Compressibility of lime-treated dredged slurry with high water content.

Lime is widely used for soft ground treatment, rendering the compressibility of lime-treated soil a crucial factor in deformation analysis in engineering applications. This study investigated the compressibility of three remoulded lime-treated slurries with high water content in Southeast China. Sixty groups of oedometer tests were conducted on lime-treated soils with an initial water content of 1 to 3 times the liquid limit and lime contents between 1 and 3%. The oedometer test results were discussed to examine the remoulded yield stress σ y ' of lime-treated slurry. Considering the relationships between σ y ' , the void ratio, lime content, and initial water content were preliminarily discussed and quantitatively established. Research on the normalised compression curve of lime-treated soil revealed that for soil samples containing a lime content of 0-%, the normalised compression curve at σ p ' > σ y ' can be represented by a unique line. Furthermore, the log(1 + e) - log σ v ' compression curve of lime-treated slurry at pre-yield state is analysed, and a prediction method for the modified compression index is proposed.

Multicomponent Self-Assembly of a Giant Heterometallic Polyoxotungstate Supercluster with Antitumor Activity.

The hierarchical aggregation of molecular nanostructures from multiple components is a grand synthetic challenge, which requires highly selective linkage control. We demonstrate how two orthogonal linkage groups, that is, organotin and lanthanide cations, can be used to drive the aggregation of a giant molecular metal oxide superstructure. The title compound {[(Sn(CH3 )2 )2 O]4 {[CeW5 O18 ] [TeW4 O16 ][CeSn(CH3 )2 ]4 [TeW8 O31 ]4 }2 }46- (1 a) features dimensions of ca. 2.2×2.3×3.4 nm3 and a molecular weight of ca. 25 kDa. Structural analysis shows the hierarchical aggregation from several independent subunits. Initial biomedical tests show that 1 features an inhibitory effect on the proliferation of HeLa cells based on an apoptosis pathway. In vivo experiments in mice reveal the antiproliferative activity of 1 and open new paths for further development of this new compound class.

Risks and predicting factors of bleeding complications in hepatitis B virus-related acute-on-chronic liver failure.

BACKGROUND/AIMS: This study aimed to provide supporting evidence for prevention and prognostic evaluation of bleeding complications in the early stage by exploring the risk and predicting factors in patients with acute-on-chronic liver failure (ACLF). MATERIALS AND METHODS: A total of 101 hospitalized patients with ACLF were retrospectively included from January 1, 2014 to December 31, 2015. The patients were divided into bleeding (n=38) and nonbleeding groups (n=63). Demographic data and laboratory tests were recorded and compared between the two groups. The incidence, risk factors, and prognosis of bleeding complications among patients with ACLF were investigated. RESULTS: A total of 38 cases (37.62%) had bleeding complications: 26 (25.74%) were spontaneous and 12 (11.88%) were postprocedural. Patients with bleeding complications had lower platelet (p=0.008), fibrinogen (p<0.001), factor V (p=0.001), and factor VII (p=0.026) levels; higher serum creatinine levels (p=0.004); and a higher proportion of cirrhosis (p=0.013). Logistic regression analysis showed that cirrhosis (odds ratio=3.251, p=0.046), fibrinogen level (odds ratio=0.352, p=0.007), and factor VII level (odds ratio=0.951, p=0.011) contributed to the development of bleeding complications. A subgroup analysis of invasive manipulation-induced bleeding complications showed lower levels of factors V (p=0.018) and VII (p=0.021) in the postprocedural bleeding group. Follow-up studies showed that the nonbleeding group had a higher survival rate than the bleeding group at day 90 (73.33% versus 51.85%, p=0.040). CONCLUSION: Liver cirrhosis, lower levels of fibrinogen, and major coagulation factor activity in patients with ACLF were associated with an elevated risk of bleeding events during hospitalization, which further impaired the 90-day survival rate.

High Expression of Interleukin-33/ST2 Predicts the Progression and Poor Prognosis in Chronic Hepatitis B Patients with Hepatic Flare.

BACKGROUND: Interleukin-33 (IL-33), along with its receptor suppression of tumorigenicity 2 (ST2), is capable of regulating immune responses. Immunologically mediated events play a critical role in the acute phase of chronic hepatitis B (CHB) infection. The present study primarily aimed to determine whether the IL-33/ST2 axis could be used as a reliable biomarker to predict disease progression and prognosis. METHODS: The study included 130 cases of CHB, with 48 cases in stable condition, 50 cases of progression to hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF), and 32 cases of progression to HBV related pre-ACLF. The demographic data and laboratory test results were recorded and compared among the groups. The blood samples for the measurement of serum IL-33 and soluble ST2 (sST2) levels were collected at admission and evaluated twice using the ELISA method. RESULTS: The patients in which the disease progressed to HBV-ACLF had the highest serum IL-33 and sST2 levels among the three groups (p<0.001). The correlation analysis showed that the serum IL-33 levels were associated with the levels of ALT (r = 0.367, p<0.001), AST (r = 0.456, p<0.001) and the MELD score (r = 0.377, p = 0.001). The area under the curve (AUC) of IL-33 and sST2 levels for differentiation of disease progression were 0.861 (95% CI: 0.787-0.934, p<0.001) and 0.788 (95% CI: 0.692-0.884, p<0.001), respectively. The serum IL-33 levels combined with the MELD score had the highest 90-day mortality prediction efficiency, with an AUC of 0.918 (95% CI: 0.859-0.977, p<0.001), a sensitivity of 92.3%, and a specificity of 88.7%. CONCLUSIONS: The IL-33/sST2 axis could be used to evaluate the progression and mortality in CHB patients with hepatic flare. The combinatorial use of multiple indicators could achieve the highest diagnostic and predictive accuracy.

[Atmospheric Nitrogen Dioxide, Nitric Acid, Nitrate Nitrogen Concentrations, and Wet and Dry Deposition Rates in a Double Rice Region in Subtropical China].

Nitrogen dioxide (NO2) and nitric acid (HNO3) are nitrogen-containing acidic gases in the atmosphere, and they are important precursors of nitrate in aerosol and rainwater. The emission intensity of atmospheric nitrogen oxides is high in the subtropical region of China, but the concentrations and deposition rates of atmospheric nitrogen dioxide, nitric acid, particulate nitrate-nitrogen (NO3--Np), and rainwater nitrate-nitrogen (NO3--Nr) in a double rice region in subtropical China are still unclear,. In this study, the atmosphere concentrations of NO2-N, HNO3-N, NO3--Np in PM10, and NO3--Nr and related meteorological parameters were simultaneously monitored in a typical double rice region within a subtropical hilly region of China, with the aim of determining the characteristics and influencing factors of NO2-N, HNO3-N, NO3--Np, and NO3--Nr concentrations and quantifying the wet and dry deposition rates. The results showed that the annual mean concentrations of NO2-N, HNO3-N, NO3--Np, and NO3--Nr were 4.2 µg·m-3, 0.7 µg·m-3, 4.0 µg·m-3, and 1.0 mg·L-1, respectively, and the deposition rates were 1.5, 3.2, 2.3, and 6.1 kg·hm-2, respectively. The NO2-N concentrations were negatively correlated with air temperatures, and the HNO3-N concentrations were negatively correlated with wind speeds. TheNO3--Np concentrations were negatively correlated with air temperatures, positively correlated with NO2-N concentrations, but not significantly correlated with HNO3-N concentrations, thus indicating that NO2-N concentrations were an important limiting factor forNO3--Np pollution in this study area. The NO3--Nr concentrations were negatively correlated with rainfall, as well as the concentrations of HNO3-N and NO3--Np. The annual total dry and wet depositions of the atmospheric NO2-N, HNO3-N, NO3--Np, and NO3--Nr were 13.0 kg·hm-2, which indicates that these compounds are important sources of nitrogen in paddy fields and may have significant impacts on paddy fields and surrounding ecosystems.

Cardiac health in patients with hepatitis B virus-related cirrhosis.

Not only alcoholic cirrhosis related to cardiac dysfunction, cirrhosis caused by nonalcoholic etiology including hepatitis B virus (HBV) infection also related to impaired cardiac health. The aims of present study were to perform a noninvasive evaluation of cardiac function and to evaluate exercise performance in HBV related cirrhotic patients without typical symptoms of cardiac disease.Seventy-nine HBV related cirrhotic patients and 103 matched subjects without a previous history of cardiac involvement were recruited. Clinical examination and cardiac health evaluation were performed. The incidence, risk factors of cardiac dysfunction and exercise tolerance were investigated.A correlation between QTc interval and model for end-stage liver disease score (R = 0.239, P = .018) was detected, however, the connection between QTc prolongation and the severity of liver disease was uncertain. Patients with HBV related cirrhosis had a tendency toward left ventricular wall thickening (P = .007). Forty-one patients (51.90%) were in accordance with the definition of cirrhotic cardiomyopathy, and a significant increase in the incidence of cardiac diastolic dysfunction (CDD) could be found with increasing Child-Pugh grade (P = .004). HBV related cirrhotic patients with CDD had a higher level of pro-brain natriuretic peptide (P = .025), international normalized ratio (P = .010) Child-Pugh score (P = .020), and a higher proportion of ascites (P < .001). The higher Child-Pugh score (odds ratio = 1.662, P = .010) was an independent diagnostic predictor of CDD. The cardiac depression and exercise tolerance also got worse with increasing Child-Pugh score (P < .001).Impaired cardiac health was common in HBV related cirrhotic patients. Cardiogenic factors must be carefully considered in the integral therapy of cirrhosis. Hepatology physicians should lay emphasis on exercise training in daily life.

[Comparison Between Atmospheric Wet-only and Bulk Nitrogen Depositions at Two Sites in Subtropical China].

Atmospheric emissions of reactive nitrogen (N) species are at high levels and have caused high N deposition in China in recent years. In this study, atmospheric wet-only and bulk N depositions were monitored simultaneously in a two-year study at an agricultural site (HN) and a forest site (XS) in the Jinjing River catchment in Changsha County, Hunan Province in subtropical China. The differences in concentration and deposition of NH4+-N, NO3--N, DON, and TN between wet-only and bulk N depositions were compared, and the correlation between wet-only and bulk N depositions was analyzed, with the aim of estimating atmospheric wet N deposition based on bulk N deposition. During the monitoring period, NH4+-N was the dominant species in both wet-only and bulk deposition at the sampling sites. The average values of total N (TN) depositions for wet-only and bulk depositions at HN were 26.2 and 28.9 kg·(hm2·a)-1, respectively. The proportions of NH4+-N, NO3--N, and DON in TN in wet-only deposition were 49.7%, 31.3%, and 19.0%, respectively, while the proportions in the bulk deposition were 48.7%, 31.6%, and 19.7%, respectively. The average values of TN depositions for wet-only and bulk depositions at XS were 23.6 and 27.8 kg·(hm2·a)-1, respectively. The proportions of NH4+-N, NO3--N, and DON in TN in wet-only deposition were 53.9%, 34.78%, and 11.4%, respectively, while they were 49.6%, 31.6%, and 18.9%, respectively, for bulk deposition. The concentrations of N species in wet-only and bulk depositions were significantly and negatively correlated with precipitation, while the amount of N deposition was significantly and positively correlated with precipitation. The concentrations of N species in wet-only deposition had a significant linear correlation with those in the bulk deposition at the two sites (R2>0.82). According to the regression equation for wet-only and bulk N deposition at the monitoring sites, the proportions of NH4+-N, NO3--N, and TN in wet-only to bulk deposition were 0.875, 0.774, and 0.852, respectively, at HN and 0.859, 0.783, and 0.819, respectively, at XS. These values were mainly related to the amount of wet-only N deposition and the pollution level of atmospheric particulate N species at the monitoring sites. In the subtropical region of China, atmospheric wet N deposition can be overestimated by 10% to 18% when the atmospheric bulk N deposition is used to replace the wet N deposition. Based on the regression equation between atmospheric bulk N deposition and wet N deposition, the atmospheric wet N deposition can be estimated well using the atmospheric bulk N deposition data.

Utility and Safety of Tolvaptan in Cirrhotic Patients with Hyponatremia: a Prospective Cohort Study

Abstract: Introduction and aim. Hyponatremia is common in patients with decompensated cirrhosis and is associated with increased mortality. Tolvaptan, a vasopressor V2 receptor antagonist, can increase free wáter excretion, but its efficacy and safety in cirrhotic patients remain unclear. Material and methods. We studied the usage and safety of tolvaptan in cirrhotic patients in a real-life, non-randomized, multicenter prospective cohort study. Forty-nine cirrhotic patients with hyponatremia were treated with tolvaptan 15 mg daily, and 48 patients not treated with tolvaptan in the same period served as controls. Improvement in serum sodium level was defined as an increase in serum sodium from < 125 to ≥ 125 mmol/L or from 125-134 to ≥ 135 mmol/L on day 7. Results. Twenty-three (47%) patients in the tolvaptan group and 17 (35%) in the control group had normal serum sodium on day 7 (p = 0.25). Serum sodium improved in 30 (61%) patients in the tolvaptan group and 17 (35%) patients in the control group (p = 0.011). Adverse events occurred in 46-47% of patients in both groups, and tolvaptan was not associated with worsened liver function. No patient with normal serum sodium on day 7 died within 30 days of treatment, whereas 16% of those with persistent hyponatremia died (p = 0.0019). Conclusion. In conclusion, short-term tolvaptan treatment is safe and can improve serum sodium level in cirrhotic patients with hyponatremia. Normalization of serum sodium level is associated with better survival.

Utility and safety of tolvaptan in cirrhotic patients with hyponatremia: A prospective cohort study.

Introduction and aim. Hyponatremia is common in patients with decompensated cirrhosis and is associated with increased mortality. Tolvaptan, a vasopressor V2 receptor antagonist, can increase free water excretion, but its efficacy and safety in cirrhotic patients remain unclear. MATERIAL AND METHODS: We studied the usage and safety of tolvaptan in cirrhotic patients in a real-life, non-randomized, multicenter prospective cohort study. Forty-nine cirrhotic patients with hyponatremia were treated with tolvaptan 15 mg daily, and 48 patients not treated with tolvaptan in the same period served as controls. Improvement in serum sodium level was defined as an increase in serum sodium from < 125 to ≥ 125 mmol/L or from 125-134 to ≥ 135 mmol/L on day 7. RESULTS: Twenty-three (47%) patients in the tolvaptan group and 17 (35%) in the control group had normal serum sodium on day 7 (p = 0.25). Serum sodium improved in 30 (61%) patients in the tolvaptan group and 17 (35%) patients in the control group (p = 0.011). Adverse events occurred in 46-47% of patients in both groups, and tolvaptan was not associated with worsened liver function. No patient with normal serum sodium on day 7 died within 30 days of treatment, whereas 16% of those with persistent hyponatremia died (p = 0.0019). CONCLUSION: In conclusion, short-term tolvaptan treatment is safe and can improve serum sodium level in cirrhotic patients with hyponatremia. Normalization of serum sodium level is associated with better survival.

[Atmospheric Ammonia/Ammonium-nitrogen Concentrations and Wet and Dry Deposition Rates in a Double Rice Region in Subtropical China].

Ammonia (NH3) is the most abundant alkaline gas in the ambient air, and it is also one of the important precursors for the ammonium salts in aerosol and rainwater. Though the emission intensities of NH3 and acidic gases are high, the concentrations and deposition rates of atmospheric ammonia-nitrogen (NH3-N), particulate ammonium-nitrogen (NH4+-Np) and rainwater ammonium-nitrogen (NH4+-Nr) in double rice regions in subtropical China are still less known. In this study, atmospheric concentrations of NH3-N, NH4+-Np in PM10 and NH4+-Nr and related meteorological parameters were observed simultaneously in a typical double rice region in the subtropical hilly region of China, with the aim to clarify the characteristics and influencing factors of atmospheric NH3/NH4+-N concentrations and to quantify the wet and dry deposition rates of atmospheric NH3/NH4+-N. The results showed that the annual mean concentrations of nitrogen in NH3-N, NH4+-Np and NH4+-Nr were 5.7 µg·m-3, 12.8 µg·m-3 and 0.8 mg·L-1, respectively, and their deposition rates were 8.38, 5.61 and 9.07 kg·(hm2·a)-1, respectively. The NH3-N concentration was significantly increased after application of nitrogen fertilizer in the paddy field, and had a significant positive correlation with the air temperature. The NH4+-Np concentration did not show significant correlation with NH3-N concentration, indicating that atmospheric NH3-N concentration was not the main limiting factor for the NH4+-Np pollution in the studied region. The NH4+-Nr concentration was positively correlated with the NH4+-Np concentration but negatively correlated with precipitation. The high concentrations and deposition rates of atmospheric NH3-N/NH4+-N in the studied region indicated that the atmospheric NH3/NH4+-N pollution was serious, and atmospheric deposition of NH3/NH4+-N was an important nitrogen source in paddy fields, which should be considered in cropland nitrogen nutrient management.

Submassive hepatic necrosis distinguishes HBV-associated acute on chronic liver failure from cirrhotic patients with acute decompensation.

BACKGROUND & AIMS: Distinguishing between acute on chronic liver failure (ACLF) and decompensated liver cirrhosis is difficult due to a lack of pathological evidence. METHODS: A prospective single-center study investigated 174 patients undergoing liver transplantation due to acute decompensation of hepatitis B virus (HBV)-associated liver cirrhosis. Two groups were distinguished by the presence or absence of submassive hepatic necrosis (SMHN, defined as necrosis of 15-90% of the entire liver on explant). Core clinical features of ACLF were compared between these groups. Disease severity scoring systems were applied to describe liver function and organ failure. Serum cytokine profile assays, gene expression microarrays and immunohistochemical analyzes were used to study systemic and local inflammatory responses. RESULTS: SMHN was identified in 69 of 174 patients proven to have cirrhosis by histological means. Characteristic features of SMHN were extensive necrosis along terminal hepatic veins and spanning multiple adjacent cirrhotic nodules accompanied by various degrees of liver progenitor cell-derived regeneration, cholestasis, and ductular bilirubinostasis. Patients with SMHN presented with more severely impaired hepatic function, a higher prevalence of multiple organ failure (as indicated by higher CLIF-SOFA and SOFA scores) and a shorter interval between acute decompensation and liver transplantation than those without SMHN (p<0.01 for all parameters). Further analyzes based on serum cytokine profile assays, gene expression microarrays and immunohistochemical analyzes revealed higher levels of anti-inflammatory cytokines in patients with SMHN. CONCLUSIONS: SMHN is a critical histological feature of HBV-associated ACLF. Identification of a characteristic pathological feature strongly supports that ACLF is a separate entity in end-stage liver disease.

[Relationship between hepatitis B virus polymerase gene mutation patterns of rtM204I/V and pre-core/basal core promoter mutations].

OBJECTIVE: To investigate the relationship between mutations of rtM204V/I (methionine to valine or isoleucine at position rt204 of reverse transcriptase domain) in the hepatitis B virus (HBV) polymerase gene and the G1896A and G1899A single mutations in the pre-eore (PC) region and the A1762T and G1764A double-mutations in the basal core promoter (BCP) region. METHODS: A total of 2,849 hepatitis B complete genome sequences were retrieved from the GenBank/EMBL/DDBJ. The amino acid sequence of the of reverse transcriptase domain and genome sequences of the PC region and the BCP region were aligned using MEGA4 software. Data were calculated using Microsoft Excel and evaluated using SPSS 13.0 statistical software. RESULTS: Among the 2, 849 HBV complete genome sequences, 217 (8%) strains were identified with Y(I/V) DD and 120 of those had the YIDD mutation and 97 had the YVDD mutation. Of the 1543 strains (54.2%) with PC-BCP mutations, seven mutation patterns of G 1896A-G 1899A-G 1896A-G 1899A-A 1762T/G 1764A, A 1762T/G 1764AG 1896A, A 1762T/G 1764A-G 1899A, and A 1762T/G 1764A-G 1896A-G 1899A were identified. of YMDD and PC-BCP had a higher incidence than the single YMDD mutation (76% vs 24.0%, x2=45.283, P=0.000). The double-mutations of YIDD and PC-BCP had a higher incidence than the double-mutation of YVDD and PC-BCP (85% vs 64.9%, x2=11.836, P=0.000). The double-mutation for lamivudine resistance of YMDD and PC-BCP had a higher incidence than the double pre-existent YMDD and PC-BCP mutations (89.3% vs 58.9%, x2=27.084, P=0.000). The three mutation patterns of G1896A-G1899A (P=0.000, OR=7.573), A1762T/G1764A-G1899A (P=0.000, OR=6.539) and A1762T/G1764A-G1896A-G1899A (P=0.000, OR=6.596) were associated with a greater risk of developing the YIDD mutation, according to binary logistic analysis. CONCLUSION: There is a relationship between the HBV YI/VDD mutation and PC-BCP mutations. Different PC-BCP mutation patterns have different effects on the YI/VDD mutation.

Plasma microRNA panel to diagnose hepatitis B virus-related hepatocellular carcinoma.

PURPOSE: More than 60% of patients with hepatocellular carcinoma (HCC) do not receive curative therapy as a result of late clinical presentation and diagnosis. We aimed to identify plasma microRNAs for diagnosing hepatitis B virus (HBV) -related HCC. PATIENTS AND METHODS: Plasma microRNA expression was investigated with three independent cohorts including 934 participants (healthy, chronic hepatitis B, cirrhosis, and HBV-related HCC), recruited between August 2008 and June 2010. First, we used microarray to screen 723 microRNAs in 137 plasma samples for diagnosing HCC. Quantitative reverse-transcriptase polymerase chain reaction assay was then applied to evaluate the expression of selected microRNAs. A logistic regression model was constructed using a training cohort (n = 407) and then validated using an independent cohort (n = 390). Area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic accuracy. RESULTS: We identified a microRNA panel (miR-122, miR-192, miR-21, miR-223, miR-26a, miR-27a and miR-801) that provided a high diagnostic accuracy of HCC (AUC = 0.864 and 0.888 for training and validation data set, respectively). The satisfactory diagnostic performance of the microRNA panel persisted regardless of disease status (AUCs for Barcelona Clinic Liver Cancer stages 0, A, B, and C were 0.888, 0.888, 0.901, and 0.881, respectively). The microRNA panel can also differentiate HCC from healthy (AUC = 0.941), chronic hepatitis B (AUC = 0.842), and cirrhosis (AUC = 0.884), respectively. CONCLUSION: We found a plasma microRNA panel that has considerable clinical value in diagnosing early-stage HCC. Thus, patients who would have otherwise missed the curative treatment window can benefit from optimal therapy.

Expression of human glucocorticoid receptor in T lymphocytes in acute-on-chronic hepatitis B liver failure.

BACKGROUND: Glucocorticoid receptor (GR) participates in the pathogenesis of liver inflammation. However, the potential role of GR in acute-on-chronic hepatitis B liver failure (ACHBLF) is still obscure. AIM: This present study was aimed to determine peripheral GR expression in ACHBLF patients. METHODS: Forty patients with ACHBLF, 20 patients with chronic hepatitis B (CHB) and 16 healthy controls were included in this retrospectively study. Flow cytometry was used to determine the peripheral expression of GR + T lymphocytes. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) was performed for assessing relative mRNA levels of GR alpha and beta isoforms in peripheral blood mononuclear cells. Serum cortisol level was evaluated using radioimmunoassay. RESULTS: The serum cortisol level and the percentage of GR + T lymphocytes in ACHBLF patients were significantly decreased compared with CHB patients and healthy controls. However, there were no significant differences in mean fluorescence intensity (MFI) of GR + T lymphocytes within three groups. The relative GR alpha mRNA expression in ACHBLF patients was significant decreased compared with healthy controls. However, the relative GR beta mRNA expression in ACHBLF patients was significantly increased compared with CHB patients and healthy controls. In ACHBLF patients, the percentage of GR + T lymphocyte was significantly positively associated with relative GR alpha expression, prothrombin activity, and HBV DNA level, but negatively correlated with serum cortisol level and MELD score. Furthermore, the percentage of GR + T lymphocytes was also obviously elevated in survivors than non-survivors. CONCLUSIONS: It was strongly suggested that GR play an important role in the pathogenesis of ACHBLF.

[Expression of nuclear factor-κB and its regulated cytokines in dendritic cells in patients with chronic severe hepatitis B and its clinical significance].

OBJECTIVE: To investigate the correlation of nuclear factor-κB (NF-κB) level and its regulated cytokines in monocyte-derived dendritic cells (MoDC) with illness severity and prognosis in patients with chronic severe hepatitis B (CSHB). METHODS: Peripheral blood mononuclear cells (PBMC) were isolated by Ficoll density gradient separation from 37 patients with CSHB, 20 chronically HBV-infected patients, and 20 normal controls. Monocytes were acquired using immunomagnetic anti-CD14-beads. Next, monocytes were induced into immature DC (iDC) in vitro. On day six, polyI:C was added to induce DC maturation. Then mature DCs (mDCs) were collected at 48 h after polyI:C treatment to test the expression of NF-κB p50 by real time PCR. The supernatants were also collected respectively. The expression of TNFα and IL-6 in the supernatants were measured by ELISA. RESULTS: The expression of NF-κB p50 in mDCs of patients with CSHB was the highest in three groups (F=19.01, P<0.01). The secretion of TNFα and IL-6 in mDCs from group CSHB was extremely high when compared with the other two groups, the secretions of TNFα in groups CSHB, CHB and NC were(15317.69+/-4124.90) pg/ml, (9670.29+/-3654.68) pg/ml and (6547.43+/-1027.20) pg/ml (F=45.77, P<0.01) respectively, and the productions of IL-6 in groups CSHB, CHB and NC were (1423.78+/-375.14) pg/ml, (862.68+/-93.68) pg/ml and (567.26+/-167.04) pg/ml (F = 67.60, P is less than 0.01), respectively. NF-κB p50 showed significant correlations with TNFα(r=0.52, P<0.01) and IL-6 (r=0.65, P<0.01) in mDCs. Furthermore, the secretions of TNFα and IL-6 in mDCs from group CSHB were negatively associated with PTA (r=-0.41, P=0.01; r=-0.40, P=0.01), but not with ALT, TBil and virus loads (r=-0.03, P=0.85, r=0.01, P=0.93, r=0.01, P=0.95; r=-0.09, P=0.58, r=0.16, P=0.34, r=0.09, P=0.59). No significant difference found in the expression of TNFα and IL-6 between the survival subgroup and the death subgroup in group CSHB (t=0.42, P=0.67; t=0.76, P=0.45). CONCLUSIONS: The expression levels of NF-κB and its regulated cytokines in monocyte-derived DCs in patients with chronic severe hepatitis B were up-regulated and perhaps associated positively with the illness severity.

[Decreased expression of serum cortisol in patients with severe hepatitis].

OBJECTIVE: To investigate the profile of serum cortisol levels in patients with severe hepatitis. METHODS: Fifty patients with viral hepatitis (including 30 severe hepatitis patients and 20 chronic hepatitis B patients) were enrolled in this present study. Serum cortisol concentration was tested using radioimmunoassay. Furthermore, liver function, coagulation and other related laboratory indices were also determined. RESULTS: Serum cortisol concentration of severe hepatitis group was lower than that of chronic hepatitis B group (P < 0.05) and lower than that of healthy controls (P < 0.05) serum cortisol concentration of severe hepatitis patients was significantly positively correlated with PTA (r = 0.445, P < 0.05); serum cortisol concentration has no relation with ALT in patients with severe hepatitis (P > 0.05), and serum cortisol concentration was significantly negatively correlated with the ratio of AST/ALT in patients with severe hepatitis (r = -0.367, P < 0.05). No significant relationship was found between serum cortisol concentration and total Bilirubin (P > 0.05). Serum cortisol concentration in death group of severe hepatitis was lower than that in survival group of severe hepatitis (P < 0.05). Of severe hepatitis patients with MELD score, the higher MELD score, the lower the cortisol concentration. CONCLUSION: Cortisol concentration decreased in patients with severe hepatitis, which was related to functional liver reserve and disease severity. Cortisol can be related to the prognosis of severe hepatitis patients.

Plasma alpha-tocopherol is negatively correlated with hepatocyte apoptosis in chronic hepatitis B patients.

AIM: Hepatocyte apoptosis is involved in the pathogenesis of liver diseases, while at the same time oxidative stress plays an important role in liver cell damage. This prompted us to evaluate the possible relationship between hepatocyte apoptosis and oxidative stress in patients with chronic hepatitis B. METHODS: CHB patients were placed in groups A (ALT >40 IU/L) and B (ALT

Hospital-acquired invasive pulmonary aspergillosis in patients with hepatic failure.

BACKGROUND: Invasive pulmonary aspergillosis (IPA) is a rapid, progressive, fatal disease that occurs mostly in immunocompromised patients. Patients with severe liver disease are at a heightened risk for infections. Little is known about the clinical presentation including predisposing factors and treatment of IPA in patients with hepatic failure. METHODS: Medical records of patients with hepatic failure between November 2005 and February 2007 were reviewed for lung infection. Nine medical records of definitive diagnosis of IPA and three of probable IPA were identified. RESULTS: The main predisposing factors were found to be prolonged antibiotic therapy and steroid exposure. Clinical signs and radiological findings were non-specific and atypical. Timely use of caspofungin was found to reduce the mortality due to the disease. CONCLUSION: A high index of suspicion is required for early IPA diagnosis in patients with hepatic failure.

[Hepatocyte apoptosis in the patients with chronic hepatitis B].

OBJECTIVE: To investigate the relationship between hepatocyte apoptosis and the level of inducible nitric oxide synthase (iNOS) in hepatic tissue in the patients with chronic hepatitis B(Ct-IB). METHODS: We observed 37 cases with CHB and 10 normal controls. Transferase-mediated-UTP-biotin nick-end labling (TUNEL) technique was used to detect apoptosis cells and immunohistochemical staining were also performed to investigate the expression of inducible nitric oxide synthase (iNOS) in biopsy samples. The serum level of ALT, HBV DNA, grading of necroinflammatory activity and staging of fibrosis were also assessed. RESULTS: Hepatocytes in all CHB liver tissues were positively stained by TUNEL in various degree. In contrast, control tissues did not show DNA fragmentation. A significant correlation was seen between apoptosis index (AI) and necroinflammatory grading (r = 0.404, P = 0.015) and serum iNOS level (r = 0.465, P = 0.004). It did not correlate with fibrosis stage and serum alanine aminotransferase level. CONCLUSION: The oxidative stress in patients with CHB may reflected the apoptosis of hepatocyte. Apoptosis involves in liver injury of CHB, but with no significant correlation to serum level of ALT.