Expert Consensus on Pathological Diagnosis of Intrahepatic Cholangiocarcinoma (2022 version)

Intrahepatic cholangiocarcinoma (iCCA) can originate from the large bile duct group (segment bile ducts and area bile ducts), small bile duct group (septal bile ducts and interlobular bile ducts), and terminal bile duct group (bile ductules and canals of Hering) of the intrahepatic biliary tree, which can be histopathological corresponding to large duct type iCCA, small duct type iCCA and iCCA with ductal plate malformation pattern, and cholangiolocarcinoma, respectively. The challenge in pathological diagnosis of above subtypes of iCCA falls in the distinction of cellular morphologies, tissue structures, growth patterns, invasive behaviors, immunophenotypes, molecular mutations, and surgical prognoses. For these reasons, this expert consensus provides nine recommendations as a reference for standardizing and refining the diagnosis of pathological subtypes of iCCA, mainly based on the 5th edition of the World Health Organization Classification of Tumours of the Digestive System.

[Effect of the nomenclature of non-alcoholic fatty liver disease on diagnosis and treatment of fatty liver disease concomitant with other liver diseases]

Fatty liver disease (FLD) is one of the major causes of chronic liver disease worldwide. With the increasing incidence of obesity and metabolic syndrome worldwide, FLD concomitant with other liver diseases is becoming more common, and multiple etiological overlap is associated with poor disease prognosis. Therefore, FLD concomitant with other liver diseases is a clinical concerning issue. Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of disease continuum from non-alcoholic fatty liver (NAFL) to non-alcoholic steatohepatitis (NASH), and relative end stage liver disease, excluding other factors that may lead to fatty liver disease such as excessive alcohol consumption et. al. Following the nomenclature of NAFLD with metabolic associated fatty liver disease (MAFLD), an international panel of experts proposed a new name in June 2023 as Metabolic dysfunction - associated steatotic liver disease (MASLD), replacing the word "fatty" with "steatotic," The effect of lipid toxicity on FLD progression was highlighted. Compared with the concept of MAFLD, the disease spectrum of MASLD is broader, and the etiology and mechanism are more clear. The nomenclature of FLD brings some influence to the diagnosis and treatment of chronic liver diseases concomitant with FLD, including chronic hepatitis B, alcoholic fatty liver disease and genetic metabolic diseases. This article reviews the influence of renaming FLD on the diagnosis and treatment of FLD concomitant with other etiologies caused liver diseases.

Stages of psychological change among patients with non-alcoholic fatty liver disease in China: a national cross-sectional study

OBJECTIVES

Non-alcoholic fatty liver disease (NAFLD) is becoming the leading cause of chronic liver disease worldwide. However, treatment of NAFLD is potentially influenced by psychological conditions. Using the simplified version of the University of Rhode Island Change Assessment (URICA-SV) scale, this study aimed to evaluate the stage of psychological change as a prerequisite to refining implementation strategies for psychological change.

DESIGN

A multicentre cross-sectional survey.

SETTING

Ninety hospitals in China.

PARTICIPANTS

5181 patients with NAFLD were included in this study.

OUTCOME MEASURES

All patients completed the URICA-SV questionnaire and were assigned to one of the three stages of change (precontemplation, contemplation or action) according to their readiness scores. A stepwise multivariate logistic regression analysis was used to identify independent factors associated with the stage of psychological change.

RESULTS

A total of 4832 (93.3%) patients were included in the precontemplation stage and only 349 (6.7%) considered making a change or preparing to make one. There were significant differences in gender (Cohen's d=0.039, p=0.005), age (Cohen's d=-0.327, p<0.001), waist circumference (Cohen's d=0.143, p=0.003), alanine transaminase (Cohen's d=0.347, p=0.001), triglyceride (Cohen's d=0.351, p=0.002), body mass index (BMI; Cohen's d=0.056, p<0.001), proportion of hyperlipidaemia (Cohen's d=0.068, p<0.001) and cardiovascular disease (Cohen's d=0.032, p=0.029), therapeutic regimen (Cohen's d=0.136, p<0.001), and Chronic Liver Disease Questionnaire-Non-Alcoholic Fatty Liver Disease overall score (Cohen's d=-0.420, p<0.001) between patients with NAFLD in the precontemplation stage and those in the contemplation/action stage. Logistic regression identified BMI (HR 0.659, 95% CI 0.469 to 0.928, p=0.017), cardiovascular disease (HR 2.161, 95% CI 1.089 to 4.287, p=0.027) and triglyceride (HR 0.751, 95% CI 0.591 to 0.955, p=0.020) as independent factors predicting psychological change.

CONCLUSIONS

The results demonstrated that very few patients with NAFLD presented psychological condition in the stage of action. Psychological condition was found to be significantly related to BMI, cardiovascular disease and triglyceride factors. Integrated diversity considerations for evaluating psychological change are necessary.

[Analysis of clinical characteristics and risk factors of hepatic fibrosis in children with chronic hepatitis B combined with metabolic-related fatty liver disease]

Objective: To compare the clinical and pathological features of children with chronic viral hepatitis B combined with metabolic-associated fatty liver disease (CHB-MAFLD) and chronic viral hepatitis B alone (CHB alone), and to further explore the effect of MAFLD on the progression of hepatic fibrosis in CHB. Methods: 701 initially treated CHB children confirmed by liver biopsy admitted to the Fifth Medical Center of the PLA General Hospital from January 2010 to December 2021 were collected continuously. They were divided into CHB-MAFLD and CHB-alone groups according to whether they were combined with MAFLD. A retrospective case-control study was conducted. CHB-MAFLD was used as the case group, and 1:2 propensity score matching was performed with the CHB alone group according to age and gender, including 56 cases in the CHB-MAFLD group and 112 cases in the CHB alone group. The body mass index (BMI), metabolic complications, laboratory indicators, and pathological characteristics of liver tissue were compared between the two groups. The related factors affecting liver disease progression in CHB were analyzed by a binary logistic regression model. The measurement data between groups were compared using the t-test and rank sum test. The χ (2) test was used for the comparison of categorical data between groups. Results: Alanine aminotransferase (ALT, P = 0.032) and aspartate aminotransferase (AST, P = 0.003) levels were lower in the CHB-MAFLD group than those in the CHB alone group, while BMI (P < 0.001), triglyceride (TG, P < 0.001), total cholesterol (P = 0.016) and the incidence of metabolic syndrome (P < 0.001) were higher in the CHB alone group. There were no statistically significant differences in HBsAg quantification or HBV DNA load between the two groups (P > 0.05). Histologically, the proportion of significant liver fibrosis (S2-S4) was higher in the CHB-MAFLD group than that in the CHB alone group (67.9% vs. 49.1%, χ (2) = 5.311, P = 0.021). Multivariate regression results showed that BMI (OR = 1.258, 95% CI: 1.145 ~ 1.381, P = 0.001) and TG (OR = 12.334, 95% CI: 3.973 ~ 38.286, P < 0.001) were the risk factors for hepatic steatosis occurrence in children with CHB. MAFLD (OR = 4.104, 95% CI: 1.703 ~ 9.889, P = 0.002), liver inflammation (OR = 3.557, 95% CI: 1.553 ~ 8.144, P = 0.003), and γ-glutamyl transferase (OR = 1.019, 95% CI: 1.001 to 1.038, P = 0.038) were independent risk factors for significant hepatic fibrosis in children with CH. Conclusion: MAFLD occurrence is related to metabolic factors in children with CHB. Additionally, the combination of MAFLD may promote liver fibrosis progression in CHB patients.

[A preliminary discussion on carnosine dipeptidase 1 as a potential novel biomarker for the diagnostic and prognostic evaluation of hepatocellular carcinoma]

Objective: To explore carnosine dipeptidase 1 (CNDP1) potential value as a diagnostic and prognostic evaluator of hepatocellular carcinoma (HCC). Methods: A gene chip and GO analysis were used to screen the candidate marker molecule CNDP1 for HCC diagnosis. 125 cases of HCC cancer tissues, 85 cases of paracancerous tissues, 125 cases of liver cirrhosis tissues, 32 cases of relatively normal liver tissue at the extreme end of hepatic hemangioma, 66 cases from serum samples of HCC, and 82 cases of non-HCC were collected. Real-time fluorescent quantitative PCR, immunohistochemistry, western blot, and enzyme-linked immunosorbent assay were used to detect the differences in mRNA and protein expression levels of CNDP1 in HCC tissue and serum. Receiver operating characteristic (ROC) curves and Kaplan-Meier survival were used to analyze and evaluate the value of CNDP1 in the diagnosis and prognosis of HCC patients. Results: The expression level of CNDP1 was significantly reduced in HCC cancer tissues. The levels of CNDP1 were significantly lower in the cancer tissues and serum of HCC patients than those in liver cirrhosis patients and normal controls. ROC curve analysis showed that the area under the curve of serum CNDP1 in the diagnosis of HCC patients was 0.753 2 (95% CI 0.676-0.830 5), and the sensitivity and specificity were 78.79% and 62.5%, respectively. The combined detection of serum CNDP1 and serum alpha-fetoprotein (AFP) significantly improved the diagnostic accuracy (AUC = 0.820 6, 95% CI 0.753 5-0.887 8). The diagnostic sensitivity and specificity of serum CNDP1 for AFP-negative HCC patients were 73.68% and 68.75% (AUC = 0.793 1, 95% CI 0.708 8-0.877 4), respectively. In addition, the level of serum CNDP1 distinguished small liver cancer (tumor diameter < 3 cm) (AUC = 0.757 1, 95% CI 0.637 4-0.876 8). Kaplan-Meier survival analysis showed that CNDP1 was associated with a poor prognosis in HCC patients. Conclusion: CNDP1 may be a potential biomarker for the diagnostic and prognostic evaluation of HCC, and it has certain complementarity with serum AFP.

[Intrahepatic and extrahepatic clinical manifestations and treatment progress for hepatitis type E]

Hepatitis type E virus (HEV) is one of the main causes of acute hepatitis globally and has thus gained attention as a public health issue. The diverse clinical manifestations of hepatitis type E are typically acute and self-limiting with mild symptoms, but populations with underlying liver disease or immunocompromised patients can have severe and chronic symptoms. Severity and chronicity can arise and manifest as fulminant hepatitis, chronic hepatitis, or even hepatic failure. HEV infection-induced hepatic failure (acute-on-chronic liver failure), based on the different backgrounds of chronic liver disease, is a clinical phenotype of severe HEV infection that requires attention. In addition, HEV infection can exhibit extrahepatic clinical manifestations of multi-system and organ involvement like neurological diseases (Guillain-Barré syndrome), renal diseases (membranous/membranous proliferative glomerulonephritis, cryoglobulinemia), and blood diseases (thrombocytopenia). At home or abroad, there are no antiviral drugs approved, particularly for HE treatment. Since most acute HE can resolve spontaneously, no special treatment is required clinically. However, in patients with severe or chronic HE, ribavirin (RBV) monotherapy and/or pegylated interferon-combination therapy have achieved certain antiviral effects. Combined small-molecule drugs and RBV have been attempted to treat HEV, but high-level evidence-based treatment is still lacking. Thus, new, highly effective anti-HEV drugs are clinical priorities to address these concerns. Severe and chronic HEV infections' clinical phenotype, early detection, mechanism, intervention, and outcome need additional study.

[Significance of histological assessment in drug-induced liver injury]

Liver histological assessment is of great clinical significance for the diagnosis, classification, and prognosis prediction of drug-induced liver injury (DILI). Liver histological evaluation can effectively supplement RUCAM. The clinical phenotypes of DILI are complex and diverse, including acute, chronic and severe hepatic injury. DILI has multiple insult-targets, including hepatocytes, cholangiocytes, and vascular endothelial cells and others. The pathological damage patterns are similar to many types of non-DILI liver diseases, therefore making differential diagnosis difficult. New anti-tumor drugs such as immune checkpoints inhibitors and targeted therapy are widely used in clinical antineoplastic practice, thus the growing incidence of related liver injury occurs. Liver histological examination can effectively assess the pathological phenotypes and severity of DILI, so as to guide treatment. In uncommon conditions such as special types of DILI (such as hepatic vascular disease), DILI with other competitive etiology overlapping, chronic DILI, and DILI induced liver failure, liver histological assessment can provide strong support for identifying the cause, rational treatment, and prognosis. Currently, the histological evaluation system for drug-induced liver injury seems to be a lack of consensus, and the diagnosis of DILI is short of highly specific and sensitive serological markers. All in all, liver histological assessment plays a crucial role in the diagnosis and differential diagnosis of DILI.

Reliability and validity of the Chinese version of chronic liver disease questionnaire-nonalcoholic fatty liver disease in patients with nonalcoholic fatty liver disease: a multicenter cross-sectional survey in China

PURPOSE

The Chronic Liver Disease Questionnaire (CLDQ)-Nonalcoholic Fatty Liver Disease (NAFLD) is a disease-specific instrument to assess the health-related quality of life (HRQL) of patients with NAFLD. In order to provide further evidence for the cross-cultural utility of this instrument in the Chinese population, we translated the CLDQ-NAFLD into Chinese and examined its reliability and validity.

METHODS

Patients with NAFLD in 90 hospitals across China were enrolled in this multicenter cross-sectional survey. Eligible patients completed the Chinese version of CLDQ-NAFLD at enrollment to assess HRQL. Internal consistency of the questionnaire was assessed using Cronbach's alpha coefficient and split-half reliability. Convergent and discriminant validity were assessed using Spearman correlation coefficient. Factor analysis was used to test the construct validity.

RESULTS

Between March and August 2019, 5181 patients with a mean age of 43.8 ± 13.3 years were enrolled. All domains exhibited good internal consistency, with Cronbach's alpha and split-half reliability greater than 0.70. The scaling success rate of all domains was 100% for convergent validity and 99.4% (179/180) for discriminant validity. The inter-scale correlations indicated a significant correlation between all CLDQ-NAFLD domains (r = 0.608 to 0.832, all p < 0.001). Factor analysis of 36 items extracted 6 factors, which explained 69.14% of the total variance.

CONCLUSION

The Chinese version of CLDQ-NAFLD is a reliable and valid instrument for assessing the HRQL of Chinese patients with NAFLD.

[The companion diagnostics of targeted therapy and immunotherapy for hepatocellular carcinoma]

Hepatocellular carcinoma (HCC) has a high incidence and low five-year survival rate in China. There is a lack of effective therapeutic approaches available for unresectable patients with advanced HCC. Recently, the development of targeted and immunotherapy agents and their application in the therapy of various solid tumors have brought new options and benefits to patients with advanced HCC. Companion diagnostics (CDx) emerged with the development of targeted agents, and its roles in selecting eligible patients for specific targeted/immunotherapy agents and improving prognosis are getting more prominent. This article focuses on the CDx technologies and applications related to HCC targeting and immunotherapy, in order to provide inspiration for the precise diagnosis and treatment of HCC.

Developing a New qFIBS Model Assessing Histological Features in Pediatric Patients With Non-alcoholic Steatohepatitis

Background

The evolution of pediatric non-alcoholic fatty liver disease (NAFLD) to non-alcoholic steatohepatitis (NASH) is associated with unique histological features. Pathological evaluation of liver specimen is often hindered by observer variability and diagnostic consensus is not always attainable. We investigated whether the qFIBS technique derived from adult NASH could be applied to pediatric NASH.

Materials and Methods

102 pediatric patients (<18 years old) with liver biopsy-proven NASH were included. The liver biopsies were serially sectioned for hematoxylin-eosin and Masson trichrome staining for histological scoring, and for second harmonic generation (SHG) imaging. qFIBS-automated measure of fibrosis, inflammation, hepatocyte ballooning, and steatosis was estabilshed by using the NASH CRN scoring system as the reference standard.

Results

qFIBS showed the best correlation with steatosis (r = 0.84, P < 0.001); with ability to distinguish different grades of steatosis (AUROCs 0.90 and 0.98, sensitivity 0.71 and 0.93, and specificity 0.90 and 0.90). qFIBS correlation with fibrosis (r = 0.72, P < 0.001) was good with high AUROC values [qFibrosis (AUC) > 0.85 (0.85–0.95)] and ability to distinguish different stages of fibrosis. qFIBS showed weak correlation with ballooning (r = 0.38, P = 0.028) and inflammation (r = 0.46, P = 0.005); however, it could distinguish different grades of ballooning (AUROCs 0.73, sensitivity 0.36, and specificity 0.92) and inflammation (AUROCs 0.77, sensitivity 0.83, and specificity 0.53).

Conclusion

It was demonstrated that when qFIBS derived from adult NASH was performed on pediatric NASH, it could best distinguish the various histological grades of steatosis and fibrosis.

Mating-Type Genes Control Sexual Reproduction, Conidial Germination, and Virulence in Cochliobolus lunatus

Cochliobolus lunatus (anamorph: Curvularia lunata) is a major pathogenic fungus that causes the Curvularia leaf spot of maize. ClMAT1-1-1 and ClMAT1-2-1, the C. lunatus orthologs of C. heterostrophus ChMAT1-1-1 and ChMAT1-2-1, were investigated in the present study to uncover their functions in C. lunatus. Southern blot analysis showed that these mating-type MAT genes exist in the C. lunatus genome as a single copy. ClMAT1-1-1 and ClMAT1-2-1 were knocked out and complemented to generate ΔClmat1-1-1 and ΔClmat1-2-1 and ΔClmat1-1-1-C and ΔClmat1-2-1-C, respectively. The mutant strains had defective sexual development and failed to produce pseudothecia. There were no significant differences in growth rate or conidia production between the mutant and wild-type strains. However, the aerial mycelia and mycelial dry weight of ΔClmat1-1-1 and ΔClmat1-2-1 were lower than those of wild type, suggesting that MAT genes affect asexual development. ClMAT genes were involved in the responses to cell wall integrity and osmotic adaptation. ΔClmat1-2-1 had a lower conidial germination rate than the wild-type strain CX-3. The virulence of ΔClmat1-2-1 and ΔClmat1-1-1 was also reduced compared with the wild-type. Complementary strains could restore all the phenotypes.

[Research on COVID-19 vaccination strategies in Singapore]

As of December 31, 2021, Singapore reported that 4 758 601 had completed at least one dose of COVID-19 vaccination, 4 714 655 had completed two doses of COVID-19 vaccination, and 2 207 341 had received one booster shot of COVID-19 vaccine. This article analyses the current performance of COVID-19 vaccination in Singapore, interprets the content of Singapore's National Vaccination Programme, and systematically introduces specific measures of COVID-19 vaccination in Singapore, such as door-to-door vaccination, vaccination differentiated management, and self-payment of medical expenses for those who refuse to be vaccinated, to provide reference for the COVID-19 vaccination in China.

Accuracy of Nolla Method for Age Estimation of Northern Chinese Han Children

Abstract

Objective To study the accuracy of Nolla method for age estimation of Northern Chinese Han children aged between 5.00 and 14.99 years based on original transformation tables and multiple regression model. Methods A total of 2 000 orthopantomographs （OPGs） were collected from the Hospital of Stomatology, Xi'an Jiaotong University, including 1 000 males and 1 000 females. Development stage of 7 left mandibular permanent teeth （except third molars） was assessed based on Nolla method, then age estimation was conducted through transformation tables and multiple regression model, respectively. Firstly, the development stage results of 7 permanent teeth were added up and the estimated age was obtained through the original transformation tables. Secondly, 80% of the samples （80 males and 80 females in each age group） were randomly selected from 2 000 OPGs as the train set. The chronological age of the selected patients was taken as the dependent variable, while gender and the development stage results of 7 permanent teeth were taken as the independent variable to establish multiple regression model. The remaining 20% of the samples were substituted into the model as the test set, to verify the accuracy of age estimation by multiple regression model. Results Mean chronological ages of males and females were 10.03±0.09 years and 10.01±0.09 years, respectively. The age estimated by original transformation tables showed an overestimation for males （0.18 years on average） and an underestimation for females （0.02 years on average）, with mean absolute error （MAE） of 0.94 years and 0.97 years, respectively. While the results by multiple regression model showed that males were overestimated by 0.06 years on average and females were underestimated by 0.02 years on average. The MAE was 0.66 years and 0.77 years, respectively. Conclusion The Nolla method is suitable for age estimation of Northern Chinese Han children. Compared with the original transformation tables method, the multiple regression model is more accurate for age estimation.

Health-related quality of life in Chinese population with non-alcoholic fatty liver disease: a national multicenter survey

Background

Health Related Quality of Life (HRQL) is a multi-dimensional construct that can comprehensively evaluate the patient’s health status, including physical, emotional, mental and social well-being. In this study, we aimed to evaluate the impact of non-alcoholic fatty liver disease (NAFLD) on HRQL in a Chinese population.

Methods

In this national multicenter cross-sectional survey, patients with NAFLD were enrolled. Chronic Liver Disease Questionnaire (CLDQ)-NAFLD was used to qualify HRQL. Univariate and multivariate analysis were used to identify independent risk factors of HRQL.

Results

A total of 5181 patients with NAFLD from 90 centers were enrolled in this study (mean age, 43.8 ± 13.3 years; male, 65.8%). The overall CLDQ score was 5.66 ± 0.89. Multivariate logistic regression analysis showed that body mass index (BMI: HR, 1.642; 95% CI, 1.330–2.026), alanine transaminase (ALT: HR, 1.006; 95% CI, 1.001–1.011), triglyceride (HR, 1.184; 95% CI, 1.074–1.305), disease severity (HR, 3.203; 95% CI, 1.418–7.232) and cardiovascular disease (HR, 4.305; 95% CI, 2.074–8.939) were independent risk factors for overall CLDQ score. In the logistic analyses of individual domain, BMI and triglyceride were independent risk factors of all domains. ALT, disease severity, diabetes, depression and cardiovascular disease were influencing factors for the CLDQ score of several domains.

Conclusions

This national multicenter cross-sectional survey in China indicated that the HRQL in patients with NAFLD was impaired. HRQL was found to be significantly associated with sociodemographic and clinical factors. Attention should be paid to the optimally managing care of patients with NAFLD to improve their HRQL.

Hepatic Macrophage activation and the LPS pathway in patients with different degrees of severity and histopathological patterns of drug induced liver injury

BACKGROUND

Inflammatory activation of hepatic macrophages plays a primary role in drug-induced liver injury (DILI). However, the exact mechanism underlying DILI remains unclear.

METHODS

A total of 328 DILI patients and 80 healthy individuals were prospectively enrolled in this study. The DILI patients were categorized into subgroups based on either disease severity or histopathological patterns. Plasma soluble CD163 (sCD163) and hepatic CD163 were examined to determine hepatic macrophage activation, and CD8, CD20, and MUM-1 were assessed to determine cellular immunity using immunohistochemistry. The lipopolysaccharide (LPS) pathway proteins [e.g. LPS, soluble CD14 (sCD14), and LPS-binding protein (LBP)] were measured using enzyme-linked immunosorbent assay.

RESULTS

Plasma sCD163 levels were nine-fold higher in DILI patients than in healthy controls at the baseline, but significantly decreased at the 4-week follow-up visit after treatment. The numbers of hepatic macrophages, B cells, and plasma cells were significantly higher in the liver tissues from DILI patients than those from healthy controls. Furthermore, the baseline levels of LPS pathway proteins in the DILI patients were significantly higher than those in the controls. Notably, these proteins significantly decreased at the 4-week follow-up visit but remained significantly higher than the levels for the controls.

CONCLUSIONS

Hepatic inflammation in DILI involves the activation of hepatic macrophages and cellular immunity, in which the LPS pathway likely plays a role, at least in part. As such, this study has improved our understanding of the pathological mechanisms for DILI and may facilitate the development of better treatments for patients with DILI.

[Research Progress and Prospect of Facial Reconstruction in Forensic Science]

Abstract

Facial reconstruction is a way to recover facial morphology by restoring soft tissues based on unidentified skulls using the knowledge of anatomy, anthropology, aesthetics, and computer science. It is applied in forensic science, oral plastic surgery and archeology, and especially plays an important role in the identification of the origin of the unknown corpses in forensic science. Facial reconstruction is the supplementary means of identification when other approaches （such as DNA comparison, imaging matching, dental records comparison, etc.） cannot identify individual identity. Facial soft tissue thickness （FSTT） is the basis of facial reconstruction and with the development of imaging and computer science, the techniques for measuring FSTT are improving rapidly and many related researches have appeared. This paper summarizes the application of facial reconstruction in forensic science, the accuracy of different methods and the research progress of this field to provide reference to this field.

[Research progress on application of laboratory indicators detection of COVID-19]

The outbreak of corona virus disease-19 (corona virus disease-19, COVID-19) caused a huge human disaster from the end of 2019 which is caused by SARS-CoV-2. It will cause damage to multiple organs function in the disease occurrence and development, viral nucleic acid, antibody and serological biochemical immune indicators are mainly indicators of clinical laboratory. The results of these indicators can reflect the organs function of patients and further guide clinical treatment. In this paper, the detection and clinical application of COVID-19 laboratory indicators are reviewed.

[Analysis of the hard and soft tissue following immediate and early implant placement in the anterior area of maxilla]

Objective: To compare the difference of soft and hard tissue changes between immediate implant and early implant placement in maxillary anterior region, so as to provide the basis for the selection of implant timing and surgical method for patients in clinical maxillary anterior dental esthetic zone. Methods: From January 2016 to January 2019, 89 patients [48 males and 41 females, aged (38.0±13.3) years] with dentition defect and single tooth implant restoration in the Department of Oral Implantology, Dalian Stomatological Hospital were retrospectively collected. The patients were divided into three groups according to different implant timing and operation methods: immediate implant flapless group (26 cases), immediate implant flap group (30 cases) and early implant group (33 cases, early implant 4-8 weeks after tooth extraction). The operation time, intraoperative and postoperative complications were compared among the three groups. Cone-beam CT was taken before operation, immediately after operation and 6 months after operation. The bone plate thickness immediately after implantation, bone plate thickness at 6 months after operation and absorption amount of bone plate thickness at labial side (immediately after operation minus 6 months after operation) were measured, and the absorption rate of labial bone plate was calculated. Three dimensional quantitative analysis was performed on the lip bone increment, residual bone volume (6 months after operation minus preoperative), and bone volume absorption rate of the three groups immediately after operation by using GuideMia, PlastyCAD and Geomagic engineering software. The pink and white esthetic indexes of the three groups were evaluated at 9 months and 15 months after implant placement. The implant stability quotient (ISQ) value was measured at 6 months after implantation, and the patients' satisfaction with the whole treatment process was investigated at 6 months after implantation. Results: The operation time of immediate implant flapless group was the shortest, the median (lower quartile, upper quartile) was 36.5 (33.3, 38.5) min. At 9 months after operation, PES was relatively high [8.5 (8.0, 9.0)], and the final patient satisfaction was 8.0 (7.3, 8.8), and the difference was statistically significant compared with the other two groups (P<0.05). There was no significant difference in the incidence of intraoperative and postoperative complications among the groups (P>0.05). At 6 months after operation, the thickness of labial bone plate in early group was 3.09 (3.00, 3.25) mm, which was greater than that in the immediate non flap group [1.90 (1.72, 2.33) mm] and that in the immediate implant flap group [2.39 (2.05, 3.06) mm], and the difference was statistically significant (P<0.05). The absorption of labial bone thickness in immediate implant flapless group [0.61 (0.35, 0.98) mm] was significantly lower than that in the immediate implant flap group [1.13 (0.97, 1.53) mm] and that in the early implant group [1.23 (1.07, 1.37) mm] (P<0.05). After 6 months, the residual bone volume of immediate flapless group was 38.7 (31.2, 54.6) mm³ and was significantly different from that in early implant group [109.1 (85.6, 263.1) mm³] (P<0.05), and there was no significant difference in the residual bone volume between immediate implant flapless group and immediate implant flap group (P>0.05). Conclusions: Immediate implant can reduce the treatment time with equal esthetic outcome of implant supported restoration of anterior teeth, and patients prefer it more. The bone volume of lip side was not significantly increased after immediate flap operation, and the bone absorption was less after immediate flap operation. Early implant placement can better maintain the three-dimensional bone mass, and the three groups can obtain good clinical results in the short term, but the long-term effect needs further follow-up study.

qFIBS: An Automated Technique for Quantitative Evaluation of Fibrosis, Inflammation, Ballooning, and Steatosis in Patients With Nonalcoholic Steatohepatitis

BACKGROUND AND AIMS

Nonalcoholic steatohepatitis (NASH) is a common cause of chronic liver disease. Clinical trials use the NASH Clinical Research Network (CRN) system for semiquantitative histological assessment of disease severity. Interobserver variability may hamper histological assessment, and diagnostic consensus is not always achieved. We evaluate a second harmonic generation/two-photon excitation fluorescence (SHG/TPEF) imaging-based tool to provide an automated quantitative assessment of histological features pertinent to NASH.

APPROACH AND RESULTS

Images were acquired by SHG/TPEF from 219 nonalcoholic fatty liver disease (NAFLD)/NASH liver biopsy samples from seven centers in Asia and Europe. These were used to develop and validate qFIBS, a computational algorithm that quantifies key histological features of NASH. qFIBS was developed based on in silico analysis of selected signature parameters for four cardinal histopathological features, that is, fibrosis (qFibrosis), inflammation (qInflammation), hepatocyte ballooning (qBallooning), and steatosis (qSteatosis), treating each as a continuous rather than categorical variable. Automated qFIBS analysis outputs showed strong correlation with each respective component of the NASH CRN scoring (P < 0.001; qFibrosis [r = 0.776], qInflammation [r = 0.557], qBallooning [r = 0.533], and qSteatosis [r = 0.802]) and high area under the receiver operating characteristic curve values (qFibrosis [0.870-0.951; 95% confidence interval {CI}, 0.787-1.000; P < 0.001], qInflammation [0.820-0.838; 95% CI, 0.726-0.933; P < 0.001), qBallooning [0.813-0.844; 95% CI, 0.708-0.957; P < 0.001], and qSteatosis [0.939-0.986; 95% CI, 0.867-1.000; P < 0.001]) and was able to distinguish differing grades/stages of histological disease. Performance of qFIBS was best when assessing degree of steatosis and fibrosis, but performed less well when distinguishing severe inflammation and higher ballooning grades.

CONCLUSIONS

qFIBS is an automated tool that accurately quantifies the critical components of NASH histological assessment. It offers a tool that could potentially aid reproducibility and standardization of liver biopsy assessments required for NASH therapeutic clinical trials.

Emperipolesis mediated by CD8+ T cells correlates with biliary epithelia cell injury in primary biliary cholangitis

Primary biliary cholangitis (PBC) is an autoimmune disease characterized by chronic destruction of the bile ducts. A major unanswered question regarding the pathogenesis of PBC is the precise mechanisms of small bile duct injury. Emperipolesis is one of cell-in-cell structures that is a potential histological hallmark associated with chronic hepatitis B. This study aimed to clarify the pathogenesis and characteristics of emperipolesis in PBC liver injury. Sixty-six PBC patients, diagnosed by liver biopsy combined with laboratory test, were divided into early-stage PBC (stages I and II, n = 39) and late-stage PBC (stages III and IV, n = 27). Emperipolesis was measured in liver sections stained with haematoxylin-eosin. The expressions of CK19, CD3, CD4, CD8, CD20, Ki67 and apoptosis of BECs were evaluated by immunohistochemistry or immunofluorescence double labelling. Emperipolesis was observed in 62.1% of patients with PBC, and BECs were predominantly host cells. The number of infiltrating CD3⁺ and CD8⁺ T cells correlated with the advancement of emperipolesis (R²  = 0.318, P < .001; R²  = 0.060, P < .05). The cell numbers of TUNEL-positive BECs and double staining for CK19 and Ki67 showed a significant positive correlation with emperipolesis degree (R²  = 0.236, P < .001; R²  = 0.267, P < .001). We conclude that emperipolesis mediated by CD8⁺ T cells appears to be relevant to apoptosis of BEC and thus may aggravate the further injury of interlobular bile ducts.

[The role and research progress of exosomes in chronic inflammatory diseases of airway]

Exosomes are nanovesicles secreted by a variety of living cells, which are involved in biological processes such as inflammation,antigen presentation,tumor invasion, and cell differentiation.They are a new mechanism of intercellular communication in the body.Airway chronic inflammatory diseases such as chronic rhinosinusitis,allergic rhinitis, chronic obstructive pulmonary disease,bronchial asthma,etc.are non-specifically involved in airway intrinsic cells,inflammatory cells and inflammatory factors under various internal and external stimuli.Heterotropic inflammatory disease.Exosomes contain a variety of protein,RNA,lipid and other signal transmission media, the are important to chronic inflammation of the airways,and chronic rhinosinusitis,nasal polyps,bronchial asthma,and chronic obstructive pulmonary disease.The occurrence and development of chronic inflammation of the airway is closely related. This article summarizes the current research progress of exosomes and discusses their role in chronic inflammatory diseases of the airways.

Long non-coding RNA PICART1 suppresses proliferation and promotes apoptosis in lung cancer cells by inhibiting JAK2/STAT3 signaling

Lung cancer remains the most common cause of tumor-related death worldwide. Recent studies have revealed that long non-coding RNAs (lncRNAs) are involved in the development of various cancers, including lung cancer. This study aimed to investigate the effect and the molecular basis of lncRNA PICART1 on lung cancer. We first assessed the PICART1 expression in lung cancer in vitro and vivo by qRT-PCR. Then the expression of PICART1 in SPC-A-1 and NCI-H1975 cell lines was inhibited and overexpressed by transient transfections. Thereafter, cell viability, cell cycle, migration and apoptosis were respectively measured by MTT, Transwell and flow cytometry assay. Furthermore, qRT-PCR and western blot analysis were mainly performed to assess the expression levels of apoptosis- and migration-related proteins and JAK2/STAT3 pathway proteins. Tumor formation was measured by xenograft tumor model assay in vivo. PICART1 expression was down-regulated in human lung cancer tissues and cell lines. Knockdown of PICART1 increased cell viability of lung cancer cell lines. However, PICART1 overexpression inhibited cell cycle progression and promoted apoptosis in SPC-A-1 and NCI-H1975 cell lines. PICART1 overexpression also inhibited migration, as evidenced by up-regulation of E-cadherin, and down-regulation of Twist1, MMP2 and MMP9. Furthermore, we found PICART1 inhibition may regulate cell apoptosis and migration through activating JAK2/STAT3 pathway. In vivo experiments revealed that PICART1 knockdown significantly promoted tumor formation. This study demonstrates that PICART1 overexpression represents an anti-growth and anti-metastasis role in lung cancer cells. Additionally, PICART1 acts as a tumor suppressor may be via regulation of JAK2/STAT3 pathway.

Temperature-dependent optical constants of highly transparent solids determined by the combined double optical pathlength transmission-ellipsometry method

The optical constants of five highly transparent substrates (polycrystalline BaF₂, CaF₂, MgF₂, ZnSe, and ZnS) were experimentally determined based on a combined technique using both the double optical pathlength transmission method and the ellipsometry method within temperature range 20°C-350°C in the ultraviolet-infrared region (0.2-20 μm). The results show that the refractive index spectra of polycrystalline BaF₂, CaF₂, and MgF₂ are similar, but differ from that of polycrystalline ZnSe and ZnS. The thermo-optic coefficient of these highly transparent substrates increases with increasing temperature. The absorption indices show a significant temperature-dependent behavior, which increases with increasing temperature from 20°C to 350°C over the transparent region. For the sake of application, the fitted formulas of the refractive index of the five highly transparent substrates as a function of wavelength and temperature are presented.

[The potential use of serum HBV RNA to guide the functional cure of chronic hepatitis B]

Hepatitis B virus (HBV) covalently closed circular DNA (cccDNA) in infected hepatocytes is the main cause of off-therapy viral rebound. The half-life of cccDNA is only 33-50 days, so the conversion of newly synthesized rcDNA to cccDNA in the nucleus is essential for the maintenance of cccDNA pool in infected hepatocytes. Though not directly targeting the existing cccDNA, current nucleos(t)ide analogues (NAs) may exhaust the cccDNA reservoir by blocking the rcDNA formation. Indeed, a prolonged consolidation therapy post loss of serum HBV DNA can achieve sustained remission and thus safe drug discontinuation in a small proportion of chronic hepatitis B (CHB) patients. In recent studies, we and others have demonstrated that it is the serum HBV RNA that reflects the cccDNA activity in infected hepatocytes, particularly among the patients on NAs. Here we suggest that instead of measuring serum HBV DNA only, simultaneous measurement of both viral DNA and RNA would improve the accuracy to reflect the cccDNA activity; therefore, the virological response should be redefined as consistent loss (less than the lower limit of detection) of both serum HBV DNA and RNA, which indicates the safety of drug discontinuation. Accumulating evidence has suggested that for the CHB patients with lower serum HBsAg, switch-to or add-on pegylated interferon (Peg-IFN) treatment would result in loss of serum HBsAg in a relatively large proportion of CHB patients. Since serum HBV RNA is an ideal biomarker to reflect the intrahepatic cccDNA activity, for the patients with a serum HBsAg level lower than 1 500 IU/ml after long-term NAs treatment, the serum HBV RNA should be measured. If serum HBV RNA is detected, peg-IFN should be added on; if serum HBV RNA is not detected, NAs treatment should be switched to peg-IFN treatment. We believe the therapy based on serum HBV RNA would make the functional cure of CHB (serum HBsAg loss or even conversion to anti-HBs) more efficient.

[Systematic review of feasibility, safety and efficacy of ex situ liver resection and autotransplantation]

OBJECTIVE

To evaluate the feasibility, safety and efficiency of ex situ liver resection (ESLR)technique in patients with hepatocaval region involvement.

METHODS

A systematic research of the data bases CNKI, Wan Fang, CQVIP, PubMed, CENTRAL, Medline, Embase, Cochrane, International Clinical Transplantation Registration Platform and Transplant Library was performed. All the current data regarding the feasibility, safety, and oncological efficiency of ESLR was systematically reviewed. Feasibility, conversion to allo-transplantation rate, complication and 90-day mortality were analyzed.

RESULTS

A literature search revealed a total of 46 publications with 191 patients who underwent ex situ liver resection (101 autotransplantation, 90 ante-situm liver resection). The most common indication was hepatocellular carcinoma (49), followed by colorectal liver metastasis (37), hepatic alveolar echinococcosis (33) and cholangiocarcinoma (26). The feasibility rate was 84.5% (CI=76.6%-90.1%), the conversion to allo-transplantation rate was 13.5% (CI=8.5%-21.0%). Overall complication rate was 58.1% (CI=48.5%-67.1%), and complications grade Ⅲa or higher occurred in 43.1% (CI=33.6%-53.1%).90-day mortality was 19.5% (CI=12.7%-28.8%).

CONCLUSION

ESLR and autotransplantation technique is an effective surgical approach for hepatic tumor with hepatocaval region involvement. Strict control of surgical indications, preoperative evaluation and precise surgical technique is essential to success.

[The clinical practice of improvement the "Volume and Quality" of functional liver in autologous liver transplantation for the patients with alveolar echinococcosis]

Objective: To investigate the clinical significance of accurate assessment of "volume and quality" of functional liver in Autologous liver transplantation (ALT) in the treatment of the advanced hepatic alveolar echinococcosis (HAE). Methods: The clinical data of 12 patients with advanced HAE who underwent ALT at the First Affiliated Hospital of Xinjiang Medical University from May 2015 to July 2016 were retrospectively analyzed. Results: The preoperative hepatic functions of 12 patients were 8 Child-Pugh Grade A, 1 Grade B, and 3 Grade C. Three of the patients had moderate or severe jaundice. Three of the patients calculated functional liver graft volume (GV) and standard liver volume (SLV) ratio (GV/SLV) were <30%. After the protection of liver function, anti-infection, percutaneous transhepatic cholangiography drainage (PTCD), selective portal vein embolization (PVE), and staging liver resection, liver function Child-Pugh grade of 11 patients was raised to A grade, and the other patient was B grade, meanwhile the bilirubin was reduced to 2 times the normal value. The GV/SLV ratios of 3 patients with low GV/SLV ratio had reached 44.4%, 47.2% and 56.2% respectively. In this study, the GV/SLV ratios of the 12 patients were between 73.2% and 40.8% with an average of 55.6%. Operation time was 11.5-20.5 h, with an average of 12.3 h. Anhepatic phase time was 193-375 min with median 253.5 min. The red blood cell suspension was 0-6 U during the operation. The average hospitalization was 10-42 d, with the average 22.7 d. Total hospital costs were 121 600-434 800 Yuan, with the median cost of 174 400 Yuan. One patient died of septic shock a week after surgery. Conclusion: (1)ALT may provide feasibility for the advanced HAE. (2)Accurate assessment of functional liver "volume and quality" appeared as the key points to the ALT. (3)Precise surgery and individualized treatment could improve and protect the functional liver "volume and quality" .

Improved transmission method for measuring the optical extinction coefficient of micro/nano particle suspensions

Extinction coefficients are fundamental for analyzing radiative transport in micro/nano particle suspensions. In the traditional transmission method for measuring the extinction coefficient of particles in a cuvette, a reference system is used to compensate for the influence of the cuvette and base fluid. However, the multiple reflections and refractions between the air-glass and liquid-glass interfaces cannot be sufficiently eliminated by using the reference system, and the induced measurement error increases significantly with increasing difference in refractive index between the two neighboring media at these interfaces. In this paper, an improved transmission method is proposed to measure the extinction coefficient of micro/nano particles. The extinction coefficient of the particles is determined based on an optical model, taking into account the multiple reflection and refraction at the glass-liquid interfaces. An experimental validation was conducted for suspensions with various mean particle sizes. By considering the higher-order transmission terms, the improved transmission method generally achieved high-accuracy improvement over the traditional transmission method for extinction coefficient measurement, especially for the case with a small optical thickness of particle suspensions. This work provides an alternative and more accurate way for measuring the extinction characteristics of micro/nano particle suspensions.

[Clinicopathological features of early- and late-stage primary biliary cirrhosis: a comparative study]

OBJECTIVE

To investigate the clinicopathological features of different stages of primary biliary cirrhosis (PBC), and to provide a basis of evidence-based medicine for early identification and effective treatment of this disease.

METHODS

A total of 130 patients with pathologically confirmed PBC and complete clinical data were enrolled and divided into early-stage group and late-stage group based on pathological results. A retrospective analysis was performed for patients' general information, clinical manifestations, laboratory examinations, and pathological changes.

RESULTS

The PBC patients had a mean age of 43.5±7.1 years, with middle-aged female patients accounting for 89%. The most common symptom was fatigue, followed by jaundice, pruritus, and abdominal distension in the late stage. Of all patients, 11.5% were complicated by autoimmune disease. The level of aminotransferases tended to decrease with the progression of PBC and showed no significant differences between the two groups (P > 0.05). Most patients showed an increase in serum bilirubin, mainly direct bilirubin; serum total bilirubin and direct bilirubin tended to increase with disease progression and showed significant differences between the two groups (P < 0.01). The patients showed increases in the serum levels of alkaline phosphatase (ALP) andγ-glutamyl transpeptidase (GGT), but with the disease progression, the serum level of ALP increased and that of GGT decreased; the serum levels of ALP and GGT showed no significant differences between the early- and late-stage groups (P > 0.05). The positive rate of antimitochondrial antibody was 85%. The histopathological changes of PBC included severe lesions in the portal area and surrounding areas and slight lobular lesions. In the early stage, there were injuries of the interlobar bile ducts, proliferation of small bile ducts, aggregation and invasion of mononuclear cells in surrounding tissues, and the formation of lymphoid follicle-like structure; in the late stage, there were fibrotic expansion of the portal area, formation of fibrous septa and pseudolobuli, and even liver cirrhosis.

CONCLUSION

PBC is commonly seen in middle-aged women and has an insidious onset. Early- and late-stage PBC have their own clinicopathological features. As for patients with no characteristic changes in serological test, liver biopsy should be performed to give a confirmed diagnosis and avoid missed diagnosis and misdiagnosis.

Mechanism of BMP and TG2 in mesenchymal stem cell osteogenesis

OBJECTIVE

To study the interactive effects of Type II glutamine transaminase (TG2) and bone morphogenetic protein-9 (BMP-9) in the induction of osteogenesis in mice mesenchymal stem cells (MSCs) C3H10T1/2 model.

MATERIALS AND METHODS

Batches of MSCs C3H10T1/2, divided into two groups, were treated with BMP-9 (control group) or BMP-9 and TG2 (experimental group) under oxygen deficient conditions. The secreted alkaline phosphatase (SEAP) chemiluminescence and the histochemical staining methods were used to detect the alkaline phosphatase (ALP) expression. The alizarin red S staining was used to detect the calcium salt precipitation and the caspase-3 protein expression was monitored using Western blot. Flow cytometry was employed to identify cell cycle, and trypan blue exclusion method to count the living cells and monitor cell proliferation.

RESULTS

The levels of ALP expression in the experimental group were much higher than that of the control group. The level of expression of advanced caspase-3 protein was significantly lower (p < 0.05) in the experimental group than in the control group. The highest fraction of cells in the experimental group was in the phase M while cells in the control group were in the interphase. Moreover, cell number in the experimental group was significantly increased (p < 0.05) relatively to the control group.

CONCLUSIONS

BMP-9 interacts with TG2 in osteogenesis of MSCs C3H10T1/2 cells. Further studies are needed to understand the exact mechanism of BMP9/PG2 interactions in osteogenesis.

miR-71b regulation of insulin/IGF-1 signaling during starvation in planarians

Planarians, which have a large population of stem cells called neoblasts, are molecularly tractable model systems used in the study of regeneration. However, planarians have strong resistance to hunger and have developed growth arrest strategies. For example, they can change their size and undergo growth regression during starvation periods. The results of the current study show that the microRNA, miR-71b, and the insulin/IGF-1 signaling pathway have important functions in the development of starvation-induced planarians. We demonstrate tissue-specific expression of miR-71b using in situ hybridization. By employing real-time polymerase chain reaction, we provide evidence that miR-71b is upregulated in starvation-induced planarians. Furthermore, we validate and verify the target genes of miR-71b.

P1BS, a conserved motif involved in tolerance to phosphate starvation in soybean

Available phosphate (Pi) is a major limiting factor for plant growth, development, and productivity. Phosphate starvation response 1 (PHR1) is a binding dimer that binds to an imperfect palindromic sequence. PHR1-binding sequences (GnATATnC) exist in the promoter of Pi starvation-responsive structural genes, indicating an effect occurring downstream in the Pi starvation signaling pathway. These sequences are referred to as PHR1-binding site (P1BS) structures. In this study, the sequences of GmPHR1 and GmSPX1 from Glycine max (L.) Merr. soybean were determined and analyzed. We found that GmPHR1 is an MYB-related transcription factor. In addition, GmSPX1 contained a P1BS structure, which is an important cis-regulatory motif in the phosphate signaling pathway. We found that GmPHR1 can physically interact with GmSPX1 through the cis-element, which may be a major pathway for the GmPHR1-mediated Pi starvation stress response. Thus, the P1BS structure in the Pi starvation signaling pathway is an important cis-regulatory motif that improves the tolerance to low phosphorus conditions in soybean.

Biomimetic Deposition of Hydroxyapatite by Mixed Acid Treatment of Titanium Surfaces

A simple chemical method was established for inducing bioactivity of Ti metal. In the present study, two kinds of mixed acid solutions were used to treat Ti specimens to induce Ca-P formation. Following a strong mixed acid activation process, Ca-P coatings successfully formed on the Ti surfaces in the simulated body fluid. Strong mixed acid etching was used to increase the roughness of the metal surface, because the porous and rough surfaces allow better adhesion between Ca-P coatings and substrate. Nano-scale modification of titanium surfaces can alter cellular and tissue responses, which may benefit osseointegration and dental implant therapy. Some specimens were treated with a 5 M NaOH aqueous solution, and then heat treated at 600 °C in order to form an amorphous sodium titanate layer on their surface. This treated titanium metal is believed to form a dense and uniform bone-like apatite layer on its surface in a simulated body fluid (SBF). This study proved that mixed acid treatment is not only important for surface passivation but is also another bioactive treatment for titanium surfaces, an alternative to alkali treatment. In addition, mixed acid treatment uses a lower temperature and shorter time period than alkali treatment.

Serum soluble CD40 is associated with liver injury in patients with chronic hepatitis B

Soluble cluster of differentiation 40 (sCD40) is proteolytically cleaved from membrane-bound CD40 and binds to CD154, thereby inhibiting CD40-CD154-mediated immune responses. The aim of the present study was to clarify the role of sCD40 in chronic hepatitis B (CHB). The sCD40 levels in sera from 132 patients with CHB and 33 healthy individuals were retrospectively measured. sCD40 concentrations in patients with CHB were higher than those in healthy controls, and sCD40 levels correlated positively with serum levels of the liver dysfunction biomarkers alanine transaminase (ALT) and aspartate transaminase (AST). sCD40 concentrations increased with a rise in the severity of liver necroinflammation and fibrosis. Patients with >75% liver tissue staining positive for hepatitis B virus (HBV) antigen expression showed significantly lower sCD40 levels than those who stained negative for the HBV antigen. The area under the receiver operating characteristic curve of sCD40 was greater than that of ALT and AST; thus, sCD40 levels have a high diagnostic accuracy for detecting severe liver inflammation in patients with CHB, and could serve as an immunological marker of hepatic tissue injury.

The Ebola epidemic is ongoing in West Africa and responses from China are positive

The ongoing Ebola outbreak poses an alarming risk to the countries of West Africa and beyond. On August 8, 2014, the World Health Organization (WHO) declared the cross-country Ebola outbreak a Public Emergency of International Concern. China has had no confirmed cases of Ebola. In this paper, virologic characteristics, pathogenesis, clinical manifestations, laboratory examination and prophylactic vaccines and therapeutic drugs of Ebola are summarized. Importantly, active responses and actions from China are introduced. Moreover, the key issues in the future prevention and control of Ebola were also addressed.

Evaluation of the bonding strength of dental zirconia with veneering porcelains

The effect of thermo-cycling treatment on the bond strength and flexural strength of porcelain veneered zirconia was evaluated. After thermo-cycling treatment between 5 degrees C to 55 degrees C, porcelain-zirconia bond strength and zirconia flexural strength was not significantly affected. In the phase analyses using XRD after thermo-cycling treatment, both the experimental group and the control group showed only tetragonal phases. That is, the porcelain-zirconia bond strength and zirconia flexural strength were not affected by low temperature degradation. So low temperature aging treatment did not reduce the flexural strength and the effect of temperature applied to the aging treatment could beignorable.

Digestibility and retention of zinc, copper, manganese, iron, calcium, and phosphorus in pigs fed diets containing inorganic or organic minerals

The objective of this experiment was to measure the apparent total tract digestibility (ATTD) and the retention rate of Zn, Cu, Mn, and Fe in pigs fed either inorganic or organic sources of Zn, Cu, Mn, and Fe. The experimental design was a randomized complete block design with a 2 × 3 factorial arrangement of treatments. There were 2 types of diets (corn grits-based or corn-soybean meal [SBM]-based diets) and 3 micromineral treatments (basal micromineral premix [BMM], inorganic micromineral premix [IMM], and organic micromineral premix [OMM]). The BMM contained no added Zn, Cu, Mn, or Fe; the IMM microminerals were provided as sulfates of Zn, Cu, Mn, and Fe at 40, 50, 20, and 100 mg/kg, respectively. The OMM contained the same levels of the 4 microminerals as IMM, but Zn, Cu, Mn, and Fe in this premix were provided by Zn(2-hydroxy-4-methylthio butanoic acid [HMTBa])2, Cu(HMTBa)2, Mn(HMTBa)2, and FeGly, respectively. Forty-eight barrows (initial BW: 31.1 ± 4.2 kg) were housed individually and allowed ad libitum access to the corn grits diet with BMM for 2 wk. All pigs were then moved to metabolism cages and randomly assigned to 1 of the 6 treatment diets with 8 replicates per diet. Fecal and urine samples were collected for 5 d following a 5-d adaptation period. Compared with corn grits diets, pigs fed corn-SBM diets had greater (P < 0.05) absorption and retention of Zn, Cu, and Mn but less (P < 0.05) ATTD of Zn and Cu. Compared with BMM, supplementation of IMM or OMM increased (P < 0.05) absorption, retention, ATTD, and retention rate of Zn, Cu, Mn, and Fe. Compared with IMM, adding OMM to the corn-SBM diet improved (P < 0.05) the absorption and retention of Cu and Mn and the ATTD of Cu, but these differences were not observed in the corn grits diets (interaction, P < 0.05). In addition, adding OMM to the corn-SBM diet increased (P < 0.05) absorption and retention of Zn and Fe and ATTD of Zn, Mn, and Fe compared with adding IMM to the corn-SBM diet. Supplementation of OMM also increased (P < 0.05) the ATTD and retention rate of P in corn-SBM diets. Results indicate that Zn(HMTBa)2 has greater digestibility and Cu(HMTBa)2 and Mn(HMTBa)2 have greater digestibility and retention rates compared with their inorganic sulfates, if included in a corn-SBM diet. Supplementation of organic microminerals also improves the digestibility of P in a corn-SBM diet.

Effect of JJYMD-C, a novel synthetic derivative of gallic acid, on proliferation and phenotype maintenance in rabbit articular chondrocytes in vitro

Tissue engineering encapsulated cells such as chondrocytes in the carrier matrix have been widely used to repair cartilage defects. However, chondrocyte phenotype is easily lost when chondrocytes are expanded in vitro by a process defined as “dedifferentiation”. To ensure successful therapy, an effective pro-chondrogenic agent is necessary to overcome the obstacle of limited cell numbers in the restoration process, and dedifferentiation is a prerequisite. Gallic acid (GA) has been used in the treatment of arthritis, but its biocompatibility is inferior to that of other compounds. In this study, we modified GA by incorporating sulfamonomethoxine sodium and synthesized a sulfonamido-based gallate, JJYMD-C, and evaluated its effect on chondrocyte metabolism. Our results showed that JJYMD-C could effectively increase the levels of the collagen II, Sox9, and aggrecan genes, promote chondrocyte growth, and enhance secretion and synthesis of cartilage extracellular matrix. On the other hand, expression of the collagen I gene was effectively down-regulated, demonstrating inhibition of chondrocyte dedifferentiation by JJYMD-C. Hypertrophy, as a characteristic of chondrocyte ossification, was undetectable in the JJYMD-C groups. We used JJYMD-C at doses of 0.125, 0.25, and 0.5 µg/mL, and the strongest response was observed with 0.25 µg/mL. This study provides a basis for further studies on a novel agent in the treatment of articular cartilage defects.

Clinical-pathological analysis of hepatitis B virus recurrence after liver transplantation in Chinese patients

BACKGROUND AND AIM

Liver transplantation (LT) for hepatitis B virus (HBV)-related disease can be complicated by HBV recurrence. The aim of this study was to evaluate the risk factors, prophylaxis treatment, and histological characteristics of HBV recurrence after LT when using long-term, low-dose hepatitis B immunoglobulin (HBIG) plus nucleoside analog (lamivudine [LAM] or entecavir [ETV]).

METHODS

Retrospective data from 253 adult LT patients using long-term, low-dose HBIG plus nucleoside analog after LT, for a mean treatment duration of 1-72 months, were collected from a single center in Beijing, China. Univariate analyses were conducted to determine the association among gender, age, hepatocellular carcinoma, hepatitis B e antigen-positive status, HBV-DNA level and tyrosine-methionine-aspartate-aspartate (YMDD) mutations on HBV recurrence in these patients.

RESULTS

Overall, the HBV recurrence rate was 6.32% (16/253). There was no significant difference in the survival rate between the HBV recurrence and non-recurrence groups. Risk factors for HBV recurrence were: hepatitis B e antigen positivity, HBV-DNA > 10(5) copies/mL, hepatocellular carcinoma, and YMDD mutation. Sixteen patients receiving LAM had HBV recurrence (16/169; mean treatment duration: 61.8 ± 18.3 months). No HBV recurrence occurred in patients receiving ETV after LT (0/84; mean treatment duration: 57.1 ± 15.9 months). Differences in rate of mortality and HBV recurrence were not significant between the two groups.

CONCLUSIONS

LT is an effective treatment for HBV-related end-stage liver disease. The combination of ETV and intramuscular HBIG for HBV recurrence prophylaxis after LT was more effective than LAM, especially in Chinese patients with HBV recurrence risk factors.

Cloning and expression analysis of a stress-induced GmIMT1 gene in soybean (Glycine max)

Here, we aimed to clone and identify the GmIMT1 gene related to the salt stress response in soybean. The full-length cDNA sequence of the GmIMT1 gene was amplified in soybean using degenerate primers of Mesembrythmum crystallium. To understand the stress response, the GmIMT1 gene was cloned and sequenced. Then, the expression vectors of the gene were constructed, and introduced into the model plant Arabidopsis thaliana through Agrobacterium mediated transformation, and the salt tolerance was analyzed in the transgenic plants. In addition, the expression patterns of GmIMT1 gene in soybean were analyzed. The expression was examined in different organs (roots, leaves, flower seeds, and stem) and under different stress conditions (drought, high salt, low temperature, salicylic acid, ethane, abscisic acid, and methyl jasmonate) by real-time fluorescent quantitative polymerase chain reaction analysis. The results showed that the root, leaves, and stems exhibited high level of GmIMT1 gene expression, whereas there was no expression in the seeds. In addition, the GmIMT1 gene expression was upregulated under all stress conditions. Overall, the results clearly indicate that GmIMT1 might be involved in multiple plant response pathways to the different environmental conditions. Furthermore transgenic plants exhibited higher salt-tolerance compared to wild type plants.

Posterior cruciate substituting versus posterior cruciate retaining total knee arthroplasty prostheses: a meta-analysis

PURPOSE

The arguments about whether posterior-substituting prostheses or cruciate-retaining prostheses are superior to the other after total knee arthroplasty never stop. This meta-analysis was conducted to evaluate the clinical effects of these two different designs.

METHODS

The study was performed according to the guidelines described in the Cochrane handbook for systematic reviews of interventions. Methodological features were collected and extracted by two reviewers independently.

RESULTS

Nine randomized controlled trials with 1261 knees were eligible for pooled analysis. The meta-analysis demonstrated there were no statistical differences in the Knee Society Score, Hospital for Special Surgery, Western Ontario and McMaster Universities index, tibial component alignment, femoral component alignment, tibial posterior slope, joint line, and incidence of complications with short-to medium-term follow-up (p>0.01). Statistically difference in postoperative range of motion (WMD: 4.34°, 95% CI: 3.18° to 5.50°) in favor of PS prostheses was found between groups (p<0.01).

CONCLUSION

The findings indicate there were no significant statistical differences in knee scores, radiological outcomes, and complications between the two types of implants. Statistically significant difference in postoperative ROM was found between the two groups, but no clinical difference.

dl-Methyl 4-(4-meth-oxy-phen-yl)-2,7,7-trimethyl-5-oxo-1,4,5,6,7,8-hexa-hydro-quinoline-3-carboxyl-ate

In the title compound, C₂₁H₂₅NO₄, the dihydropyridine ring adopts a flattened boat conformation. The N atom and the sp³ C atom deviate in the same direction from the mean plane of the other four C atoms, by 0.269 (6) and 0.111 (6) Å, respectively. This mean plane is inclined to the 4-methoxy­phenyl ring by 87.3 (5)°. The cyclohexenone ring has a sofa conformation with the C atom bearing the methyl groups deviating from the mean plane through the other five C atoms by 0.628 (6) Å. There is a short C—H⋯O hydrogen bond in the molecule. In the crystal, molecules are linked by an N—H⋯O hydrogen bond to form chains propagating along the c-axis direction.

Dimethyl 4-(4-hydroxyphenyl)-2,6-dimethyl-1,4-dihydropyridine-3,5-dicarboxylate

The title mol­ecule, C₁₇H₁₉NO₅, was prepared by a Hantzsch dihydro­pyridine synthesis from 4-hy­droxy­benzaldehyde, methyl acetoacetate and NH₄HCO₃. In the mol­ecular structure of the title compound, the dihydro­pyridine ring adopts a flattened boat conformation and the plane of the base of the boat forms a dihedral angle of 80.8 (2)° with the aromatic six-membered ring. The packing is stabilized by strong inter­molecular N—H⋯O_carbon­yl, O_hydrox­y—H⋯O_carbon­yl and weak intra­molecular C—H⋯O hydrogen bonds.

1-[3-Meth-oxy-4-(prop-2-yn-1-yl-oxy)phen-yl]ethanone

In the title compound, C(12)H(12)O(3), the meth-oxy and prop-2-yn-yloxy groups are nearly coplanar with the attached benzene ring [C-O-C-C torsion angles = 1.2 (3) and 2.2 (3)°, respectively]. In the crystal, inversion dimers linked by pairs of C-H⋯O inter-actions occur.

Antioxidants vitamin E and 1-aminobenzotriazole prevent experimental non-alcoholic steatohepatitis in mice

OBJECTIVE

Hepatic oxidative stress plays a key role in the development of non-alcoholic steatohepatitis (NASH). However, the protective effects of antioxidants on NASH are largely unknown. The aim of this study was to elucidate the effect and mechanism of antioxidants on NASH in mice.

MATERIAL AND METHODS

C57BL6/J mice were fed a methionine-choline-deficient (MCD) diet for 10 days or 3 weeks to induce steatohepatitis. Antioxidants (vitamin E, ABT, or vitamin E plus ABT) were supplemented in mice fed a MCD diet, respectively. The effect of antioxidants on oxidative stress and apoptosis was assessed, and activation of adiponectin and expressions of inflammatory factors, apoptosis-related genes, and fibrosis-related genes were assayed.

RESULTS

MCD feeding in mice showed increasing serum alanine aminotransferase (ALAT) and aspartate aminotransferase (ASAT) levels, and progressive hepatic injury including hepatic steatosis and inflammatory infiltration. Administration of antioxidants vitamin E and/or ABT significantly lowered serum ALAT and ASAT levels (p<0.001) and ameliorated hepatic steatosis and necroinflammation. These effects were associated with repressed hepatic lipid peroxides through reducing hepatic MDA content and enhancing hepatic superoxide dismutase (SOD) activity; down-regulated inflammatory factor COX-2, lowered activity of NF-kappaB, up-regulated anti-apoptotic gene Bcl-2, and down-regulated pro-apoptotic gene Bax suppressed expression of the fibrotic genes TGF-beta1 and MMP2. Moreover, expression of the anti-inflammatory factor adiponectin was also induced by vitamin E or ABT. A combination of vitamin E and ABT showed an additive effect on preventing liver injury.

CONCLUSIONS

The present study provides morphological and molecular biological evidence for the protective role of the antioxidant vitamins E and ABT in ameliorating oxidative stress, hepatic apoptosis, and necroinflammation in experimental nutritional steatohepatitis.

Compartmentalization and its implication for peripheral immunologically-competent cells to the liver in patients with HBV-related acute-on-chronic liver failure

AIMS

This study attempts to characterize the feature of immunologically competent cells (ICCs) and evaluate its clinical implication in patients with acute-on-chronic liver failure (ACLF) in relation to chronic hepatitis B virus (HBV) infection.

METHODS

Circulating ICCs were examined in ACLF patients (n = 75), as well as in patients with hepatitis B (CHB, n = 31), CHB-related liver cirrhosis (LC, n = 36), and normal controls (NC, n = 30). Intrahepatic ICCs in some patients were further analyzed via immunohistochemical and flow cytometric assays.

RESULTS

Total lymphocytes, CD4(+) T cells, CD8(+) T cells, and NK cells in circulation were numerically lower in the ACLF and LC groups compared to the CHB and NC groups. Importantly, the number of these cells was significantly lower in non-surviving ACLF patients compared with surviving ACLF patients. In comparison to NC, ACLF patients displayed a significantly higher ratio of liver-infiltrating CD4(+) T-cell frequency than its circulating counterpart, suggesting that the possiblility of the ICCs compartmentalization from the peripheral blood into the liver in ACLF. Immunohistochemical analysis showed that intrahepatic CD4(+) cells, CD8(+) cells, and CD56(+) cells were significantly higher in the ACLF group compared with the other three groups, suggesting a stronger cellular immune response-mediated inflammation in ACLF group than other patient groups.

CONCLUSIONS

The abnormal prevalence of circulating and intrahepatic ICCs possibly acts as an important factor that may drive the progression of HBV-related ACLF.

[Frequency, distribution of CD4+, CD8+ T cells and expression of CD38 in gastric mucosa of HIV infections]

OBJECTIVE

To investigate the frequencies and distribution of CD4+ T cells and CD8+ T cells as well as the changes of immune activation in gastric mucosa of HIV-infected individuals.

METHODS

42 HIV-infected individuals were recruited into this investigation, and 36 patients had definite diagnosis of clinical stage. Biopsy of gastric mucosal tissues was performed by fiberoptic gastroscope including 10 normal people as a control group. Then, immunohistochemistry was used to detect expression of CD4, CD8 and CD38 in gastric mucosa, and the distinctions among three groups were analyzed with LEICA Qwin image analysis system.

RESULTS

(1) Compared with asymptomatic HIV carriers and control group, CD4 T cells remarkably decreased in the gastric mucosa of AIDS patients (P < 0.01). In gastric mucosa of asymptomatic HIV carriers, there were still some CD4+ T cells in lymphoid follicles and stroma where CD4+ T cells were unevenly distributed, the frequency of CD4+ T cells was not significantly different between asymptomatic HIV carriers and control group (P > 0.05); (2) Phenomenon of CD8+ T cells infiltrating mucosal epithelium and gland was general in HIV-infected individuals. CD8+ T cells took on local excessive hyperplasia in gastric mucosa of some individuals. As compared with control group, CD8+ T cells markedly increased in gastric mucosa of infected individuals (P < 0.01), but the distinction of asymptomatic HIV carriers and AIDS patients was not significant (P > 0.05); (3) CD38-expressing cells mainly distributed over gastric mucosal surface to superficial layer(1/3-2/3 layer) of HIV-infected individuals, and was more intensive than control group (P < or = 0.01), but there was not noticeable difference between asymptomatic HIV carriers and AIDS patients (P > 0.05).

CONCLUSION

The frequencies and distribution of gastric mucosal CD4+ T cells of HIV-infected individuals were closely correlated with progression of disease. Disfunction of mucosal immune system which was resulted from HIV infection and injury of CD4+ T cells could be an important cause of CD8+ T cells increasing and CD38-expressing enhancement.

Rosiglitazone prevents nutritional fibrosis and steatohepatitis in mice

OBJECTIVE

Currently, no agent has been confirmed as preventing the fibrosing progression of non-alcoholic steatohepatitis (NASH). In this study, rosiglitazone was used in the clinical treatment of insulin resistance in patients with type 2 diabetes mellitus. However, its protective effect on non-alcoholic fibrosing steatohepatitis is not clear. The study aimed to elucidate the effect and the mechanism of rosiglitazone in inhibiting nutrition-related fibrosis in mice.

METHODS

C57BL6/J mice were fed a high fat, methionine-choline deficient (MCD) diet for 8 weeks to induce hepatic fibrosis, and rosiglitazone was given in the treated group. The effect of rosiglitazone was assessed by comparing the severity of hepatic fibrosis in liver sections, the activation of hepatic stellate cells (HSCs) and the expression of TGF-beta1 and connective tissue growth factor (CTGF).

RESULTS

At week 8, MCD-diet-induced fibrosing NASH models showed increased serum ALT and AST levels, severe hepatic steatosis, and infiltration of inflammation and fibrosis which, associated with down-regulated PPAR gamma mRNA and protein expression, up-regulated alpha-SMA protein expression and enhanced TGF-beta1, CTGF mRNA and protein expression. Rosiglitazone significantly lowered serum ALT and AST and it reduced MCD-induced fibrosis by repressing levels of alpha-SMA protein expression and pro-fibrosis factors TGF-beta1 and CTGF. It also restored expression of PPAR gamma.

CONCLUSIONS

The present study provides clear morphological and molecular biological evidence of the protective role of rosiglitazone in ameliorating nutritional fibrosing steatohepatitis. Rosiglitazone may ameliorate hepatic fibrosis by activating PPAR gamma, which can inhibit HSC activation and suppress TGF-beta1 and CTGF expression.