Effect of artificial liver support therapy on the short-term prognosis of patients with liver failure in the plateau stage: A stratified analysis based on Model for End-Stage Liver Disease score / 临床肝胆病杂志

ObjectiveTo investigate the effect of artificial liver support therapy on the short-term (28- and 90-day) mortality rate of patients with liver failure in the plateau stage through a stratified analysis based on Model for End-Stage Liver Disease (MELD) score. MethodsA retrospective analysis was performed for 187 patients with liver failure who were admitted to Nanfang Hospital, Southern Medical University, from January 2015 to April 2019, with 73 patients in the artificial liver group and 114 in the non-artificial liver group. The stratified analysis based on MELD score in the plateau stage was performed to investigate the differences in 28- and 90-day mortality rates, hospital costs and length of hospital stay of surviving patients, and incidence rate of adverse reactions of artificial liver support therapy between the two groups. The t-test was used for comparison of continuous data between the two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between the two groups. ResultsCompared with the non-artificial liver group, the artificial liver group had a significant reduction in the 28-day mortality rate of the patients with an MELD score of 30-39 (5.9% vs 39.6%, P＜0.001) or those with an MELD score of 40 (25.0% vs 72.7%, P＜0.05). Compared with the non-artificial liver group, the artificial liver group had a significant reduction in the 90-day mortality rate of the patients with an MELD score of 30-39 (23.5% vs 623%, P＜0.001). Artificial liver support therapy did not significantly shorten the mean hospital stay of the surviving patients (P＞0.05) and had no significant influence on the total hospital costs of the surviving patients within 90 days (P＞0.05). The incidence rate of adverse reactions related to artificial liver support therapy was 29.1%, but the symptoms were mild and were relieved after symptomatic treatment. ConclusionPatients with an MELD score of ＜30 in the plateau stage tend to have low 28- and 90-day mortality rates, and artificial liver support therapy can be reasonably selected according to the patient’s economic conditions and willingness. Artificial liver support therapy is recommended for patients with an MELD score of 30-39 in the plateau stage if there is no obvious contraindication. For patients with an MELD score of 40 in the plateau stage, artificial liver support therapy is recommended within 28 days if there is no obvious contraindication, and liver transplantation is recommended as soon as possible. Artificial liver support therapy has no significant influence on the total hospital costs and mean hospital stay of the surviving patients within 90 days and does not increase the economic burden of patients.

Tolerance of patients with chronic liver diseases undergoing gynecologic laparoscopic operations / 中国综合临床

Objective To investigate the liver function of patients with chronic liver diseases undergoing gynecologic laparoscopic operations.Methods Twenty-six asymptomatic HBV carriers,28 mild chronic hepatitis,21 compensatory cirrhosis were assigned to undergo gynecologic laparoscopic operations.Liver function were tested and compared in these three groups before operation and on the 1st、3rd、7th day after operation.Results 1st day after operation,ALT and AST in asymptomatic carriers and mild chronic hepatitis groups were significantly higher than preoperation ( asymptomatic carriers:ALT P ＜ 0.05,AST P ＜ 0.05 ; mild chronic hepatitis:ALT P ＜ 0.05,AST P ＜ 0.05 ).Then they recovered on the 3rd day after operation ( asymptomatic carriers:ALT P ＞ 0.05,AST P ＞ 0.05 ; mild chronic hepatitis:ALT P ＞ 0.05,AST P ＞ 0.05 ).ALB,total bilirubin (Tbil) after operation were not significantly different from those before operation on every tested day in these two groups ( asymptomatic carriers:ALB P ＞ 0.05,Tbil P ＞ 0.05 ; mild chronic hepatitis:ALB P ＞ 0.05,Tbil P ＞ 0.05 ).In compensatory cirrhosis group,ALT,AST,Tbil were significantly higher on the 1st day,3rd day after operation than preoperation ( 1st day:ALT P ＜0.01,AST P ＜0.01,Tbil P ＜0.01 ;3rd day:ALT P ＜ 0.05,AST P ＜ 0.05,Tbil P ＜ 0.05 ).ALB levels were significantly lower on the 1st day,3rd day after operation than preoperation ( 1st day:P ＜0.01 ;3rd day:P ＜0.05 ).All the indexes recovered to the levels of preoperation on the 7th day after operation( ALT P ＞ 0.05,AST P ＞ 0.05,Tbil P ＞ 0.05,ALB P ＞0.05).Conclusions To some extent,gynecologic laparoscopic operations have some adverse effects on short-term liver function after operation in patients with chronic liver diseases.Compensatory cirrhosis patients present delayed recovery compared with asymptomatic carriers and mild chronic hepatitis patients.

Expression of IL-18 in the peripheral blood mononuclear cells of chronic hepatitis B patients / 免疫学杂志

Objective　 To investigated the possible roles of IL-18 in HBV infection, and the expression of IL-18 in the peripheral blood mononuclear cells (PBMC) of chronic hepatitis B. Methods 　In 15 cases of asymptomatic carriers, 30 cases of active and remissive phases of chronic hepatitis and 10 healthy individuals (as normal controls), IL-18 expression in PBMC were quantitatively analyzed with flow cytometric immunological method. The PBMC were separated routinely and stimulated with LPS (SIGMA) and Monensin (SIGMA) for 6 hours. Then the cells were harvested and fixed by PBS/4% paraformaldehyde. The treated cells were stored in liquid nitrogen for detection later. After immunologic stain, the expression of IL-18 in PBMC were examined by flow cytometry. Results　 ① IL-18 was the lowest in asymptomatic carriers. It was fewer in remissive phase than in normal controls (P＜0.01).There was no difference between active phase and normal controls(P=0.25).②Within the group of active phase, IL-18 was significantly different between each grade of inflammatory activity(P＜0.01),and correlated with serum ALT positively(r=0.63,P＜0.01). Conclusion　 IL-18 may relate to disease activity and the inflammation of liver.

Tissue tropism of TT virus in experimentally infected Rhesus monkey / 中华传染病杂志

Objective To study tissue tropism of TT virus in experimentally infected Rhesus monkey. Methods Various tissues were collected from 5 experimentally infected monkeys during the viremic period. Total DNA was extracted from tissues of 5 experimentally infected Rhesus monkeys. A dot hybridization was done with virus double DNA strand probe or single antisense strand probe. Results The double strand probe was hybridized with DNA of liver, bone marrow, spleen, stomach, small intestine and colon. The single strand antisense probe was hybridized only with DNA of liver, small intestine and bone marrow of all 5 monkeys, but not with that of other tissues.Conclusions As the viral genome is of negative polarity, the plus stranded fragment identified in our study might be a replicative intermediate, and is only demonstrated in liver, small intestine, and bone marrow by dot blot hybridization with single stranded antisense probe. It suggests that TT virus might be, tropism of liver, small intestine, and bone marrow, and replicate in tissue mentioned.

Study of relationship between IL-18 and IFN therapy of chronic hepatitis B / 中国免疫学杂志

Objective:To evaluate the possible roles of IL-18 in HBV infection, and to clarify the immune state during IFN? therapy. Methods:Peripheral blood lymphocytes from 2 groups of HBV infectors(including 15 asymptomatic carriers,26 patients with chronic hepatitis B) and 10 healthy individuals (as normal controls) were analyzed by flow cytometry. The levels of IL-18 were also detected before, during, and at the end of IFNa therapy,Results: (1)The level of IL-18 was the lowest in asymptomatic carrier group. However there was no significant difference between chronic hepatitis and normal control. (2)The patients with chronic hepatitis were further divided into 4 subgroups according to the inflammation degree of liver. Results showed that the severity degree of liver inflammation was accompanied with the elevation of IL-18 production. (3)IL-18 in chronic hepatitis B correlated with serum ALT positively ( r = 0.61,P