[Investigate of the etiology and prevention status of liver cirrhosis]

Objective: To investigate the etiology, prevention and treatment status, and their corresponding regional differences of the patients with liver cirrhosis in China, in order to provide scientific basis for the development of diagnosis and control strategies in China. Methods: Clinical data of patients diagnosed with liver cirrhosis for the first time through January 1, 2018 to December 31, 2020 from 50 hospitals in seven different regions of China were collected and analyzed retrospectively, and the difference of etiology, treatment, and their differences in various regions were analyzed. Results: A total of 11 861 cases with liver cirrhosis were included in the study. Thereinto, 5 093 cases (42.94%) were diagnosed as compensated cirrhosis, and 6 768 cases (57.06%) had decompensated cirrhosis. Notably, 8 439 cases (71.15%) were determined as chronic hepatitis B-caused cirrhosis, 1 337 cases (11.27%) were alcoholic liver disease, 963 cases (8.12%) were chronic hepatitis C, 698 cases (5.88%) were autoimmune liver disease, 367 cases (3.09%) were schistosomiasis, 177 cases (1.49%) were nonalcoholic fatty liver, and 743 cases (6.26%) of other types of liver disease. There were significant differences in the incidence of chronic hepatitis B, chronic hepatitis C, alcoholic liver disease, fatty liver, schistosomiasis liver disease, and autoimmune liver disease among the seven regions (P<0.001). Only 1 139 cases (9.60%) underwent endoscopic therapy, thereinto, 718 cases (6.05%) underwent surgical therapy, and 456 cases (3.84%) underwent interventional therapy treatment. In patients with compensated liver cirrhosis, 60 cases (0.51%) underwent non-selective β receptor blockers(NSBB), including 59 cases (0.50%) underwent propranolol and 1 case (0.01%) underwent carvedilol treatment. In patients with decompensated liver cirrhosis, 310 cases (2.61%) underwent NSBB treatment, including 303 cases (2.55%) underwent propranolol treatment and 7 cases (0.06%) underwent carvedilol treatment. Interestingly, there were significant differences in receiving endoscopic therapy, interventional therapy, NSBB therapy, splenectomy and other surgical treatments among the seven regions (P<0.001). Conclusion: Currently, chronic hepatitis B is the main cause (71.15%) of liver cirrhosis in several regions of China, and alcoholic liver disease has become the second cause (11.27%) of liver cirrhosis in China. The three-level prevention and control of cirrhosis in China should be further strengthened.

MiR-183-5p-PNPT1 Axis Enhances Cisplatin-induced Apoptosis in Bladder Cancer Cells

OBJECTIVE

It has been reported that intrinsic apoptosis is associated with the progression of bladder cancer (BC). Recent evidence suggests that polyribonucleotide nucleotidyltransferase 1 (PNPT1) is a pivotal mediator involved in RNA decay and cell apoptosis. However, the regulation and roles of PNPT1 in bladder cancer remain largely unclear.

METHODS

The upstream miRNA regulators were predicted by in silico analysis. The expression levels of PNPT1 were evaluated by real-time PCR, Western blotting, and immunohistochemistry (IHC), while miR-183-5p levels were evaluated by qPCR in BC cell lines and tissues. In vitro and in vivo assays were performed to investigate the function of miR-183-5p and PNPT1 in apoptotic RNA decay and the tumorigenic capability of bladder cancer cells.

RESULTS

PNPT1 expression was decreased in BC tissues and cell lines. Overexpression of PNPT1 significantly promoted cisplatin-induced intrinsic apoptosis of BC cells, whereas depletion of PNPT1 potently alleviated these effects. Moreover, oncogenic miR-183-5p directly targeted the 3' UTR of PNPT1 and reversed the tumor suppressive role of PNPT1. Intriguingly, miR-183-5p modulated not only PNPT1 but also Bcl2 modifying factor (BMF) to inhibit the mitochondrial outer membrane permeabilization (MOMP) in BC cells.

CONCLUSION

Our results provide new insight into the mechanisms underlying intrinsic apoptosis in BC, suggesting that the miR-183-5p-PNPT1 regulatory axis regulates the apoptosis of BC cells and might represent a potential therapeutic avenue for the treatment of BC.

[Clinical analysis and surgical treatment evaluation of 23 cases with primary parapharyngeal space tumors]

Objective: To analyze the clinical characters and surgical treatment of primary parapharyngeal space (PPS) tumors. Methods: A total of 23 cases of primary PPS tumors which were treated from November 2011 to December 2017 were included for the retrospective analysis in this study. Results: Twenty-three cases of patients with primary PPS tumors were analyzed in this study. Surgical approach was as follows: transcervial approach applied in 7 cases, transparotid approach in 4 cases, transoral approach in 2 cases, transmandibular approach in 4 cases, and the combined approaches on 6 cases. Besides, among 7 cases with upper PPS tumor, we applied the surgical navigation system in the surgery of 3 cases. The mean surgery duration of these cases, 3.5 h, was shorter than unused ones, while the mean maximum size (MMS) of tumors, 5.7 cm, was also larger. So far, 23 cases had no recurrence and metastasis. The most frequent histopathological type of all the cases was pleomorphic adenoma (8 cases), followed by Schwannoma (5 cases). With an 8-to-72-months follow up, 23 cases had no recurrence, metastasis or death. Conclusions: Surgical resection is preferred in the treatment of PPS tumors. In the upper PPS tumor cases, the surgical navigation system could reduce the operative duration significantly and is more suitable for larger tumors.

Postoperative radiotherapy is dispensable for OSCC patients with micrometastases in lymph nodes

Lymph node metastasis is a decisive factor for performing postoperative radiotherapy for oral squamous cell carcinoma (OSCC). However, whether OSCC patients with only micrometastasis need postoperative radiotherapy is unclear. In this study, OSCC patients (n = 311) with negative (n = 247), only micrometastasis (n = 44) and macrometastasis (n = 20) were detected and selected by HE staining. Micrometastasis was re-assessed using immunohistochemical staining of cytokeratin (CK) in HE-negative patients to find out the false negative cases. The results indicated that, among the negative lymph node cases (n = 247), the positive rate of CK was 4.94% (n = 12). Besides, the clinical features of the primary tumor in relation to the only micrometastatic status and the value of the postoperative radiotherapy on the only micrometastasis patients were evaluated. Patients with only micrometastasis had higher T stage and inferior worst pattern of invasion (WPOI) than patients without micrometastasis, but they had longer overall survival (OS), metastasis-free survival (MFS), and disease-free survival (DFS) than macrometastasis patients. However, the survival time of only micrometastasis patients with or without postoperative radiotherapy was comparable, even in patients with inferior WPOI. Radiotherapy, however, may only benefit patients with IV/V levels of micrometastasis. These data indicated that postoperative radiotherapy is dispensable for only micrometastasis OSCC patients.

Antiviral therapy after curative treatment of hepatitis B/C virus-related hepatocellular carcinoma: A systematic review of randomized trials

AIM

Available published work on the benefit of adjuvant antiviral therapy after curative treatment of hepatocellular carcinoma (HCC) reports controversial results. The objective of this systematic review was to evaluate the effect of adjuvant antiviral therapy on recurrence and survival after curative treatment of HCC.

METHODS

We conducted an extensive search strategy. All randomized controlled trials comparing adjuvant antiviral therapy versus placebo or no treatment were considered for this review. Results were expressed as hazard ratio for time-to-event outcomes with 95% confidence intervals using RevMan 5.

RESULTS

We included nine trials (three of low risk of bias and six of unclear risk of bias) with 954 patients. All the included studies used conventional interferon (IFN) as adjuvant antiviral therapy; none of them used pegylated IFN or nucleoside analogs. There were significant improvements for recurrence-free survival and overall survival in the adjuvant IFN group compared with the control group. Subgroup analysis also showed a significant difference favoring IFN therapy in hepatitis C virus (HCV)-related HCC patients, but for hepatitis B virus (HBV)-related patients, the difference failed to reach statistical significance. A dose reduction was needed in 28.3% of patients and discontinuation of IFN therapy happened in 8.2% of patients due to moderate to severe side-effects.

CONCLUSION

Our study suggested potential benefits of adjuvant IFN therapy following curative treatment of HCC, especially for HCV-related HCC. Further high-quality randomized controlled trials of more effective adjuvant antiviral regimens, either used alone or in combination, for virus-related HCC, especially HBV-related HCC, are needed.

Hepatocellular carcinoma and macrophage interaction induced tumor immunosuppression via Treg requires TLR4 signaling

AIM: To investigated the interaction between toll-like receptor 4 (TLR4)-activated hepatoma cells and macrophages in the induction of tumor-immune suppression mediated by CD4+CD25^high family of transcription factor P3 (FOXP3) regulatory T cells (Tregs).

METHODS: The proportion of FOXP3+ Tregs was identified in peripheral blood and tumor tissues of 60 hepatocellular carcinoma (HCC) patients. TLR4 expression was examined in tumor tissues and cell lines. The correlation was examined between FOXP3+ Tregs in peripheral blood and TLR4 expression of HCC tissues. Following activation of TLR4 in H22 murine hepatoma cells pre-incubated with lipopolysaccharide (LPS) and co-cultured with macrophage cell line RAW246.7, the synthesis of cytokines tumor necrosis factor-α, CCL22, and interleukin (IL)-10 by the two cell lines was detected and analyzed.

RESULTS: FOXP3+ Tregs were enriched in tumor sites, and circulating FOXP3+ Tregs were increased in HCC patients in correlation with multiple tumor foci and up-regulated TLR4 expression in HCC tissues. Semi-quantitative analysis indicated that TLR4 was over-expressed in HCC compared with the matched normal tissues. Cell cultivation experiments indicated that the mRNAs of IL-10 and CCL22 were significantly up-regulated in the RAW246.7 cell line when co-cultured with LPS pre-incubated H22 cells.

CONCLUSION: In hepatoma cell lines, TLR4 may indirectly facilitate the recruitment of Tregs to the tumor site and promote intrahepatic metastasis through its interaction with macrophages.

TNF-α treatment alters Mfn2 expression and mitochondrial morphology and function in hepatic LO2 cells

AIM: To investigate the influence of treatment with tumor necrosis factor-alpha (TNF-α) on the expression of mitofusin 2 (Mfn2) and mitochondrial morphology and function in hepatic LO2 cells.

METHODS: After pEGFP-Mfn2 plasmid was transfected into LO2 cells with Lipofectamine 2000, transfected LO2 cells were incubated with TNF-α for 12 h. The expression of Mfn2 mRNA and protein was detected by reverse transcriptase-polymerase chain reaction (RT-PCR) and Western blot, respectively. MitoTracker Mitochondrion-Selective Probes were used to detect the changes in mitochondrial morphology. ATP synthesis and reactive oxygen species (ROS) production were measured to assess mitochondrial function.

RESULTS: RT-PCR and Western blot analyses showed that Mfn2 was highly expressed in LO2 cells. After treatment of LO2 cells with TNF-α, Mfn2 expression was significantly suppressed (0.279 ± 0.026 vs 0.742 ± 0.018; 0.196 ± 0.024 vs 0.580 ± 0.011, P < 0.05), ATP level decreased (2.00 µmol/g ± 0.15 µmol/g vs 5.81 µmol/g ± 0.31 µmol/g, P < 0.05), ROS production increased (80.68 ± 4.02 vs 65.44 ± 3.47, P < 0.05), and the normal tubular network of mitochondria was fragmented into short rods or spheres when compared to control cells. In contrast, these changes were not significant in Mfn2-transfected LO2 cells.

CONCLUSION: TNF-α treatment may alter mitochondrial morphology and impair mitochondrial function by decreasing the expression of Mfn2 in hepatic LO2 cells.

Serum carbohydrate antigen (CA) 19-9 as a prognostic factor in cholangiocarcinoma: a meta-analysis

This study was performed to determine the prognostic role of preoperative serum carbohydrate antigen (CA) 19-9 levels in the survival of patients with cholangiocarcinoma. Articles published up to June 1(st), 2010 that evaluated preoperative CA19-9 levels and the prognosis of cholangiocarcinoma were collected for meta-analysis. The required information for calculating individual relative risk (RR) was extracted from the studies, and a combined overall RR was estimated. Nine eligible studies were included. One study dealt with extra-hepatic cholangiocarcinoma, while the other eight studies analyzed intra-hepatic cholangiocarcinoma. The mean methodological quality score was 74.1%, ranging from 65.5% to 82.5%. The overall RR for the nine studies was 1.28 (95% confidence interval = 1.10-1.46), and the Z-score for overall effect was 13.83 (P<0.001). The association between serum CA19-9 level and lymph node involvement was also assessed. The combined RR was 1.471 (95% confidence interval = 0.411-5.264) and Z-score for overall effect was 0.59 (P = 0.553). CA19-9 levels were associated significantly with the prognosis of patients with cholangiocarcinoma. This meta-analysis shows that elevation of preoperative CA19-9 levels is correlated with a poor prognosis of patients with cholangiocarcinoma. However, larger scale and randomized studies are needed to draw a more substantive conclusion.

Involvement of Cdc42 in epidermal growth factor-stimulated formation of filopodia in HepG2 cells

AIM: To explore the role of Cdc42 in epidermal growth factor (EGF)-stimulated formation of filopodia in HepG2 cells.

METHODS: HepG2 cells were divided into four groups: normal control group, EGF-treated group, small interfering RNA (siRNA) transfection group, and EGF-treated siRNA transfection group. The siRNA targeting the Cdc42 gene was introduced into HepG2 cells by liposome-mediated transfection. The expression of Cdc42 mRNA and protein was detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot, respectively. Actin-tracker green fluorescent probe was used to detect the formation of filopodia in HepG2 cells. Cell migration was measured by Transwell migration assay.

RESULTS: No significant differences were noted in the expression levels of total Cdc42 protein and Cdc42 mRNA between the EGF-treated group and the normal control group. However, the expression level of active Cdc42 protein was significantly higher in the EGF-treated group than in the normal control group (0.713 ± 0.021 vs 0.423 ± 0.015, P < 0.05). Transfection of siRNA targeting the Cdc42 gene could not only inhibit the expression of Cdc42 protein and mRNA (0.118 ± 0.017 vs 1.128 ± 0.024, and 0.351 ± 0.021 vs 0.936 ± 0.024, respectively; both P < 0.05) but also reduce filopodia formation and cell migration in EGF-treated cells (98.43 ± 3.11 vs 61.09 ± 3.58, 50.53 ± 2.34 and 62.73 ± 2.64, respectively; all P < 0.05).

CONCLUSION: Cdc42 activation is crucial for EGF-stimulated filopodia formation and cell migration in HepG2 cells.

The influence of Enteral Nutrition in postoperative patients with poor liver function

AIM: To investigate the safety, rationality and the practicality of enteral nutritional (EN) support in the postoperative patients with damaged liver function and the protective effect of EN on the gut barrier.

METHODS: 135 patients with liver function of Child B or C grade were randomly allocated to enteral nutrition group (EN, 65 cases), total parenteral nutrition group (TPN, 40 cases) and control group (CON, 30 cases). Nutritional parameters, hepatic and kidney function indexes were measured at the day before operation, 5th and 10th day after the operation respectively. Comparison was made to evaluate the efficacy of different nutritional support. Urinary concentrations of lactulose (L) and mannitol (M) were measured by pulsed electrochemical detection (HPLC-PED) and the L/M ratio calculated to evaluate their effectiveness on protection of gut barrier.

RESULTS: No significant damages in hepatic and kidney function were observed in both EN and TPN groups between pre- and postoperatively. EN group was the earliest one reaching the positive nitrogen balance after operation and with the lowest loss of body weight and there was no change in L/M ratio after the operation (0.026 ± 0.004) at the day 1 before operation, 0.030 ± 0.004 at the day 5 postoperative and 0.027 ± 0.005 at the day 10 postoperative), but the change in TPN group was significant at the day 5 postoperative (0.027 ± 0.003 vs 0.038 ± 0.009, P < 0.01).

CONCLUSION: EN is a rational and effective method in patients with hepatic dysfunction after operation and has significant protection effect on the gut barrier.

Increased frequency of the mannose-binding lectin LX haplotype in Chinese systemic lupus erythematosus patients

Mannose-binding lectin (MBL) is an important complement-activating protein of the human immune system. As a result of one of three structural gene mutations in exon 1 (variants B, C and D) and/or the presence of a low-efficiency promoter polymorphism, MBL deficiency may be associated with increased susceptibility to infectious diseases and to autoimmune disorders, including systemic lupus erythematosus (SLE). Using a combined approach of heteroduplex generator and polymerase chain reaction, a systematic search for mutations in exon 1 and the promoter region of the MBL gene was performed in a Chinese study population comprising 41 SLE patients and 111 healthy controls. Two alleles, a wild-type allele A and a variant allele B (a previously reported mutation of GGC to GAC at codon 54), were identified in MBL exon 1. The frequency of the B allele (0.15) was higher in the SLE patients than in the healthy controls (0.09), but the difference did not attain statistical significance (P > 0.05). However, for two polymorphisms at positions -550 and -221 in the promoter region, the frequency of the low-MBL-producing haplotype (LX) in the patients (0.2073) was significantly higher than that in the controls (0.0855) (P = 0.003, relative risk = 2.79). Our results suggest that the LX haplotype represents a strong risk factor among Chinese SLE patients. Although of lesser importance, the MBL B allele also may be a risk component in the developing process of SLE in Chinese patients.

[Advances of construction of tissue engineered blood vessels]

OBJECTIVE

To discuss the approaches of tissue engineered blood vessels (TEBV) reconstruction.

METHODS

The recent literatures about TEBV were widely reviewed. We summarized various types of biomaterials served as scaffold for TEBV and evaluated the construction model of TEBV. And the biological properties of some TEBV were compared.

RESULTS

Although the final model of construction of TEBV was not clear, reports in the last two years had shown several important advances in this exciting field.

CONCLUSION

Mimicry of some or all of the properties of three layers of natural healthy blood vessels has been the strategy of all TEBV approaches.

[Observation of the biodegradation of domestic poly-DL-lactic acid plates in vivo]

OBJECTIVE:To analyze the degradation and related factors of domestic poly-DL-lactic acid(PDLLA) plates in vivo. METHODS: The artifical transverse fractures in mandibular bodies of dogs were created and internal fixed with domestic PDLLA plates as experimental group,the implanted PDLLA plates in femurs as control.A certain time after the operation,the plates in fractured and implanted regions were collected and undertaken macroscopy and scanning electromicroscopy(SEM),meanwhile the fracture-healing status was evaluated. RESULTS: With time going on,the surface of domestic PDLLA plates y and density of micro-holes among poly-DL-lactic acid molecules in the PDLLA plates increased gradually.16-20 weeks Domestic PDLLA plates can be gradually biodegradation in vivo,in which it is correspondent with and accelerative the fracture-healing process.

[Observation in vivo histological response induced by imlplanted domestic poly-DL-lactic acid plates]

OBJECTIVE:To analyze the histological response and biocompatibility to implanted domestic PDLLA plates in vivo METHODS:Bilateral artificial fractures were created in mandibular bodies in dog and internal fixed with domestic PDLLA plate,TM plate respectively;meanwhile,a domestic PDLLA plate was imlplanted in femur.The interfacial soft tissue around the plates were collected and performed histological study RESULTS:All the skin wound healed well without abscess and fistula formation. From 2 to 4 weeks after the operation,the inflmmatory granulomatous response around the intenal fixation PDLLA plates was more serious than that of the control,in which more macrophages,plasmocytes and less lymphocytes,mononuclear cells infiltrated CONCLUSION:Domestic PDLLA plate is an inert internal fixation material with good biocompatibility, which induced a non-speciflc foreign reaction

[Yield and cytotoxicity of tumor-infiltrating lymphocyte(TIL) following immunochemotherapy]

Tumor-infiltrating lymphocyte (TIL) in the primary site of oral SCC treated with S-PVP of PVP therapy was collected respectively and its yield,that is calculating the amount of TIL per tumor tissue.The cytotoxicity of TIL against the target,Tca8113 was detected.The results showed that the yield of TIL in S-PVP group was three times over that in PVP group.At the ratio of 5 to 1 (effector to target) the cytotoxicity was 38% in S-PVP group and 32% in PVP group.There was no significant difference in its cytotoxicity between two groups.The results revealed that immunochemotherapy of S-PVP regimen for treating oral SCC had neither direct damage to tumor cell from the agents nor antitumor immune reactivity with BRM stimulating an increasing in numbers of TIL.

[Effect on intratumoral T lymphocyte and its subset in oral squamous cell carcinoma following immumnochemotherapy]

The relative numbers of CD(3)(+),CD(3)(+),CD(8)(+) and HLA-RD(+) cells in the tumor tissue before and after inductive therapy was counted using immunohistochemical technique of Avidin Biotin-Peroxidase Complex(ABC),and then the effect on local immune cell following two different inductive therapies was comparatively analysed.The results showed that S-PVP therapy could result in significant increasing in numbers of CD(3)(+)and CD(4)(+) cells intratumorally as compared with pre-therapy(P<0.05),and in slignt increasing in numbers of CD(8)(+) and HLA-DR(+) cell,which is no significant difference between pre-and post-therapy.In the PVP group,there was no significant difference in numbers of CD(3)(+),CD(4)(+),CD(8)(+) and HLA-DR(+) cells between pre-and post-treatment.The results suggested that T lymphocyte in the tumor site could significantly increase in numbers following the S-PVP therapy,and PVP chemotherapy did not obviously affect the local cellular immunity.

[Observation of clinical and pathological responses in short-term following immunochemotherapy for oral squamous cell carcinoma]

24 patients with oral SCC in Stage T3 or T4 were randomly divided into two groups,and treated with two inductive therapies,13 cases of whom received an immumochemotherapy regimen(Sapylin 15 KE+CDDP 70mg/m(2)+VCR 1.4mg/m(2)+PYM 80mg,S-PVP) and 11 cases,a chemotherapy regimen(CDDP 90mg/m(2)+VCR 1.4mg/m(2)+PYM 80mg,PVP) as control.The clinical response and pathological effect after immunochemotherapy or chemotherapy were evaluated through the clinical measurement of tumor size and pathological examination of the specimen.The results showed that the rate of clinical and pathological responses in S-PVP group were 92.3% and 84.6%,respectively;and in PVP group,72.7% and 45.5%.There was a significant difference between two groups in pathological effect(P<0.05),which indicated that the S-PVP regimen in short-term was better than of inductive chemotherapy.It may be relatively objective and accurate in comparison with clinical investigation which could act as an important supplement to the evaluation of clinical response.

[A retrospective study evaluating effectiveness of different TMJ arthroscopic techniques for discal displacement with or without reducing]

The three arthroscopic techniques were particularly method I(lysis and lavage),method II(disc repositioning and sclerotherapy plus method I),method III(traction,fixation plus method II) in order to make comparative study.The distributions between the 76 joints and three techniques were:14 joints in method I,31 in II,and,31 in III.The total follow-up was 30m(6-84m),and the total success rate was 73.7%(53/76).The mean follow-ups were particularly:28.6m in method I,38.4m in II.and,74.2%(23/31) in III,particularly.There were no statically significance between I and II.In disc displacement with reducing,there were no statically significance between method II(18/20) or III(14/15) and I(1/40),and no statically significance between II and III.In disc displacement without reducing,there were no statically significance between method I(6/10)and II(8/11) or III(9/16),or between II and III.Conclusions were that II or method III was effective on disc displacement with reducing,and that it don't make clear for any one of three methods to be more effective on disc displacement without reducing.

[A prospective study evaluating effectiveness of TMJ arthroscopy for particular stages of internal derangement]

The purpose of this prospective study is to evaluate effect on particular stages of internal derangement by TMJ arthroscopy.According to Wilkes-Bronstein classification,the distributions between 81 joints and particular stages of ID were:25 joints in II stage,18 in III,24 in IV,and 14 in V.The total 81 joints were undergone by arthroscopic surgery,the total success rates of different stages of ID were:24/25 joints in II stage,16/18 in III,13/24 in IV,and 7/14 in V particularly.The success rates were no statically significance (P>0.05) between II stage and III stage or between IV and V or V stages.The conclusion is that these cases in II or III stages of ID choose arthroscopic surgery than those cases in IV or V stages.