[Value of autocrine motility factors in the prediction of the disease progression of PBC- associated hepatocellular carcinoma]

Objective: To clarify the value of autocrine motility factor (ATX) in predicting the disease progression of primary biliary cholangitis (PBC)-associated hepatocellular carcinoma (HCC). Methods: A prospective cohort of 179 newly diagnosed autoimmune liver disease (PBC) patients admitted to the Department of Hepatology at the Fifth Medical Center of the People's Liberation Army General Hospital from January 2016 to January 2018 was selected. All PBC patients received ursodeoxycholic acid (UDCA) treatment and were followed up.The endpoint of the follow-up was the occurrence of primary liver cancer. The relationship between ATX and the clinical characteristics of patients and its significance in predicting disease progression and HCC were analyzed. Results: The peripheral blood ATX level was significantly higher in PBC patients than that of alcoholic cirrhosis (t = 3.278, P = 0.001) and healthy controls (t = 6.594, P < 0.001), but there was no significant difference in ATX levels compared with patients with non-PBC- associated HCC (t = -0.240, P = 0.811). The expression of ATX in liver tissue of PBC patients was significantly higher than that of healthy individuals (Z = -3.633, P < 0.001) and patients with alcoholic cirrhosis (Z = -3.283, P < 0.001), while the expression of ATX in the advanced stage was significantly higher than that in early-stage PBC patients (Z = -2.018, P = 0.034). There was a significant difference in baseline ATX levels between PBC patients without HCC and PBC patients with HCC (228.451 ± 124.093 ng/ml vs. 301.583 ± 100.512 ng/ml, t = 2.339, P = 0.021). Multivariate logistic regression analysis showed that ATX was an independent predictor of PBC progression to HCC (OR = 1.245, 95%CI 1.097-1.413). The baseline peripheral blood ATX level in predicting AUROC of PBC-associated HCC was 0.714, 95%CI 0.597-0.857 and the sensitivity and specificity were 84.6%, and 59.0%, respectively. The optimal cutoff value for predicting serum ATX levels in the occurrence of HCC was 235.254 ng/ml. Conclusion: Patients with PBC have significantly higher levels of ATX expression in their peripheral blood and liver tissue, which can be utilized to assess treatment effectiveness and predict disease progression.

[Immune pathogenesis of primary biliary cholangitis]

Primary biliary cholangitis (PBC) is an autoimmune liver disease, mainly characterized by chronic progressive cholestasis. The root cause of PBC is the loss of immune tolerance to autoantigen E2 subunit of pyruvate dehydrogenase (PDC-E2). The unique immunobiological characteristics of intrahepatic bile duct epithelial cells make it an active participant in the pathogenesis of PBC. In recent years, the detection rate of PBC has been increasing year by year, but the clinical situation of ursodeoxycholic acid monotherapy has not changed. Therefore, an in-depth understanding of the immune pathogenesis of PBC will help clinicians better prevent and treat diseases.

Temporal changes in laboratory markers of survivors and non-survivors of adult inpatients with COVID-19

Background

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2, and outbreaks have occurred worldwide. Laboratory test results are an important basis for clinicians to determine patient condition and formulate treatment plans.

Methods

Fifty-two thousand six hundred forty-four laboratory test results with continuous values of adult inpatients who were diagnosed with COVID-19 and hospitalized in the Fifth Hospital in Wuhan between 16 January 2020 and 18 March 2020 were compiled. The first and last test results were compared between survivors and non-survivors with variance test or Welch test. Laboratory test variables with significant differences were then included in the temporal change analysis.

Results

Among 94 laboratory test variables in 82 survivors and 25 non-survivors with COVID-19, white blood cell count, neutrophil count/percentage, mean platelet volume, platelet distribution width, platelet-large cell percentage, hypersensitive C-reactive protein, procalcitonin, D-dimer, fibrin (ogen) degradation product, middle fluorescent reticulocyte percentage, immature reticulocyte fraction, lactate dehydrogenase were significantly increased (P < 0.05), and lymphocyte count/percentage, monocyte percentage, eosinophil percentage, prothrombin activity, low fluorescent reticulocyte percentage, plasma carbon dioxide, total calcium, prealbumin, total protein, albumin, albumin-globulin ratio, cholinesterase, total cholesterol, nonhigh-density/low-density/small-dense-low-density lipoprotein cholesterol were significantly decreased in non-survivors compared with survivors (P < 0.05), in both first and last tests. Prothrombin time, prothrombin international normalized ratio, nucleated red blood cell count/percentage, high fluorescent reticulocyte percentage, plasma uric acid, plasma urea nitrogen, cystatin C, sodium, phosphorus, magnesium, myoglobin, creatine kinase (isoenzymes), aspartate aminotransferase, alkaline phosphatase, glucose, triglyceride were significantly increased (P < 0.05), and eosinophil count, basophil percentage, platelet count, thrombocytocrit, antithrombin III, red blood cell count, haemoglobin, haematocrit, total carbon dioxide, acidity-basicity, actual bicarbonate radical, base excess in the extracellular fluid compartment, estimated glomerular filtration rate, high-density lipoprotein cholesterol, apolipoprotein A1/ B were significantly decreased in non-survivors compared with survivors (P < 0.05), only in the last tests. Temporal changes in 26 variables, such as lymphocyte count/percentage, neutrophil count/percentage, and platelet count, were obviously different between survivors and non-survivors.

Conclusions

By the comprehensive usage of the laboratory markers with different temporal changes, patients with a high risk of COVID-19-associated death or progression from mild to severe disease might be identified, allowing for timely targeted treatment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-020-05678-0.

Increased Th17 cells contribute to disease progression in patients with HBV-associated liver cirrhosis

T helper (Th) 17 cells have been demonstrated to participate in the pathogenesis of HBV-associated liver damage. However, little is known regarding the immunopathogenic role of liver fibrosis in patients with HBV-associated liver cirrhosis. The aims of this study were to evaluate whether Th17 cells are related to disease progression in patients and to explore the possible mechanisms. The frequencies of circulating Th17 cells were analysed in 78 patients with hepatitis B and cirrhosis (Child A: 34; Child B: 22; Child C 22) and matched controls. Liver samples were collected from 13 patients with HBV-associated cirrhosis, 23 patients with chronic hepatitis B and 12 healthy controls for immunohistochemical analysis. IL-17 receptor expression was studied on liver biopsies and in human hepatic stellate cells as well as their response to recombinant IL-17 by flow cytometry. Patients with hepatitis B-associated cirrhosis with more severe disease displayed significant increases in peripheral numbers of Th17 cells as well as in IL-17 plasma levels. The increased intrahepatic IL-17(+) cells correlated positively with fibrotic staging scores and clinical progression from CHB to cirrhosis. Moreover, many IL-17(+) cells were located in fibrotic areas in the liver of patients with cirrhosis. In vitro, IL-17 together with IL-17-activated monocytes, could promote the activation of stellate cells, which, in turn, aggravated liver fibrosis and the inflammatory response. In summary, increased peripheral and intrahepatic Th17 cells are enriched in patients with hepatitis B and cirrhosis and contribute further to the severity of disease progression through induction of stellate cell activation.

[Comparative study on clinical features of 215 patients with acute and subacute severe hepatitis.]

BACKGROUND

To analyze the clinical features of acute severe hepatitis (ASH) and subacute severe hepatitis (SSH) by comparison analysis.

METHODS

The clinical features of 215 cases with ASH and SSH from 1995 to 2005 were retrospectively analyzed by using chi-test, t-test and regression analysis.

RESULTS

The most common cause of ASH or SSH was hepatitis B virus (HBV) infection (>30%). Anti-tuberculosis therapy was the main cause of drug-induced ASH or SSH. The incidences of hepatic encephalopathy were 78.13% and 43.05% respectively (P less than 0.001). Prothrombin activity was less than 20% and less than 30%, respectively in cases with ASH and SSH. The most common complications of ASH were hepatic encephalopathy, imbalance of electrolyte and cerebral edema, and that of SSH were ascites, imbalance of electrolyte and hepatic encephalopathy. Prothrombin time, ratio of WBC and neutrophil count were positively related to case fatality of ASH or SSH. Prothrombin activity and total cholesterol (TC) were negatively correlated with fatality of ASH or SSH. Total bilirubin, blood ammonia and creatinine were also positively correlated with fatality of SSH; chlolinesterase, triglyceride, PLT, albumin were negatively correlated with fatality of SSH.

CONCLUSION

ASH and SSH are two different entities because of obvious differences in the ages of suffering, the incidence and occurring time of hepatic encephalopathy, abnormality of function of blood coagulation and the marker for predicting prognosis. Severe abnormality of function of blood coagulation is an important marker with high sensitivity and specificity in ASH or SSH patients without hepatic encephalopathy.

[Preliminary report on portal hypertension treated by transjugular intrahepatic portosystemic stent shunt]

Transjugular intrahepatic portosystemic stent shunt (TIPSS) was carried out in 50 cases of liver cirrhosis with portal hypertension. An average Child-Pugh score in these cases was 10.33 +/- 2.34. Except for 5 cases with portal vein occlusion, the technical success rate of in 45 cases was 95.6%. Acute variceal bleeding was immediately controlled. Portal pressure was reduced by 1.36 +/- 0.48 kPa. Esophageal varices and ascites disappeared. The shrink of spleen, the reducing of body weight were also observed in a week following TIPSS. The velocity of blood flow in stents was 85.61 +/- 35.83 cm/s. Follow-up of 1-9 months found norebleeding and ascites. The velocity of blood flow in stents was 83.83 +/- 34.74 cm/s. Three patients died of liver failure and variceal rebleeding within a month after TIPSS. Slight encephalopathy was observed in 6 cases.

Parietal cell vagotomy and selective vagotomy plus antrectomy in the treatment of duodenal ulcer. A follow-up of 10 years

Two hundred and thirty-eight patients with duodenal ulcer were subjected to vagotomy. According to the clinical manifestations and the results of gastric acid secretion test, parietal cell vagotomy was done in 100 patients and selective vagotomy plus antrectomy in 138 patients. Follow-up after operation for 10 years showed that 96% and 97% of patients belonged to Visick Grade I and II respectively. The recurrence rate for parietal cell vagotomy was 1.96%, but no recurrence was seen in the group of selective vagotomy plus antrectomy. Long-term side-effects were rarely found in the patients. They had good nutritional states. The follow-up data showed that the recurrence rate could be greatly reduced if the modality of vagotomy was selected according to the type of gastric acid secretion test. The importance of surgeons experience and careful manipulation was emphasized.

Intraoperative coronary venography in observing changes of portal blood flow after portal-azygos disconnection

Intraoperative coronary venography was performed in 24 patients before and after portal-azygos disconnection for portal hypertension. Before the procedure the portal vein was found to be communicated with cardial and esophageal veins by two pathways, i,e., from the esophageal and gastric branches of the coronary vein to the esophageal varices, with the latter branches by way of the gastric intramural venula. The portal blood flow was postulated to be hepatofugal because the portal trunk could not be seen venographically. Coronary venography done after the disconnection revealed no pericardial and esophageal varices and the portal vein with hepatopetal blood flow. We conclude that the operation had the advantage of complete disconnection between the portal vein and the cardio-esophageal varices, thus preventing the bleeding from the varix and increasing hepatopetal blood flow.

[Intraoperative coronary venography for portal hemodynamic observation in the procedure of combined portozygos disconnection]

Since 1986, intraoperative coronary venography was performed on 24 patients before and after undergoing portoazygos disconnection for portal hypertension. Before the disconnection the portal vein was found to be communicated with cardial and esophageal veins by two pathways, i.e. from the esophageal branches of the coronary vein to the esophageal varices, and from the gastric branches of the coronary vein to the esophageal varices by way of the gastric intramural venula. The portal blood flow was postulated to be hepatofugal because the portal trunk could not be seen on the venography. Coronary venography done after the disconnection found no pericardial and esophageal varices but the portal vein with hepatoportal blood flow. The authors come to the conclusion that the operation has the advantage of both complete disconnection between the portal vein and the cardio-esophageal varices, thus preventing the varices bleeding, and increasing hepatic blood flow.

[Parietal cell ultrastructure and acid secretory function before and after vagotomy]

Vagotomy was performed in 238 consecutive patients with duodenal ulcer since 1977. Electron microscopy of parietal cells from gastric body mucosa, gastric acid secretory test, and serum gastrin evaluation were done in randomly selected 15 PCV and 13 SV+A cases before and after vagotomy. It was found that 2-6 weeks after the surgery, the ultrastructure of parietal cells presented the feature of secretory depression and gastric acid output was decreased. One to ten years after PCV, the ultrastructure gradually regained its preoperative morphology, serum gastrin level was also increased, though acid output remained on low level. During the same period, patients undergoing SV+A were characterized with the feature of depressed secretion in gastric mucosa ultrastructure, and constantly low level of gastric acid output and serum gastrin. These results, in the authors' belief, may explain low gastric acid output after vagotomy and provide theoretical basis for the application of vagotomy in surgical treatment of duodenal ulcer.