Association between AST/ALT ratio and diabetic retinopathy risk in type 2 diabetes: a cross-sectional investigation.

Objective: This study aimed to explore the association between the aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT ratio) and diabetic retinopathy (DR) in patients with type 2 diabetes. Methods: In this cross-sectional study, clinical data from 3002 patients with type 2 diabetes admitted to the Department of Endocrinology of our hospital between January 1, 2021, and December 1, 2022, were retrospectively collected. Measurements of AST and ALT were conducted and diabetes-related complications were screened. The association between AST/ALT ratio and diabetic retinopathy was assessed using multivariate logistic regression, and a generalized additive model (GAM) was used to investigate nonlinear relationships. Subgroup analyses and interaction tests were also conducted. Results: Among the 3002 patients, 1590 (52.96%) were male and 1412 (47.04%) were female. The mean AST/ALT ratio was 0.98 ± 0.32, ranging from 0.37 (Min) to 2.17 (Max). Diabetic retinopathy was present in 40.47% of the patients. After multivariate adjustments, for each 0.1 unit increase in AST/ALT ratio, the risk of DR increased by 4% (OR = 1.04, 95% CI: 1.01-1.07, p=0.0053). Higher AST/ALT ratio quartiles were associated with Higher prevalence of DR (OR vs. Q1: Q4 = 1.34 (CI: 1.03-1.75, p=0.0303).The GAM and smoothed curve fit indicated a linear relationship between AST/ALT ratio and DR risk, with no significant interaction effects across different subgroups. Conclusion: Our study demonstrates a positive correlation between the AST/ALT ratio and diabetic retinopathy risk in type 2 diabetes, suggesting its potential role in assessing DR risk.

The hepatoprotective potentials of Olea europaea L. leaves against carbon tetrachloride-induced hepatic injury in rats.

OBJECTIVE: To examine the therapeutic effects of Olea europaea L. leaves extract on carbon tetrachloride-induced liver injury in rats. Methods: The experimental study was conducted at the Department of Physiology, University of Karachi, Karachi, in July 2021, and comprised Albino Wistar male rats weighing 180-220gm. The animals were divided into control group I, carbon tetrachloride group II, Olea europaea L. + carbon tetrachloride group III and Olea europaea L. group IV. In Vitro model of hepatic toxicity was developed by carbon tetrachloride. A daily dose of 50mg/kg of aqueous extract of olive leaves was administered orally and 0.8ml/kg of carbon tetrachloride was administered twice a week subcutaneously for 28 days. On the 29th day, the animals were sacrificed, and tested for hepatic enzymes, lipid peroxidation markers and histopathology. Data was analysed using SPSS 20. RESULTS: Of the 24 rats, 6(25%) were in each of the 4 groups. Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and total bilirubin levels were significantly reduced (p<0.05) in group II whereas, 4- hydroxynonenal, isoprostane and malondialdehyde levels were significantly increased (p<0.05). However, total antioxidant level increased significantly (p<0.05) in group III compared to group II. Histopathology showed severe liver damage in group II and mild damage in group III. Conclusion: Olea europaea L. leaves extract was found to have profound hepatoprotective effects.

Association between De Ritis ratio and intraoperative blood transfusion in patients undergoing surgical clipping of unruptured intracranial aneurysms: a single center, retrospective, propensity score-matched study.

BACKGROUND: Although elective surgery for unruptured intracranial aneurysms (UIA) has increased, few studies have evaluated the risk factors for transfusion during UIA surgery. We evaluated the association between the preoperative De Ritis ratio (aspartate transaminase/alanine transaminase) and the incidence of intraoperative transfusion in patients who had undergone surgical UIA clipping. METHODS: Patients who underwent surgical clipping of UIA were stratified into two groups according to the preoperative De Ritis ratio cutoff levels (< 1.54 and ≥ 1.54), and the propensity score (PS)-matching analysis was performed to compare the incidence of intraoperative transfusion. Logistic regression analyses were performed to determine the risk factors for intraoperative transfusion. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses were performed to verify the improvement in the intraoperative transfusion predictive model upon addition of the De Ritis ratio. RESULTS: Intraoperative transfusion incidence was 15.4% (77/502). We observed significant differences in the incidence of intraoperative transfusion (16.2% vs. 39.7%, P = 0.004) between the groups after matching. In the logistic regression analyses, the De Ritis ratio ≥ 1.54 was an independent risk factor for transfusion (odds ratio [OR]: 3.04, 95% CI [1.53, 6.03], P = 0.002). Preoperative hemoglobin (Hb) value was a risk factor for transfusion (OR: 0.33, 95% CI [0.24, 0.47], P < 0.001). NRI and IDI analyses showed that the De Ritis ratio improved the intraoperative blood transfusion predictive models (P = 0.031 and P = 0.049, respectively). CONCLUSIONS: De Ritis ratio maybe a significant risk factor for intraoperative transfusion in UIA surgery.

Alteraciones en el perfil hepático y otros marcadores de pacientes asintomáticos que acuden a exámenes de rutina en un área urbana de Lima, Perú

Introducción: las enzimas y marcadores del perfil hepático permiten evaluar la funcionalidad y condición del hígado. Sus elevaciones pueden ser silentes y con cierta prevalencia en muchos adultos. Objetivo: determinar las principales alteraciones en el hepatograma en pacientes que acuden a consulta médica de rutina. Metodología: estudio descriptivo, prospectivo y transversal realizado a partir de resultados de laboratorio de historias clínicas de 364 pacientes de todas las edades y ambos sexos pertenecientes a un policlínico del distrito de Villa el Salvador, Perú desde enero de 2021 a julio de 2022. Las variables fueron: edad, sexo, valores de transaminasa glutámico pirúvica (TGP), transaminasa glutámico oxalacética (TGO), bilirrubina directa, indirecta y total, albúmina, globulinas y fosfatasa alcalina (FA). Resultados: en el promedio total de la muestra, la TGP fue alta (51,05 U/L), así como la bilirrubina total (1,50 mg/dL) y la FA (135,84 U/L). La TGP fue alta en hombres (54,92 U/L) y mujeres (48,86 U/L). La TGO fue normal en mujeres y alta en hombres (48,24 U/L). La bilirrubina indirecta fue alta en hombres (1,33 mg/dL). La FA fue más alta en ambos sexos (143,28 U/L en hombres y 126,38 en mujeres). Según grupo etario, los valores de TGO fueron más altos en el grupo de edad igual o mayor a 40 años (49,99 U/L). Los valores de TGP fueron elevados en ambos sexos (55,96 U/L en hombres y 50,90 U/L en mujeres), así como en la bilirrubina total, la que fue más alta en el grupo de edad igual o mayor a 40 años (2,03 mg/dL). La bilirrubina indirecta, albúmina y FA fueron normales en el grupo de edad igual o menor de 39 años, pero fueron elevadas en el grupo de edad igual o mayor a 40 años (1,13 mg/dL, 5,77 gr/dL y 147,95 U/L, respectivamente). Conclusiones: existen alteraciones en el perfil hepático en pacientes asintomáticos en la muestra estudiada. A pesar de no ser elevaciones significativamente grandes, se recomienda identificar y tratar las posibles causas que pudieran desencadenar dichas elevaciones, así como la realización de más estudios similares a nivel nacional para caracterizar el perfil hepático de nuestra población.

Introduction: The enzymes and markers of the liver profile allow us to evaluate the functionality and condition of the liver. Their elevations may be silent and have a certain prevalence in many adults. Objective: To determine the main alterations in the hepatogram in patients who attend routine medical consultation. Methodology: Descriptive, prospective and cross-sectional study carried out based on laboratory results from medical records of 364 female and male patients of all ages attending a polyclinic in the district of Villa El Salvador, Peru from January 2021 to July 2022. The variables were: age, sex, values ​​of alanine aminotransferase (ALT), aspartate transaminase (AST), direct, indirect and total bilirubin, albumin, globulins and alkaline phosphatase (ALP). Results: In the total average of the sample, ALT was high (51.05 U/L), as well as total bilirubin (1.50 mg/dL) and ALP (135.84 U/L). ALT was high in men (54.92 U/L) and women (48.86 U/L) while AST was normal in women and high in men (48.24 U/L). Indirect bilirubin was high in men (1.33 mg/dL) and ALP was higher in both sexes (143.28 U/L in men and 126.38 in women). According to age group, AST values ​​were highest in the age group equal to or greater than 40 years (49.99 U/L). ALT values ​​were high in both sexes (55.96 U/L in men and 50.90 U/L in women), as well as total bilirubin, which was highest in the age group equal to or greater than 40 years (2.03 mg/dL). Indirect bilirubin, albumin and ALP were normal in the age group equal to or less than 39 years, but were elevated in the age group equal to or greater than 40 years (1.13 mg/dL, 5.77 gr/dL and 147.95 U/L, respectively). Conclusions: There are alterations in the liver profile of asymptomatic patients in the sample studied. Although they are not significantly large elevations, it is recommended to identify and treat the possible causes that could trigger these elevations, as well as carrying out more similar studies at a national level to characterize the liver profile of our population.

A simple-to-use score system for predicting HBsAg clearance to peginterferon alfa-2b in nucleoside analogs-experienced chronic hepatitis B patients.

Objective: Patients with chronic hepatitis B (CHB) often fail to achieve clearance of the hepatitis B surface antigen (HBsAg) with peginterferon treatment. Our study aimed to develop a simple-to-use scoring system to predict the likelihood of HBsAg clearance following treatment with peginterferon alfa-2b(PEG-IFN-α2b) in patients with CHB. Methods: A total of 231 patients were enrolled and divided into HBsAg clearance (n = 37) and non-HBsAg clearance (n = 194) groups. Multifactor logistic models were constructed using univariate and multiple logistic regression analyses. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis were used to evaluate the discrimination, calibration, and clinical applicability of the predictive scoring system. Results: Four clinical variables (age, baseline HBsAg level, HBsAg level decline at week 12, and alanine aminotransferase ratio at week 12) were independently associated with HBsAg clearance after PEG-IFN-α2b treatment and, therefore, were used to develop a predictive scoring system ranging from 0 to 13. The optimal cut-off value was >4, with a sensitivity of 86.49%, specificity of 72.16%, positive predictive value of 37.2%, negative predictive value of 96.6%, and an AUC of 0.872. This model exhibited good discrimination, calibration, and clinical applicability. Among patients with scores <4, 4, or > 4 HBsAg clearance was achieved in 0.85, 14.29, and 37.21% of the patients, respectively. Conclusion: The scoring system could effectively predict the predominance of HBsAg clearance after PEG-IFN-α2b treatment in the early stage. This may be helpful when making clinical decisions for the treatment of patients with CHB.

Potential anti-obesity effects of two-graded doses of Iraqi Hibiscus tiliaceus leaves extract, alone and in combination with orlistat, on high-fat diet-induced obesity in male rats.

Obesity is a world health concern and a serious risk factor for several chronic diseases. Hibiscus tiliaceus is a plant with reported anti-obesity properties. However, the preclinical anti-obesity effect of ethanolic extract of Iraqi Hibiscus tiliaceus has not been studied yet. This study aimed to evaluate the preclinical anti-obesity properties of Iraqi Hibiscus tiliaceus extract, alone or in combination with orlistat, on high-fat diet-induced obesity in male rats. Male rats were divided into five groups: control, induction, ethanolic extract of Iraqi Hibiscus tiliaceus (250 mg/kg and 500 mg/kg), orlistat (Xenical) alone (10 mg/kg), and a combination of the extract (250 mg/kg) with Xenical. The rats were fed a high-fat diet to induce obesity, and treatments were given orally for 8 weeks. Body weight, food intake, serum lipid profile, and liver enzymes were measured. Administration of ethanolic extract of Iraqi Hibiscus tiliaceus (250 mg/kg and 500 mg/kg), Xenical alone (10 mg/kg), and combination with the extract (250 mg/kg) for 8 weeks significantly reduced body weight, food intake, serum triglycerides, total cholesterol, low-density lipoprotein cholesterol, and liver enzymes (aspartate transaminase and alanine transaminase) when compared to the induction group. The ethanolic extract of Iraqi Hibiscus tiliaceus showed anti-obesity effects and could be a potential therapeutic agent in managing obesity. However, further studies are needed to evaluate its clinical efficacy and safety.

Comparison of Biochemical, Haematological and Plasmatic Butyrylcholinesterase Parameters in Farmers and Non-Farmers, Morocco.

Background: The long-term use of pesticides can cause harmful consequences to both human health and the environment. In the present research, we aimed to compare biochemical, hematological, and plasmatic measurements of butyrylcholinesterase (BChE) between farmers and non-farmers. Materials and Methods: The study is cross-sectional and included 270 participants, with 135 farmers using pesticides and a control population of 135 non-farmers. The recruitment of the participants was conducted from August 2017 to the end of December 2019. Blood samples from participants were collected for the evaluation of biochemical markers of the function of the liver and determination of BChE activity. A whole blood sample with ethylenediamine tetraacetic anticoagulant (EDTA) was also taken for a complete blood count. Results: The results showed a statistically significant (P = 0.03) decrease in mean corpuscular hemoglobin (MCH) in the cases (28.45 ± 2.94 pg) as compared with controls (29.17 ± 2.54 pg). The statistical analysis of the renal parameters between the two groups determined that the uremia value was significantly higher in cases (34 ± 12 mg/dL) when compared to the control group (29 ± 8 mg/dL) P < 0.001. The cases recorded a significant increase in aspartate aminotransferase (AST) (26.22 ± 11.59 U/L) and alanine aminotransferase (ALT) (25.63 ± 13.47 U/L) enzyme activities among cases versus controls. The results obtained showed a significantly decreased BChE activity in the group of cases exposed to pesticides (7554.52 ± 2107 U/l) compared to the unexposed control group (10135.58 ± 1909 U/l) (t-test, P < 0.001). Conclusion: The education of the farmers on correct practices concerning phytosanitary use has the potential of reducing their exposure to these products.

Is Endoscopy Mandatory In Cases Mimicking Acute Pancreatitis?

Objectives: To detect the utility of nonspecific rising of pancreatic enzymes in patients with stomach discomfort, and to explore the possibility of hyperamylasemia as a differential diagnosis. Method: The cross-sectional study was conducted from April 2020 to April 2021 at two large tertiary care centres in Kafrelsheikh and Zagazig governorates in northern Egypt, and comprised patients complaining of dull aching abdominal pain. They were classified into two groups. Patients with nonspecific rise in pancreatic enzymes less than threefold in the absence of acute pancreatitis were in group I, while those having abdominal pain without rise in pancreatic enzymes were in group II. All patients were subjected to detailed history and clinical examination followed by laboratory assessment, imaging studies and upper endoscopy. Data was analysed using SPSS 20. RESULTS: Of the 270 patients, 170(63%) were in group I; 120(70.5%) males and 50(29.5%) females with mean age 51±6.58 years, There were 100(37%) patientsin group II; 65(65%) males and 35(35%) females with mean age 53±8.96 years (p>0.05). Amylase, lipase, serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, Creactive protein and helicobacter pylori values were significantly different between the groups (p<0.05). CONCLUSIONS: Elevation of pancreatic enzymes with a level less than three-fold in patients with abdominal pain reflected mucosal injury of the gastrointestinal tract and may raise the necessity for diagnostic upper endoscopy.

New Insight into Short Time Exogenous Formaldehyde Application Mediated Changes in Chlorophytum comosum L. (Spider Plant) Cellular Metabolism.

Chlorophytum comosum L. plants are known to effectively absorb air pollutants, including formaldehyde (HCHO). Since the metabolic and defense responses of C. comosum to HCHO are poorly understood, in the present study, biochemical changes in C. comosum leaves induced by 48 h exposure to exogenous HCHO, applied as 20 mg m-3, were analyzed. The observed changes showed that HCHO treatment caused no visible harmful effects on C. comosum leaves and seemed to be effectively metabolized by this plant. HCHO application caused no changes in total chlorophyll (Chl) and Chl a content, increased Chl a/b ratio, and decreased Chl b and carotenoid content. HCHO treatment affected sugar metabolism, towards the utilization of sucrose and synthesis or accumulation of glucose, and decreased activities of aspartate and alanine aminotransferases, suggesting that these enzymes do not play any pivotal role in amino acid transformations during HCHO assimilation. The total phenolic content in leaf tissues did not change in comparison to the untreated plants. The obtained results suggest that HCHO affects nitrogen and carbohydrate metabolism, effectively influencing photosynthesis, shortly after plant exposure to this volatile compound. It may be suggested that the observed changes are related to early HCHO stress symptoms or an early step of the adaptation of cells to HCHO treatment. The presented results confirm for the first time the direct influence of short time HCHO exposure on the studied parameters in the C. comosum plant leaf tissues.

Hepatotoxicity with High-Dose Green Tea Extract: Effect of Catechol-O-Methyltransferase and Uridine 5'-Diphospho-glucuronosyltransferase 1A4 Genotypes.

The predominant catechin in green tea, epigallocatechin gallate (EGCG), may be hepatotoxic in high doses. Our objective was to investigate the influence of catechol-O-methyltransferase (COMT) and uridine 5'-diphospho-glucuronosyltransferase 1A4 (UGT1A4) genotypes on changes in liver injury biomarkers in response to long-term, high-dose green tea extract (GTE) supplementation among postmenopausal women. A secondary analysis was conducted using data from the Minnesota Green Tea Trial (N = 1,075), in which participants were randomized to consume high-dose GTE (843 mg/day EGCG) or placebo capsules for 12 months. Analysis of covariance adjusting for potential confounders was performed to examine changes in aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST: ALT ratio, and alkaline phosphatase from baseline to months 3, 6, 9, and 12 across COMT and UGT1A4 genotypes. Mean age and BMI within the GTE group (n = 400) were 59.8 yrs and 25.1 kg/m2, respectively, and 98% of subjects were white. From baseline to month 3, mean AST: ALT ratio change was +1.0% in the COMT (rs4680) A/G genotype versus -4.8% in the A/A genotype (p = 0.03). From baseline to months 6 and 9, respectively, mean ALT change was +78.1% and +82.1% in the UGT1A4 (rs6755571) A/C genotype versus +28.0% and +30.1% in the C/C genotype (p < 0.001 and p = 0.004, respectively). The UGT1A4 (rs6755571) A/C genotype may be an important risk factor for clinically-relevant serum transaminase elevations with 6-9 months of high-dose GTE supplementation among postmenopausal women. Understanding the genetic underpinnings of GTE-related hepatotoxicity may allow for a genetically-informed paradigm for therapeutic use of GTE.

Value of liver ultrasonic elasticity index combined with APRI, FIB-4 and GP in the diagnosis of autoimmune hepatitis complicated with liver cirrhosis / 中国医师杂志

Objective:To investigate the value of liver ultrasonic elasticity index combined with aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on the four factors (FIB-4) and globulin platelet model (GP) in the diagnosis of autoimmune hepatitis complicated with liver cirrhosis.Methods:From January 2020 to January 2022, 82 patients with autoimmune hepatitis and cirrhosis treated in West China Hospital of Sichuan University were selected as observation group, and 90 patients with autoimmune hepatitis were selected as controls (control group). All of them underwent liver ultrasound elastic examination, and the APRI, FIB-4, GP of patients were calculated. The differences of shear wave velocity (SWV), liver hardness value (LSM), strain rate ratio (SR), APRI, FIB-4, GP between the two groups were compared. At the same time, the differences of SWV, LSM, SR, APRI, FIB-4 and GP among patients with autoimmune hepatitis with different degrees of liver fibrosis and inflammation were analyzed. The value of liver ultrasound elasticity index, APRI, FIB-4 and GP in predicting autoimmune hepatitis complicated with cirrhosis was evaluated by the receiver operating characteristic (ROC) curve.Results:The SWV, LSM, FIB-4 and GP in the observation group were (1.60±0.21)m/s, (13.98±1.82)kPa, (8.10±1.43) and (4.15±1.05) respectively, which were significantly higher than those in the control group (all P<0.05), while SR and APRI were (5.04±0.98) and (2.41±0.92) respectively, which were significantly lower than those in the control group (all P<0.05). With the aggravation of liver fibrosis, the levels of SWV, LSM, FIB-4 and GP in patients with autoimmune hepatitis were higher (all P<0.05), while the SR and APRI were lower (all P<0.05). There was no statistically significant difference in SWV, LSM, SR, APRI, FIB-4 and GP between patients with G1-G2 and G3-G4 inflammatory degree of autoimmune hepatitis (all P>0.05). SWV, LSM, SR, APRI, FIB-4 and GP were included in the binary logistic regression analysis, and SWV, FIB-4 and GP were finally selected as independent predictors for diagnosis of autoimmune hepatitis with cirrhosis (all P<0.05). The area under the ROC curve of combined prediction of SWV, FIB-4 and GP for autoimmune hepatitis with cirrhosis was 0.931, which was significantly higher than other indicators (all P<0.05), and the sensitivity and specificity were 95.00% and 84.00% respectively. Conclusions:Liver ultrasonic elasticity index, APRI, FIB-4 and GP are related to the degree of liver fibrosis in patients with autoimmune hepatitis. SWV, FIB-4 combined with GP have high application value in predicting autoimmune hepatitis complicated with liver cirrhosis.

Efficacy of peginterferon alfa-2a combined with entecavir in sequential treatment of chronic hepatitis B / 中国基层医药

Objective:To investigate the efficacy of peginterferon alfa-2a (Peg-IFNα-2a) combined with entecavir in sequential treatment of chronic hepatitis B.Methods:A total of 106 patients with chronic hepatitis B who received treatment in Affiliated Hangzhou Xixi Hospital of Zhejiang University School of Medicine from January 2020 to February 2022 were included in this study. They were divided into a control group (entecavir treatment, n = 53) and a study group (sequential therapy with Peg-IFNα-2a followed by entecavir, n = 53). Liver function indicators, liver fibrosis indicators, clinical treatment efficacy, and incidence of adverse reactions were compared between the two groups before and after treatment. Results:After treatment, total bilirubin, alanine aminotransferase and aspartate transaminase in the control and study groups were (94.79 ± 8.71) μmol/L and (67.67 ± 9.19) μmol/L, (256.93 ± 44.07) U/L and (186.56 ± 48.37) U/L, (256.47 ± 43.73) U/L and (200.69 ± 41.34) U/L, and they were (140.05 ± 26.15) μmol/L and (141.32 ± 25.35) μmol/L, (433.66 ± 77.16) U/L and (429.77 ± 73.73) U/L, (352.34 ± 65.19) U/L and (354.05 ± 66.13) U/L before the treatment. After treatment, these indexes in each group were decreased compared with before treatment ( t = 19.19, -12.13, -28.85, -20.96, -19.27, -12.03, all P < 0.05). After treatment, these indexes in the study group were significantly lower than those in the control group ( t = -6.49, -7.30, -6.74, all P < 0.001). After treatment, the levels of hyaluronic acid, laminin, type III procollagen peptide, and type IV collagen in the control and study groups were (124.91 ± 22.99) μg/L and (101.29 ± 22.67) μg/L, (132.71 ± 25.37) μg/L and (110.56 ± 25.49) μg/L, (116.93 ± 20.29) μg/L and (93.14 ± 20.39) μg/L, (63.14 ± 12.19) μg/L and (50.81 ± 11.63) μg/L, and they were (175.73 ± 48.56) μg/L and (177.61 ± 48.51) μg/L, (163.43 ± 41.52) μg/L and (165.57 ± 41.59) μg/L, (139.71 ± 31.75) μg/L and (141.72 ± 31.78) μg/L, (106.97 ± 32.24) μg/L and (104.02 ± 34.12) μg/L before treatment. After treatment, the levels of these indexes in each group were significantly decreased compared with before treatment ( t = -13.04, -8.68, -10.43, -5.82, -13.35, -6.26, -13.02, -10.72, all P < 0.05). After treatment, the levels of these indexes in the study group were significantly lower than those in the control group ( t = -5.32, -4.48, -6.02, -5.32, all P < 0.001). The total response rate in the study group was 88.68% (47/53), which was significantly higher than 62.26% (33/53) in the control group ( χ2 = 9.98, P < 0.05). The HBsAg conversion rate in the study group was 33.96% (18/53), which was significantly higher than 1.32% (6/53) in the control group ( χ2 = 7.75, P < 0.05). There was no statistically significant difference in the incidence of adverse reactions between the study and control groups [26.42% (14/53) vs. 30.19% (16/53), χ2 = 0.81, P > 0.05]. Conclusion:Sequential therapy with Peg-IFNα-2a followed by entecavir can effectively improve liver function,reduce liver fibrosis , improve clinical treatment efficacy, and will not increase adverse reactions.

Clinical analysis of 202 patients with drug-induced liver injury / 中国基层医药

Objective:To investigate the clinical characteristics of drug-induced liver injury and provide a theoretical basis for the prevention and treatment of drug-induced liver injury.Methods:The clinical data of 202 patients with complete information on drug-induced liver injury who received treatment in First Hospital of Shanxi Medical University from November 2018 to November 2021 were collected. The information including gender, age, type and name of drugs taken or exposed, clinical characteristics, autoantibodies, and liver function was statistically analyzed.Results:Among the 202 patients with drug-induced liver injury, 77 patients (38.1%) were male and 125 patients (61.9%) were female. Age distribution was mainly at > 40-60 years. There were 141 cases (69.8%) of hepatocellular type, 27 cases (13.4%) of cholestatic type, and 34 cases (16.8%) of mixed type. There were statistically significant differences in alanine aminotransferase, aspartate aminotransferase, γ-glutamine transferase, alkaline phosphatase, prothrombin time, international standardized ratio, and prothrombin activity between different clinical types ( H = 91.43, 58.65, 9.25, 32.69, 9.56, 8.19, 9.40, all P < 0.05). Among the 202 patients with drug-induced liver injury, severe liver injury occurred in the largest proportion of cases (40.6%). There was no significant difference in the disease severity between different clinical types ( P = 0.789). The top three types of drugs causing liver injury were traditional Chinese medicine [52.0% (105/202)], antineoplastic drugs [6.4% (13/202)], and antipsychotics [5.9% (12/202)]. The detection rate of autoantibodies in 202 patients with drug-induced liver injury was 29.7% (60/202). Conclusion:Drug-induced liver injury lacks specificity in clinical manifestations. A wide variety of drugs can cause liver injury. Clinicians should strengthen liver function monitoring in key populations. The proportion of patients with mixed-type liver failure is high, which should be taken seriously. When patients with drug-induced liver injury are positive for liver disease-related antibodies, clinicians should be vigilant about the possibility of drug-induced liver injury.

Correlation between peak viral load and liver function damage in children with infectious mononucleosis induced by Epstein-Barr virus / 中国基层医药

Objective:To investigate the relationship between the peak load of Epstein-Barr virus (EPV) and live function damage in children with infectious mononucleosis caused by EPV.Methods:Eighty children with infectious mononucleosis caused by EPV who received treatment in Pingxiang People's Hospital from January 2018 to December 2021 were included in this study. Five mL of venous blood was taken from each child for detecting the peak load of EBV-DNA and liver function indicators. These children were divided into a low-load group ( n = 25, EBV-DNA load < 10 4 copies/mL), a medium-load group ( n = 34, EBV-DNA load of 10 4-10 5 copies/mL), and a high-load group ( n = 21, EBV-DNA load > 10 5 copies/mL) according to the peak EBV-DNA load. The relationships between different peak loads of EBV-DNA and live function, age, and sex were analyzed. Results:The rate of liver dysfunction in the high-load group [85.71% (18/21)] was significantly higher than [38.24% (13/34)] in the medium-load group and [20.00% (5/25)] in the low-load group ( χ2 = 11.90, 19.71, P = 0.001, P < 0.001). Alanine aminotransferase and aspartate aminotransferase levels in the high-load group were (156.24 ± 13.21) U/L and (171.69 ± 13.49) U/L, respectively, which were significantly higher than (125.89 ± 10.54) U/L and (143.26 ± 10.29) U/L in the medium-load group and (89.64 ± 6.75) U/L and (64.89 ± 5.74) U/L] in the low-load group (all P < 0.001). There was no significant difference in the peak load of EBV-DNA between children of different ages and between children of different sexes (both P > 0.05). Conclusion:Children with infectious mononucleosis caused by EPV have a high EBV-DNA peak load. A higher peak load of EVB-DNA indicates a higher risk of liver function damage. More attention should be paid in clinical practice. Effective diagnosis and treatment should be performed in time to control the patient's condition as early as possible.

Diagnostic and prognostic values of the ratio of red blood cell distribution width to platelet count for hepatitis B and liver cirrhosis / 中国基层医药

Objective:To analyze the diagnostic and prognostic values of the red blood cell distribution width-to-platelet count ratio (RPR) for hepatitis B and liver cirrhosis.Methods:The clinical data of 80 patients with hepatitis B and liver cirrhosis who were diagnosed and treated in Yiwu Central Hospital from June 2020 to August 2021 were retrospectively analyzed. These patients were included in the hepatitis B and liver cirrhosis group. They were subdivided into survival ( n = 69) and death ( n = 11) groups according to their prognosis outcomes. Eighty patients with chronic hepatitis B were included in the chronic hepatitis B group. Eighty healthy controls who concurrently underwent physical examination were included in the control group. The diagnostic and prognostic values of RPR, aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis index based on four factors (FIB-4) for hepatitis B and liver cirrhosis were analyzed. Results:Red blood cell distribution width, alanine transaminase, and aspartate transaminase in the hepatitis B and liver cirrhosis group and chronic hepatitis B group were significantly higher compared with the control group (all P < 0.05). Platelet count in the hepatitis B and liver cirrhosis group and chronic hepatitis B group was significantly lower than that in the control group (both P < 0.05). Red blood cell distribution width in the hepatitis B and liver cirrhosis group was significantly higher than that in the chronic hepatitis B group [(18.25 ± 3.28)% vs. (14.67 ± 2.15)%, t = 8.16, P < 0.05]. Platelet count, alanine transaminase, and aspartate transaminase levels in the hepatitis B and liver cirrhosis group were (78.47 ± 11.43) × 10 9/L, (49.48 ± 6.85) U/L, (45.86 ± 6.28) U/L, respectively, which were significantly lower than (133.36 ± 18.42) × 10 9/L, (128.36 ± 15.40) U/L, (98.67 ± 14.41) U/L in the chronic hepatitis B group ( t = -22.65, -41.86, -30.05, all P < 0.05). PRP, APRI, and FIB-4 in the hepatitis B and liver cirrhosis group were (0.23 ± 0.05), (1.85 ± 0.44), (4.25 ± 0.81) respectively, which were significantly higher than (0.11 ± 0.02), (1.46 ± 0.33), (3.38 ± 0.63) in the chronic hepatitis B group ( t = 19.93, 6.34, 7.58, all P < 0.001). The RPR, APRI, and FIB-4 in the death group were (0.25 ± 0.08), (1.97 ± 0.48), (4.52 ± 1.31), respectively, which were significantly higher than (0.18 ± 0.05), (1.68 ± 0.40), (3.69 ± 1.21) in the survival group ( t = 3.94, 2.17, 2.09, all P < 0.05). The receiver operating characteristic curve revealed that PRP has an extremely high value in diagnosing hepatitis B and liver cirrhosis and predicting the death of patients with hepatitis B and liver cirrhosis. Conclusion:RPR has an extremely high value in diagnosing hepatitis B and liver cirrhosis and predicting the prognosis of this disease.

Identification of High Death Risk Coronavirus Disease-19 Patients using Blood Tests.

Background: The coronavirus disease (COVID-19) pandemic has made a great impact on health-care services. The prognosis of the severity of the disease help reduces mortality by prioritizing the allocation of hospital resources. Early mortality prediction of this disease through paramount biomarkers is the main aim of this study. Materials and Methods: In this retrospective study, a total of 205 confirmed COVID-19 patients hospitalized from June 2020 to March 2021 were included. Demographic data, important blood biomarkers levels, and patient outcomes were investigated using the machine learning and statistical tools. Results: Random forests, as the best model of mortality prediction, (Matthews correlation coefficient = 0.514), were employed to find the most relevant dataset feature associated with mortality. Aspartate aminotransferase (AST) and blood urea nitrogen (BUN) were identified as important death-related features. The decision tree method was identified the cutoff value of BUN >47 mg/dL and AST >44 U/L as decision boundaries of mortality (sensitivity = 0.4). Data mining results were compared with those obtained through the statistical tests. Statistical analyses were also determined these two factors as the most significant ones with P values of 4.4 × 10-7 and 1.6 × 10-6, respectively. The demographic trait of age and some hematological (thrombocytopenia, increased white blood cell count, neutrophils [%], RDW-CV and RDW-SD), and blood serum changes (increased creatinine, potassium, and alanine aminotransferase) were also specified as mortality-related features (P < 0.05). Conclusions: These results could be useful to physicians for the timely detection of COVID-19 patients with a higher risk of mortality and better management of hospital resources.

AST·MLR index and operation injury condition are novel prognostic predictor for the prediction of survival in patients with colorectal cancer liver metastases undergoing surgical resection.

BACKGROUND: The prognostic values of preoperative aspartate aminotransferase (AST), monocyte-to-lymphocyte ratio (MLR), AST·MLR index (AMLRI) and operation injury condition in patients with colorectal cancer liver metastases (CRLM) remains unclear. This retrospective study assessed the relationship between these markers, progression-free survival (PFS), and overall survival (OS) in CRLM patients undergoing resection. METHODS: AMLRI was defined as AST × MLR. Operation injury condition was defined according to operation time and blood loss. Cox regression analyses were used to identify risk factors and to develop nomograms. C-indexes, time-dependent receiver operating characteristic (time-ROC) curves and calibration curves were used to assess the models. RESULTS: A total of 379 patients were enrolled. The optimal cut-off value of the AMLRI was 3.33. In the multivariable analysis, AMLRI > 3.33 (hazard ratio [HR] = 2.162, p = 0.002) and serious operation injury condition (HR = 1.539, p = 0.012) were predictive for unfavourable OS, and AMLRI > 3.33 (HR = 1.462, p = 0.021) was predictive for unfavourable PFS. The nomograms were superior to Fong's Clinical Risk Score (CRS) according to the C-indexes (PFS: 0.682 vs. 0.600; OS: 0.730 vs. 0.586) and time-ROCs. CONCLUSIONS: Preoperative AMLRI and operation injury condition are easily accessible predictors for prognosis. The nomograms performed better than CRS for the prediction of recurrence and survival.

Demographic and Clinical Characteristics of 907 Cases with Naltrexone Intoxication; a 14-Year Cross-Sectional Study.

Introduction: Opioids have been the leading cause of death from poisoning in Iran for several years. This study aimed to evaluate the clinical and para-clinical presentations of naltrexone intoxication, its toxic dose, and its epidemiological properties. Methods: This retrospective cross-sectional study was conducted on medical records of patients presenting to Toxicology Department of Loghman Hakim Hospital, Tehran, Iran, following naltrexone intoxication, from 2002 to 2016. Patients' demographic and laboratory data, clinical signs, supposed ingested dose, and intent of naltrexone consumption were collected, analyzed, and then interpreted. Results: 907 patients with the mean age of 36.6 ±11.7 years were evaluated (94.3% male). The mean amount of naltrexone consumed by the intoxicated patients reported in the medical records was 105.8 ± 267.8 mg. One hundred thirty patients (14.3%) used naltrexone to treat substance use disorder. Two hundred eighty-seven poisoned patients (31.6%) were current opium users who intentionally or unintentionally used naltrexone concomitantly. The most common symptoms observed in these patients were agitation (41.8%), vomiting (16.4%), and nausea (14.8%). Among patients with naltrexone poisoning, 25 patients were intubated (2.8%), and three passed away. Aspartate aminotransferase (AST) levels were significantly higher in patients intoxicated with naltrexone who needed intubation (p = 0.02). Conclusion: The probability of intubation of cases with naltrexone intoxication was associated with AST elevation. It seems that, the number of intensive care unit (ICU) admissions and mortality rates are not high among these patients.

Association Between Cadmium Exposure and Liver Function in Adults in the United States: A Cross-sectional Study.

OBJECTIVES: Cadmium is widely used, leading to extensive environmental and occupational exposure. Unlike other organs, for which the harmful and carcinogenic effects of cadmium have been established, the hepatotoxicity of cadmium remains unclear. Some studies detected correlations between cadmium exposure and hepatotoxicity, but others concluded that they were not associated. Thus, we investigated the relationship between cadmium and liver damage in the general population. METHODS: In total, 11 838 adult participants from National Health and Nutrition Examination Survey 1999-2015 were included. Urinary cadmium levels and the following liver function parameters were measured: alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), total bilirubin (TB), and alkaline phosphatase (ALP). Linear and logistic regression analyses were performed to assess the associations between urinary cadmium concentrations and each liver function parameter after adjusting for age, sex, race/ethnicity, annual family income, smoking status, alcohol consumption status, physical activity, and body mass index. RESULTS: The covariate-adjusted results of the linear regression analyses showed significant positive relationships between log-transformed urinary cadmium levels and each log-transformed liver function parameter, where beta±standard error of ALT, AST, GGT, TB, and ALP were 0.049±0.008 (p<0.001), 0.030±0.006 (p<0.001), 0.093±0.011 (p<0.001), 0.034±0.009 (p<0.001), and 0.040±0.005 (p<0.001), respectively. Logistic regression also revealed statistically significant results. The odds ratios (95% confidence intervals) of elevated ALT, AST, GGT, TB, and ALP per unit increase in log-transformed urinary cadmium concentration were 1.360 (1.210 to 1.528), 1.307 (1.149 to 1.486), 1.520 (1.357 to 1.704), 1.201 (1.003 to 1.438), and 1.568 (1.277 to 1.926), respectively. CONCLUSIONS: Chronic exposure to cadmium showed positive associations with liver damage.

Increased Visit-to-Visit Liver Enzyme Variability Is Associated with Incident Diabetes: A Community-Based 12-Year Prospective Cohort Study.

BACKGROUND: Fatty liver and/or increased liver enzyme values have been reported to be associated with incident diabetes. We sought to determine whether increased visit-to-visit liver enzyme variability is associated with incident diabetes. METHODS: Study participants were recruited from the Korean Genome and Epidemiologic Study (KoGES). A total of 4,151 people aged 40 to 69 years was recruited and tested every 2 years for up to 12 years. Visit-to-visit aspartate aminotransferase (AST) and alanine aminotransferase (ALT) variability was evaluated in first the 6-year period through the use of various variability measurements: standard deviation (SD), average successive variability, coefficient of variation (CV), and variation independent of mean (VIM). Oral glucose tolerance test was performed at every visit. RESULTS: During the 6-year follow-up appointments, 13.0% (538/4,151) of people developed incident diabetes. Visit-to-visit AST variability was associated with an increased risk of diabetes independent of conventional risk factors for diabetes (hazard ratio per 1-SD increment [95% confidence interval]: 1.06 [1.00 to 1.11], 1.12 [1.04 to 1.21], and 1.13 [1.04 to 1.22] for SD, CV, and VIM, respectively; all P<0.05); however, no such associations were observed in the visit-to-visit ALT variability. According to alcohol consumption status, both AST and ALT variability were independent predictors for incident diabetes in subjects with heavy alcohol consumption; however, neither AST nor ALT variability was associated with diabetes risk in subjects who did not drink alcohol heavily. CONCLUSION: Visit-to-visit liver enzyme variability is an independent predictor of incident diabetes. Such association was more evident in those who consumed significant amounts of alcohol.