBV genotypes were determined by PCR-restriction fragment length polymorphism analysis.</p><p><b>RESULTS</b>Of the 157 HCC cases 110 experienced tumor metastasis or recurrence; the cumulative probability of post-treatment HCC metastasis or recurrence was 4 (2.55%) at week 12, 14 (8.92%) at week 24, 28 (17.83%) at week 48, 64 (40.76%) at week 72, 92 (58.60%) at week 96, and 110 (70.06%) at week 120. Multivariate analysis indicated that both the BCP 1762/1764 double mutations and HBV DNA levels were risk factors for HCC recurrence or metastasis. In particular, the incidence of HCC recurrence or metastasis increased with baseline serum HBV DNA levels in a dose-response manner, ranging from 8/19 (42.1%) for less than 3 log10 copies/ml HBV DNA to 35/61 (57.3%) for 3-5 log10 copies/ml and 67/77 (87.0%) for more than 5 log10 copies/ml. After adjusting for potential confounders, serum HBV DNA level remained independently associated with HCC metastasis or recurrence. HCC recurrence or metastasis occurred in 22/43 (51.2%) of patients without BCP 1762/1764 mutations and 88/114 (77.2%) of patients with BCP 1762/1764 mutations. The adjusted odds ratio for patients infected with BCP 1762/1764 double mutation HBV, compared with those infected with non-BCP 1762/1764 mutation HBV, was 5.264 (95% CI: 1.436-12.574, P less than 0.05).</p><p><b>CONCLUSION</b>Infection with HBV carrying the BCP 1762/1764 double mutation and presence of high HBV DNA load are independent risk factors for developing HCC metastasis or recurrence after surgery or TACE.</p>

Establishment and application of real-time fluorescence quantitative PCR for detecting recent thymic output function / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To establish an accurate and efficient method for detecting recent thymic output function and analyze the content of T-cell receptor (TCR) rearrangement excision circles (TRECs) within peripheral blood mononuclear cells (PBMCs).</p><p><b>METHODS</b>According to the specific sequence of TCRdelta, the primers and the fluorescent probe (TaqMan) were designed and synthesized. The standard quantitative template was constructed by T/A cloning. The method for detecting TRECs was established after optimization of reaction condition, then its specificity, sensitivity and stability were tested. Quantitative detection of TRECs in DNA of PBMCs from normal individuals and patients of chronic hepatitis B were preformed by real-time PCR using TaqMan technique.</p><p><b>RESULTS</b>Detection of TRECs was quick and accurate by real-time fluorescence quantitative PCR. The CV value of Ct was 1.06%, the product was specific which was confirmed by electrophoresis and sequencing and the method showed high sensitivity. The mean value of TRECs from normal individuals was (7767.4 +/- 2369.5) copies/10(6)PBMCs in healthy controls at age 21.45 but (28,374.4 +/- 7820.4) copies/10(6)PBMCs in those at age 16.20 (P < 0.05). The mean value of TRECs from patients with chronic hepatitis B was (6480.9 +/- 2031.2) copies/10(6) PBMCs in those at age 21.45, which was statistically significant as compared with normal individuals at age 21.45.</p><p><b>CONCLUSION</b>Real-time fluorescence quantitative PCR for detecting the TRECs is an accurate, efficient and stable method and the recent thymic output function might decrease in patients with chronic hepatitis B.</p>

[Arterial blood gas and electrolytes in severe pulmonary tuberculosis with respiratory failure: analysis of 50 cases].

OBJECTIVE: To study the characteristics of arterial blood gas and electrolytes in patients with severe pulmonary tuberculosis with respiratory failure. METHOD: In 50 patients with severe pulmonary tuberculosis, the arterial blood gas and electrolytes were measured after the onset of respiratory failure to define the types of respiratory failure and acid-base imbalance. RESULTS: Severe pulmonary tuberculosis with respiratory failure was characterized by development of hypoxia, and the degree of hypercapnia may vary; more extensive tuberculous involvement or longer disease course suggest greater chance of type II respiratory failure. Increment of the anion gap occurred irrespective of the pH value. CONCLUSION: Analysis of arterial blood gas and electrolytes may help monitor the progression of severe pulmonary tuberculosis and provides valuable information for implementing treatment and making prognostic decisions.

[Delayed diagnosis or misdiagnosis of pulmonary tuberculosis: 458 cases clinical analysis].

OBJECTIVE: To explore the reason of delayed diagnosis or misdiagnosis of pulmonary tuberculosis. METHOD: The clinical data of 458 patients pulmonary tuberculosis patients undergoing treatment between January 1999 and December 2003 in our hospital were retrospectively analysed. RESULTS AND CONCLUSION: The reasons for delayed diagnosis or misdiagnosis are as follows: A careless attitude towards health condition by patients themselves; neglected bacteriological evidence or ignorance of tuberculosis by physicians.

[A study of the psychological and social factors in patients with pulmonary tuberculosis].

OBJECTIVE: To investigate the mental health and social support in patients with tuberculosis. METHODS: Questionnaires were performed in 132 patients with tuberculosis and 71 healthy volunteers using Symptom Checklist 90 (SCL-90) and Social Support Rating Scale (SSRS). Statistical analyses were processed using Student's t test and ANOVA test. RESULTS: Somatization, obsessive-compulsiveness, anxiety, phobic anxiety and paranoid ideation, psychotism and the mean of positive factors of SCL-90 of the tuberculosis group (1.77 +/- 0.51, 1.63 +/- 0.50, 1.53 +/- 0.51, 1.33 +/- 0.41, 1.40 +/- 0.45, 1.41 +/- 0.40 and 36.07 +/- 20.84, respectively) were significantly higher than those of the control group (1.30 +/- 0.49, 1.43 +/- 0.49, 1.38 +/- 0.65, 1.24 +/- 0.48, 1.49 +/- 0.69, 1.30 +/- 0.44 and 24.92 +/- 18.22, respectively) (all P < 0.01). The result of symptom self-check differed among patients with different educational levels. The SSRS results of subjective and objective supports and total score of social supports of the tuberculosis group were 6.90 +/- 2.81, 19.25 +/- 5.62 and 32.96 +/- 7.86, respectively, much lower than those of the control group (7.92 +/- 2.57, 21.54 +/- 5.82 and 36.51 +/- 9.01, respectively) (all P < 0.01). Subjective support of patients with smear positive tuberculosis was much lower than that of patients with smear negative disease (18.15 +/- 5.72 vs. 20.75 +/- 5.78, P < 0.05); Subjective support, objective support and total score of social support of the unmarried patients (17.19 +/- 4.20, 6.17 +/- 2.18, 30.35 +/- 5.96, respectively) were lower than those of the married (20.72 +/- 5.96, 7.66 +/- 3.03, 35.19 +/- 8.74, respectively) (all P < 0.01). The results of SCL-90 and SSRS had no statistical relationship. CONCLUSION: Our results suggest that the disordered mental conditions and lower social support in patients with tuberculosis need psychosocial interventions in addition to medical care.