中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

2013 No. 7

Display Method:
Editorial
Clinical advances in acute pancreatitis
Qian JiaMing, Lai YaMin
2013, 29(7): 481-483. DOI: 1001-5256 (2013) 07-0481-03
Abstract(2545) PDF (579KB)(680)
Abstract:
Acute pancreatitis (AP) is a common gastroenterological emergency.Because of the diverse prognosis in AP, it is crucial to identify severe acute pancreatitis (SAP) early and provide timely treatment.Thus, there are a number of clinical advances in this aspect.This paper reviews two advances in AP.Firstly, AP is classified into mild acute pancreatitis, moderately severe acute pancreatitis (MSAP) , and SAP according to 2012 revision of the Atlanta Classification;SAP is distinguished from MSAP by the presence of persistent organ failure, that is, organ failure >48 h.Secondly, bedside index for severity in acute pancreatitis, a new scoring system, has confirmed value in predicting the severity and prognosis of AP both in China and abroad.These advances show more insight into AP and may help to improve the prognosis in AP patients.
Discussions by experts
Investigation of treatment strategy for advanced cancer according to treatment of pancreatic cancer
Xu KeCheng
2013, 29(7): 484-488. DOI: 1001-5256 (2013) 07-0484-05
Abstract:
The majority of pancreatic cancer diagnoses are made at the advanced stage and when metastasis has already occurred, and the 1-and 5-year survival rates are extremely low.Cemcitabine remains the most frequently applied treatment option, yet the most effective chemotherapeutic agents and combinations with multiple agents and/or radiotherapy only marginally improve patient survival and may even establish an environment conducive to cancer cells with stem cell-like characteristics.An alternative treatment modality, cryoablation, is available and has been applied at our institute to patients with unresectable pancreatic cancer since 2001.In this article, we present our collective experience with patient outcome using cryoablation, alone or combined with other treatment modalities such as brachytherapy (125iodine seed implantation) .The overall outcomes have been encouraging, suggesting that comprehensive therapy including cryoablation may prolong the survival of patients with advanced or metastatic pancreatic cancer, and we are achieving particular success with a novel combination of percutaneous cryoablation, cancer microvascular intervention with 125iodine seed implantation, and combined immunotherapy (3C) applied using an individualized patient strategy (P) .The 1-through 10-year survival rates of 145 patients treated with the so-called "3C+P model" are presented in support of this new strategy as a promising new treatment for advanced and metastatic cancer.
Values of MRI and CT in diagnosis and treatment of acute pancreatitis
Liu BinBin, Wang YuHong
2013, 29(7): 489-491. DOI: 1001-5256 (2013) 07-0489-03
Abstract(2984) PDF (622KB)(726)
Abstract:
This paper reviews the values of MRI and CT in the diagnosis and treatment of acute pancreatitis in recent years and presents the image-based alterations in the revised Atlanta classification of acute pancreatitis (2008) , including further standardization of terms concerning acute pancreatitis defined according to imaging findings, so as to evaluate the roles of imaging tools in the diagnosis and treatment of this disease.It is thought that imaging technology is of great clinical significance for the diagnosis and treatment of acute pancreatitis and standardization of related terms may facilitate the communication in the research and clinical practice regarding this disease.
Differentiation between gastrointestinal neuroendocrine tumors and pancreatic neuroendocrine tumors
Li XiaoQing, Qian JiaMing
2013, 29(7): 492-495. DOI: 1001-5256 (2013) 07-0492-04
Abstract(2976) PDF (957KB)(775)
Abstract:
Gastrointestinal and pancreatic neuroendocrine tumors (GEP-NETs) are mainly derived from the neuroendocrine cells of the gastrointestinal-pancreatic system, which express cell type-specific peptide hormones and general markers (synaptic vesicle proteins and chromogranin A) .GEP-NETs have the following characteristics: they are rarely seen in the clinical setting;the tumor sizes are usually small (<1 cm) ;tumors grow slowly (for months or years) , with several stages of development, and they probably have no symptoms for years;metastases often occur before onset of symptoms, with the liver and bones commonly affected, and the tumor sizes are larger than 2 cm at this time.Thus, GEP-NETs are often misdiagnosed;the diagnostic process is complex, not only relying on clinical manifestations, but also advanced laboratory and scanning means.Moreover, gastrointestinal NETs and pancreatic NETs differ in clinical manifestations, diagnosis, and treatment, and clinicians need to pay more attention to differentiation between them.
Advances in treatment of autoimmune pancreatitis
Li Ji, Qian JiaMing
2013, 29(7): 496-498. DOI: 1001-5256 (2013) 07-0496-03
Abstract(2891) PDF (480KB)(738)
Abstract:
Autoimmune pancreatitis (AIP) is a type of chronic pancreatitis characterized by an autoimmune inflammatory process.Treatment protocols for AIP are still evolving.According to the articles about AIP treatment in recent years, the indications for steroid therapy include specific clinical manifestations (jaundice, abdominal pain, etc.) , markedly abnormal imaging findings, and extrapancreatic organ involvement.The initial dose of steroid (prednisone) is usually 0.6 mg·kg-1·d-1 or 30-40 mg/d;after 3 weeks to 1 month of treatment with the initial dose, the dose is decreased by 5-10 mg every 1-2 weeks until it drops to 2.5-5 mg/d;this dose is maintained for 6 months to 3 years.No consensus has been reached on the adverse effect of steroid on diabetes mellitus complicating AIP.Immunosuppressive agents should be used for the patients with disease relapses or with important extrapancreatic organs involved.Rituximab might become one of the therapies for refractory AIP.Although some patients achieved remission after surgical treatment, surgery is still not recommended as a routine treatment protocol due to the complications after surgery.
Original articles_Pancreatic diseases
Risk factors for peptic ulcer in patients with acute pancreatitis
Liao Juan, Yuan Cong, Liu Juan, Feng YingChun
2013, 29(7): 499-502. DOI: 1001-5256 (2013) 07-0499-04
Abstract:
Objective To investigate the clinical characteristics of acute pancreatitis (AP) associated with peptic ulcer (PU) and to analyze the risk factors for PU in AP patients.Methods A retrospective analysis was performed on the clinical data of 156 AP patients who were admitted to our hospital from January 2008 to January 2012.All patients underwent gastroscopy within 48 h after admission to detect PU and Helicobacter pylori (Hp) infection.The severity of AP was assessed by Ranson score, APACHE Ⅱ score, and CT severity index.The clinical characteristics of AP patients with or without PU were statistically analyzed using independent samples t-test and chi-square test.The univariate and multivariate logistic regression analyses were used to determine the risk factors for PU in AP patients.Results Among the 156 AP patients, 88 (56.4%) had PU, but only 28 (31.8%) of the 88 cases were infected with Hp.Of the 28 patients, 22 had gastric ulcer, and 6 had both gastric ulcer and duodenal ulcer.Of the 60 PU patients not infected with Hp, 25 had gastric ulcer, 26 had duodenal ulcer, and 9 had both gastric ulcer and duodenal ulcer.The univariate logistic regression analysis showed that male gender, alcohol-induced pancreatitis, smoking, alcohol consumption, high triglyceride level, high C-reactive protein level, and APACHE Ⅱ score ≥8 were significantly associated with PU in AP patients.However, the multivariate logistic regression analysis showed that APACHE Ⅱ score ≥8 was the independent risk factor for PU in AP patients (OR=8.54, 95% CI: 4.52-16.15, P<0.01) .Conclusion AP patients are susceptible to PU, but the infection rate of Hp is low.APACHE Ⅱ score ≥8 is the independent risk factor for PU in AP patients.
Effects of Forsythia suspensa on expression of NF-κB and Foxp3 during liver injury in rats with severe acute pancreatitis
Fan XiaoBin, Li WenXing, Chen BingHe, Xiong ZeYi, Duan JiMing
2013, 29(7): 503-507. DOI: 1001-5256 (2013) 07-0503-05
Abstract(2857) PDF (816KB)(657)
Abstract:
Objective To investigate the roles of nuclear factor-kappa B (NF-κB) and forkhead box P3 (Foxp3) during liver injury in rats with severe acute pancreatitis (SAP) and the effects of Forsythia suspensa on their expression.Methods Eighty male Wistar rats were randomly allocated into sham operation (SO) group, SAP group, and intervention group.The intervention group was further divided into high-dose, middle-dose, and low-dose Forsythia suspensa subgroups and positive control (PDTC) subgroup.A rat model was induced by injecting sodium taurocholate into the bile-pancreatic duct.The rats in SO and SAP groups were sacrificed at 3, 6, and 12 h after operation, and those in intervention group were sacrificed at 12 h after operation.The serum levels of amylase (Amy) , alanine aminotransferase (ALT) , and tumor necrosis factor (TNF) α were measured.The endotoxin content in plasma was determined using a limulus reagent.The percentage of Treg cells among peripheral blood lymphocytes was measured by flow cytometry.The pathological examination and scoring of the liver and pancreas were performed.The mRNA expression levels of NF-κB and Foxp3 in liver tissue were measured by RT-PCR.One-way analysis of variance was used for comparison among groups;multiple comparison was performed by LSD test;the indices were subjected to linear correlation analysis.Results Compared with those in the SO group, all the indices in the SAP group increased over time and reached the peak levels at 12 h after operation.Compared with the rats in SAP group that were sacrificed at 12 h after operation, the intervention group (mortality = 0) had significantly decreased mRNA expression of NF-κB and Foxp3 in liver tissue (P<0.01) .The NF-κB mRNA level was positively correlated with the percentage of Treg cells (r=0.738, P<0.01) .As the dose of Forsythia suspensa rose, Amy, ALT, and TNFα levels decreased significantly, and the inflammation of liver and pancreas was significantly alleviated.There were no significant differences between the high-dose Forsythia suspensa subgroup and PDTC subgroup (P>0.05) .Conclusion Activation of NF-κB contributes to the liver injury in rats with SAP.Forsythia suspensa can significantly reduce the activation of NF-κB and the mRNA expression of NF-κB and Foxp3 in liver tissue, thus alleviating the liver injury in rats with SAP.
Original articles_Viral hepatitis
Clinical effects of lamivudine combined with adefovir dipivoxil and entecavir alone in 48-week treatment of HBeAg-positive chronic hepatitis B:preliminary comparative study
Yan HaiMing, Chen JianHua, Ye YiNong, Long Hui, Wang XiangHuai
2013, 29(7): 508-511. DOI: 1001-5256 (2013) 07-0508-04
Abstract:
Objective To compare treatment outcome, drug resistance rate, and safety between initial combination therapy with lamivudine (LAM) plus adefovir dipivoxil (ADV) and monotherapy with entecavir (ETV) in the treatment of HBeAg-positive chronic hepatitis B (CHB) .Methods Fifty-six HBeAg-positive CHB patients, who received treatment in The First People′s Hospital of Foshan from May 2008 to February 2010, were divided into combination therapy group and monotherapy group using a random number table.The combination therapy group received LAM (100 mg/d) plus ADV (10 mg/d) once daily for 48 weeks, while the monotherapy group received ETV (0.5 mg/d) once daily for 48 weeks.The alanine aminotransferase (ALT) normalization rate, hepatitis B virus (HBV) DNA clearance rate, and HBeAg clearance rate were compared between the two groups by chi-square test.Results After 48 weeks of treatment, the ALT normalization rate showed no significant difference between the two groups (χ2=1.018, P>0.05) , but after 36 weeks of treatment, the ALT normalization rate was significantly higher in the monotherapy group than in the combination therapy group (χ2=4.082, P<0.05) .After 12 and 48 weeks of treatment, the HBV DNA clearance rate showed no significant difference between the two groups (χ2=1.167, P>0.05;χ2=1.976, P>0.05) , but after 24 and 36 weeks of treatment, the HBV DNA clearance rate was significantly higher in the monotherapy group than in the combination therapy group (χ2=5.600, P<0.05;χ2=9.164, P<0.05) .There was no significant difference in HBeAg clearance rate between the two groups.Over the course of treatment, neither group developed drug resistance, and the two therapies had good safety.Conclusion Both initial combination therapy with LAM and ADV and monotherapy with ETV produce a good clinical effect in HBeAg-positive CHB patients after 48 weeks of treatment.ALT normalization and HBV DNA clearance occur earlier in patients receiving ETV alone than those receiving LAM plus ADV.The two therapies have good safety, cause little drug resistance, and produce good treatment outcome and hold promise for clinical application.
Original articles_Fatty liver
Therapeutic efficacy of atorvastatin in treatment of non-alcoholic fatty liver disease in patients with type Ⅱ diabetes mellitus
Feng MengDie, Tan MinZhen, Liang Ke, Lan ChangMing
2013, 29(7): 512-515. DOI: 1001-5256 (2013) 07-0512-04
Abstract(2181) PDF (633KB)(628)
Abstract:

Objective To observe the therapeutic efficacy of atorvastatin in the treatment of non-alcoholic fatty liver disease (NAFLD) in patients with type Ⅱ diabetes mellitus.Methods A total of 118 patients with type Ⅱ diabetes mellitus complicated by NAFLD, who visited the outpatient department of internal medicine or were hospitalized in our hospital from January 2010 to March 2012, were divided randomly into treatment group (n=61) and control group (n=57) .Both groups received liver protection therapy and blood glucose control, and atorvastatin (20 mg/d) was administered as an addition in the treatment group.The clinical symptoms, body mass index (BMI) , blood levels of total cholesterol (TC) , triglyceride (TG) , high-density lipoprotein cholesterol (HDL-C) , low-density lipoprotein cholesterol (LDL-C) , alanine aminotransferase (ALT) , and aspartate aminotransferase (AST) , and liver B-mode ultrasound findings were evaluated before and after 6 months of treatment.The enumeration data were analysed by chi-square test, the indices before and after treatment were compared by t-test.Results After 6 months of treatment, the treatment group had a significantly decreased clinical symptom score (t=21.07, P=0.0000) , significantly decreased blood levels of TC ( (6.80±1.20) vs (5.24±0.67) mmol/L, t=8.87, P=0.000) , LDL-C ( (4.38±0.75) vs (3.45±0.68) mmol/L, t=7.17, P=0.0000) , TG ( (2.14±0.56) vs (1.69±0.34) mmol/L, t=5.36, P=0.0000) , ALT ( (61±11) vs (46±9) U/L, t=8.24, P=0.0000) , and AST ( (53±14) vs (41±12) U/L, t=5.08, P=0.0000) , and increased blood HDL-C level (t=1.95, P>0.05) , but there was no significant change in BMI (t=1.84, P=0.0683) .No significant changes in these indices were found in the control group (P>0.05) .Both groups showed changes in liver density as measured by B-mode ultrasound, but there was no significant difference between them (P>0.05) .No adverse events occurred in either group.Conclusion Atorvastatin can markedly relieve clinical symptoms and lower blood levels of TC, LDL-C, TG, ALT, and AST and is safe and effective in the treatment of NAFLD in patients with type Ⅱ diabetes mellitus.

Original articles_Biliary diseases
Clinical effect of laparoscopic reoperation combined with choledochoscope in treatment of intra-and extrahepatic bile duct stones:analysis of 35 cases
Wu LiMing, Cheng CaiTao, Wang JiangHua, Chen XianXiang
2013, 29(7): 516-519. DOI: 1001-5256 (2013) 07-0516-04
Abstract(2168) PDF (620KB)(610)
Abstract:
Objective To investigate the feasibility and safety of laparoscopic reoperation combined with choledochoscope in the treatment of intra-and extrahepatic bile duct stones.Methods The 35 patients with intra-and extrahepatic bile duct stones who underwent laparoscopic bile duct reoperation from January 2008 to May 2012 were selected as a laparoscopic treatment group;50 patients with recurrent intra-and extrahepatic bile duct stones who underwent open surgery in the same period were selected as an open surgery group.The t-test was used to compare the two groups in terms of off-bed activity early after operation, recovery of intestinal function, and length of hospital stay;the chi-square test was used to compare the incision infection rate between the two groups.Results Among the 35 cases of intra-and extrahepatic bile duct stones, 32 completed laparoscopic surgery, 2 had the procedure converted to open surgery due to severe adhesion, and 1 had the procedure converted to open surgery due to subcutaneous emphysema.In the laparoscopic treatment group, the mean operative time of laparoscopic bile duct reoperation was 148 min (range, 105-200 min) ;there were no bleeding and bile leak in the perioperative period.All patients underwent T-tube drainage;postoperative peritoneal drainage was performed for 2-5 d;the mean length of hospital stay after operation was 5-8 d.No case of incision infection occurred in the laparoscopic treatment group.The laparoscopic treatment group had a significantly better outcome than the open surgery group in terms of time to off-bed activity early after operation, time to recovery of intestinal function, length of hospital stay after operation, and incision infection rate (P<0.05) .In the laparoscopic treatment group, 3 cases had retained bile duct stones, and the stones were taken out through the sinus tract using a fiber choledochoscope at 2 months after operation.All cases were followed up for 6-24 months after operation, and no recurrence was found in the laparoscopic treatment group.Conclusion Laparoscopic bile duct reoperation is minimally invasive and causes few complications, and the patients have rapid recovery after this procedure.Laparoscopic bile duct reoperation is safe and effective in the patients with intra-and extrahepatic bile duct stones who have the indications for this procedure.
Original articles_Hepatopancreatobiliary tumor
STAT3 protein expression profile and its clinical significance in hepatocellular carcinoma
Gou ZePeng, Wang DeSheng, Zhou Liang, Zhang Yong, Zhu PuLi, Lu Peng, Sun Wei
2013, 29(7): 520-524. DOI: 1001-5256 (2013) 07-0520-05
Abstract:

Objective To determine the protein expression profiles of STAT3 and its activated form, p-STAT3, in hepatocellular carcinoma (HCC) and investigate the potential clinical significance.Methods The expressions of STAT3 and p-STAT3 were detected in 90 HCC tissues and patient-matched cancer-adjacent healthy tissues by immunohistochemistry.The significance of between-tissue differences in protein expression was assessed by Chi-squared test.The relations of significant differential expression with patients′ clinicopathological features and prognoses (based on 5-year follow-up) were assessed by Cox regression models.Five-year survival rates were determined by Kaplan-Meier analysis with Log-rank test.Results In HCC tissues, STAT3 was mainly detected in the cytoplasm and p-STAT3 was mainly detected in the nucleus.The levels of both STAT3 and p-STAT3 were significantly higher in HCC than in adjacent non-cancer tissues.There was no significant relation for either STAT3 or p-STAT3 protein expression with satellite lesions, vascular invasion, AJCC stage of disease progression, sex, age, tumor size, tumor number, degree of differentiation, or alpha-fetoprotein expression.The 5-year survival rate of patients with high expressions of STAT3 and p-STAT3 in HCC tissues was significantly lower than patients with low expression.Conclusion STAT3 and p-STAT3 protein may contribute to the invasive and metastatic qualities of HCC, and represent a useful new prognosis reference index of this liver cancer.

DNMT expression in hepatocellular cancer
Li HaiPing, Yu ZongTao, Fan JinBo, Gao Bo, Zhang JiCai
2013, 29(7): 525-528. DOI: 1001-5256 (2013) 07-0525-04
Abstract(2746) PDF (569KB)(646)
Abstract:

Objective To investigate the differential expression of DNA methyltransferase (DNMT) in hepatocellular carcinoma (HCC) .Methods DNMT mRNA expression was measured by fluorescence quantitative-PCR in specimens of cancerous tissues (n=44) and case-matched cirrhotic (n=35) and non-cancerous, non-cirrhotic (normal;n=44) liver tissues from 44 HCC patients with different tumor stages.Results The mean mRNA levels of the four DNMT types tested (1, 2, 3A, 3B) were higher in cancerous and cirrhotic tissues than in adjacent normal tissues.The DNMT1 elevated expression reached statistical significance (vs.adjacent normal tissues, P<0.01 for cancerous tissue and P=0.02 for cirrhotic tissue) , unlike the DNMT2 elevated expression which did not reach statistical significance (vs.adjacent normal tissues, P=0.12 for cancerous and P=0.35 for cirrhotic tissues) .Both DNMT3 isoforms, A and B, were significantly higher than the levels detected in the adjacent healthy tissues (DNMT3A: P<0.01 for cancerous and P=0.01 for cirrhotic tissue;DNMT3B: P=0.03 for cancerous and P<0.05 for cirrhotic tissue) .Stratification analysis of the four DNMTs mRNA expression levels according to patient sex, tumor staging, and tumor differentiation revealed no correlations (DNMT1: P=0.23;DNMT2: P=0.45;DNMT3A: P=0.32;DNMT3B: P=0.36) .However, trends were found for increased DNMTs mRNA expression levels and male sex, poor tumor differentiation, and high tumor stage.Conclusion The mRNA expressions of DNMT1, DNMT3A, and DNMT3B are higher in cancerous and cirrhotic tissues from HCC patients than in their adjacent non-cancerous, non-cirrhotic liver tissues.Expression of DNMTs may be associated with pathogenesis of HCC or HCC associated with cirrhosis.

Construction of lentiviral vector carrying miR-122 and function of miR-122 in hepatocellular carcinoma cells
Zhuang Peng, Li ZhiYing, Wang XiangChen, Zheng ChangJing, Huang Jian
2013, 29(7): 529-531. DOI: 1001-5256 (2013) 07-0529-03
Abstract:

Objective To construct the lentiviral vector carrying miR-122 (Lv-miR122) and investigate the function of stably expressed miR-122 in hepatocellular carcinoma (HCC) cells.Methods Pre-miR-122 was cloned into lentiviral vector pLUNIG to obtain the Lv-miR122 that had stable expression of miR-122;Lv-miR122 was packaged in 293T cells along with other three vectors pRRE, pRSV-REV, and pCMV-VSVG, and virus supernatant was obtained by concentration;the virus supernatant was used to infect HCC cell line HepG2.The expression of miR-122 was measured by Q-RT-PCR.The proliferation of HepG2 cells was analyzed by MTT assay and colony formation assay.Blank lentiviral vector (Lv-Ctrl) -infected HepG2 cells and uninfected HepG2 cells were used as controls.Results The expression of miR-122 was significantly higher in Lv-miR122-infected HepG2 cells than in Lv-Ctrl-infected HepG2 cells (t=10.745, P<0.01) .The Lv-miR122-infected HepG2 cells (with stable expression of miR-122) had significantly suppressed proliferation compared with Lv-Ctrl-infected and uninfected HepG2 cells (P<0.05 for both comparisons) ;moreover, miR-122 significantly inhibited the colony formation of HepG2 cells (t=5.256, P<0.01) .Conclusion The Lv-miR122 can be successfully constructed, and the carried miR-122 can be stably expressed and can inhibit the proliferation of HepG2 cells.

Original articles_Others
Relationship between glucose metabolism and hepatic encephalopathy in patients with liver cirrhosis
Zhang LiHang, Mao JunLing, Ren HaiFeng, Wang ShanJuan, Zhang Hui, Wan Jian, Liu YanLi, Wang YiFei, Lin YongHui
2013, 29(7): 532-534. DOI: 1001-5256 (2013) 07-0532-03
Abstract(2962) PDF (570KB)(717)
Abstract:

Objective To observe the changes in blood glucose in patients with liver cirrhosis and investigate the relationship between glucose metabolism and hepatic encephalopathy (HE) .Methods Sixty patients with liver cirrhosis (cirrhosis group) and 30 patients without liver cirrhosis (control group) , who were hospitalized in Department of Gastroenterology, Jiading District Central Hospital from August 2008 to August 2010, were included in the study.The general data were collected;the consciousness of patients was observed;the physical examination was performed for detecting flapping tremors;blood samples were collected for measuring blood glucose.The cirrhosis group was further divided into flapping tremor subgroup and non-flapping tremor subgroup.The cirrhosis group and control group were compared in terms of the incidence rate of abnormal glucose metabolism.The patients were divided into normal glucose metabolism group and abnormal glucose metabolism group, and the two groups were compared in terms of the incidence rates of flapping tremors and HE.Results Of the 60 patients in cirrhosis group, 28 had no flapping tremors, and 32 had flapping tremors.The incidence rate of abnormal glucose metabolism was significantly lower in the control group than in the cirrhosis group (13.33% vs 26.67%;χ2=2.058, P<0.05) .the="" incidence="" rates="" of="" flapping="" tremors="" and="" he="" were="" in="" the="" normal="" glucose="" metabolism="" versus="" abnormal="" group="" p="">0.05) .Conclusion The patients with liver cirrhosis have abnormal glucose metabolism, but which is not necessarily associated with HE.It suggests that the patients with HE may have impaired glucose utilization in the brain.

Relationship between changes in serum cytokine levels after artificial liver therapy and clinical prognosis in patients with liver failure
Zhou Jian, Wan Hong
2013, 29(7): 535-537. DOI: 1001-5256 (2013) 07-0535-03
Abstract(2729) PDF (569KB)(626)
Abstract:

Objective To investigate the relationship between changes in serum cytokine levels at 72 h after artificial liver therapy (plasma exchange, PE) and clinical prognosis in patients with liver failure.Methods Fifty-eight patients with liver failure, who received PE in Department of Infectious Diseases, The No.2 People′s Hospital of Lanzhou from April 2011 to April 2012, were included in the investigation;they were divided into improved group and uncured group according to their treatment outcomes.The serum interleukin (IL) -4, IL-6, IL-10, tumor necrosis factor (TNF) α, and interferon (IFN) γ levels before and 72 h after therapy were measured, and the relationship between the changes in these indices and prognosis was observed.The data were expressed in the form of mean ± standard deviation.The baseline values and values after therapy were compared by paired t-test, and the differences between two groups were determined by the t-test for comparison between groups.Results After PE therapy, 67.24% of all patients (39/58) showed an improvement, while 32.75% (19/58) were not cured.At 72 h after therapy, the improved group had significant changes in serum IL-4, IL-6, IL-10, TNFα, and IFNγ levels (t=2.048-5.163, P<0.05) , and had more decrease in serum IL-4, IL-6, TNFα, and IFNγ and more increase in serum IL-10 level compared with the uncured group.Before therapy, the serum IL-6 and TNFα levels were significantly higher in the uncured group than in the improved group (t=2.024-2.174, P<0.05) .Conclusion Artificial liver therapy can decrease TNFα, IL-4, IL-6, and IFNγ and increase IL-10 in serum and thus is an effective treatment for liver failure.It seems that IL-6 and TNFα play a more important role than other cytokines in immune injury in patients with liver failure.

Clinical analysis of 22 patients with hepatobiliary disease caused by liver fluke
Zhang Hui, Zhu Lei, Wang Lu, Chen Qian, Pan Yu
2013, 29(7): 538-540. DOI: 1001-5256 (2013) 07-0538-03
Abstract(2769) PDF (561KB)(651)
Abstract:

Objective To clinically analyze the hepatobiliary disease caused by the liver fluke and to increase the knowledge of this disease and reduce misdiagnosis.Methods A retrospective analysis was performed on the clinical data of 22 patients who had a confirmed diagnosis of clonorchiasis after being admitted to our hospital due to hepatobiliary disease over the past 20 years.Results Of the 22 patients, who had a mean age of 45.41 years, 19 were males, and 3 were females.When admitted to the hospital, 8 cases were diagnosed with cholecystitis or gallstones, 7 cases with clonorchiasis, and 7 cases with other diseases.Alanine aminotransferase elevation was found in 14 cases (63.63%) , aspartate aminotransferase elevation in 16 cases (72.72%) , total bilirubin elevation in 11 cases (50.00%) , gamma-glutamyl transpeptidase elevation in 17 cases (77.27%) , and increased eosinophils in 14 cases (63.63%) .Ten cases (45.45%) were diagnosed by fecal examination, 7 cases (31.82%) by bile smears, 2 cases (9.09%) by liver fluke antibody detection, and 3 cases (13.64%) according to the history of clonorchiasis.Deworming and comprehensive treatment produced a good outcome in these patients.Conclusion Clonorchiasis is endemic and clinically rare, without specific clinical features, and it is easily confused with other hepatobiliary diseases, resulting in a high rate of misdiagnosis.Therefore, for the patients with abdominal pain, jaundice, and liver damage of unknown causes, we should inquire whether they or their family have a special dietary history and need to perform relevant examinations to confirm the diagnosis, so as to provide timely treatment.

Case reports
Case of IgG4-related autoimmune pancreatitis with liver injury
Zhang Min, Han Tao, Li Ying, Xiao ShiXiang, Yan JunQing, Guo Zhen
2013, 29(7): 541-542. DOI: 1001-5256 (2013) 07-0541-02
Abstract(2272) PDF (758KB)(674)
Abstract:
Reviews
Risk factors for pancreatic fistula and its prevention and treatment measures
Xing GuoSheng, Meng XingKai
2013, 29(7): 543-546. DOI: 1001-5256 (2013) 07-0543-04
Abstract(2570) PDF (612KB)(655)
Abstract:

Pancreatic fistula, a common complication after pancreaticojejunostomy, is a deadly disease with high fatality.Thus, early detection of this condition, as well as effective prevention and treatment, is essential.Gives a further review of the diagnostic criteria for pancreatic fistula, the risk factors for this disease, and research advances in the prevention and treatment of pancreatic fistula.

Role of endoplasmic reticulum stress in pathogenesis of alcoholic liver disease
Tao Li, Chen Xi
2013, 29(7): 547-549. DOI: 1001-5256 (2013) 07-0547-03
Abstract(2493) PDF (668KB)(742)
Abstract:

Endoplasmic reticulum stress (ERS) is a pathological condition characterized by the homeostasis imbalance and physiological dysfunction of endoplasmic reticulum.It is summarized from existing articles and reports that the various factors that lead to physical dysfunction can cause ERS and unfolded protein response.Recent studies have shown that ERS is involved in the pathogenesis of alcoholic liver injury and plays an important role in the process.

Research progress in related clinical factors and molecular biomarkers for microvascular invasion in hepatocellular carcinoma
Jin Yun, Li JiangTao
2013, 29(7): 550-553. DOI: 1001-5256 (2013) 07-0550-04
Abstract:

Microvascular invasion (MVI) is considered an important influential factor for postoperative recurrence and prognosis of hepatocellular carcinoma (HCC) .Little attention has been given to the treatment targeting MVI, and the preoperative identification of MVI remains an unsolved challenge.This paper reviews the research progress in related clinical factors and molecular biomarkers for MVI in HCC and summarizes the confirmed factors closely associated with MVI, such as tumor size, tumor number, tumor differentiation, des-γ-carboxy prothrombin, and alpha-fetal protein.Seeking a new specific serum marker for MVI is still the research orientation in this area.

Progress in application of nanotechnology in diagnosis and treatment of liver diseases
Xue Liang
2013, 29(7): 558-560. DOI: 1001-5256 (2013) 07-0558-03
Abstract(2538) PDF (516KB)(690)
Abstract:

With the development of nanotechnology, its application in medical fields has attracted increasing attention from medical workers.Reviews the application of nanotechnology in the diagnosis and treatment of liver diseases in recent years, and expounds the advantages of nanotechnology in clinical application from the aspects of imaging diagnosis, laboratory diagnosis, chemotherapy, radiotherapy, thermotherapy, gene therapy, and so on, with an emphasis on its application in the diagnosis and treatment of liver cancer and viral hepatitis.The article indicates that joint use of nanotechnology and various examinations, tests, or clinical medications will greatly improve the accuracy and effectiveness of diagnosis and treatment of diseases.However, because of the immaturity of nanotechnology and the shortage of medical knowledge, the development of nanotechnology is still restricted at present.