Association between hepatic steatosis and entecavir treatment failure in Chinese patients with chronic hepatitis B.

BACKGROUND: The coexistence of HBV infection and nonalcoholic fatty liver disease (NAFLD) becomes characteristic of liver disease in China, with unknown bilateral influence. We aimed to investigate the effect of hepatic steatosis, a common hepatocyte change in NAFLD, on antiviral therapy in patients with chronic hepatitis B (CHB). METHODS AND FINDINGS: We carried out a prospective nested case control study in CHB patients receiving Entecavir for initial antiviral therapy, by recording demographic, anthropometric and clinical data at baseline, 24(wk), 48(wk) and 96(wk). Univariate analysis and multivariate logistic regression were applied to find out independent factors of hepatic steatosis and Entecavir treatment failure. The rates of HBV-DNA clearance, HBeAg seroconversion and ALT normalization were compared between CHB patients with and without steatosis by post hoc analysis. A total of 267 Chinese patients with CHB entered final analysis, with overall percentages of hepatic steatosis and HBeAg positive as 30.5% and 62.4%. Multivariate analysis showed waist circumference, serum TG and uric acid levels were independent factors of hepatic steatosis. The response rates to Entecavir were 54.9%, 63.8%, 74.2% at 24(wk), 48(wk) and 96(wk). Hepatic steatosis was revealed as an independent factor of Entecavir treatment failure by multivariate logistic regression at 24(wk), 48(wk) and 96(wk). In CHB patients with hepatic steatosis, HBV-DNA clearance and HBeAg seroconversion were both lower throughout the follow-up, but only the former reached statistical significance. Besides, ALT normalization was also significantly lower at 24(wk) and 48(wk). CONCLUSION: Hepatic steatosis is significantly associated with Entecavir treatment failure and metabolic factors are independent factors of hepatic steatosis in CHB patients, which called for a specified antiviral strategy in CHB patients with NAFLD.

Biomechanical properties of skin in vitro for different expansion methods.

OBJECTIVE: In plastic surgery, clinicians are interested in replacing conventional expansion by rapid expansion, because the expansion period could be shortened greatly. Also people are concerned that skin properties after rapid expansion might not approach those after conventional expansion. DESIGN: Biomechanical testing of skin for different expansion methods. BACKGROUND: It would be useful to know how much the mechanical properties of skin have been altered during rapid and conventional expansion and during different maintaining times. METHODS: Tensile strength, stress-strain relationship, stress relaxation, and creep were measured by a material testing machine. RESULT: The biomechanical properties of experimental specimens differ significantly from those of their controls immediately after expansion, however, the difference is reduced with time. With the same maintaining period, the biomechanical properties of rapidly expanded skin are similar to conventionally expanded skin. CONCLUSION: Rapid skin expansion did not demonstrate any deleterious effect when compared with the conventional expansion. Extension of the maintaining period can improve the biomechanical properties of expanded skin. Therefore, rapid expansion with an extended maintaining period is acceptable in clinical practice.

Morphologic and biomechanical changes of rat oesophagus in experimental diabetes.

AIM: To study morphologic and biomechanical changes of oesophagus in diabetes rats. METHODS: Diabetes was induced by a single injection of streptozotocin (STZ). The type of diabetes mellitus induced by parenteral STZ administration in rats was insulin-dependent (type I). The samples were excised and studied in vitro using a self-developed biomaterial test machine. RESULTS: The body mass was decreased after 4 d with STZ treatment. The length of esophagus shortened after 4, 7, 14 d. The opening angle increased after 14 d. The shear, longitudinal and circumferential stiffness were obviously raised after 28 d of STZ treatment. CONCLUSION: The changes of passive biomechanical properties reflect intra-structural alteration of tissue to a certain extent. This alteration will lead to some dysfunction of movement. For example, tension of esophageal wall will change due to some obstructive disease.

Biomechanical comparison between conventional and rapid expansion of skin.

This study was designed to investigate the effects of different surgical expansion regimens on the biomechanical features of expanded skin. Two hundred and forty millilitres expanders were implanted on the backs of six adult dogs. Six flaps were designed on the dorsum of each dog. After serial expansion, the expander was left beneath the skin for a certain period of time, which is called the maintaining period. Rapid expansion and conventional expansion with various maintaining periods were compared. The experimental result shows that the area gain of expanded skin surface had no significant difference between the rapid and conventional expansion. Both the tension in vivo and the instant stretch-back ratio increased during the expansion, but fell almost to control values after four weeks' maintaining period. Biomechanical properties in vitro, such as tensile strength, stress-strain, stress-relaxation, and creep were tested by INSTRON material testing machine. Results show that the biomechanical properties of expanded specimens differ significantly from those of their controls immediately after expansion. However, the difference reduces with prolongation of maintaining time. With the same maintaining period, the biomechanical properties of rapidly expanded skin are similar to conventionally expanded skin. We conclude that rapid skin expansion did not demonstrate any deleterious effect when compared with the conventional expansion. Extension of the maintaining period can improve the biomechanical properties of expanded skin and effectively reduce the stretch-back ratio. Therefore, rapid expansion with an extended maintaining period is acceptable in clinical practice.