To explore the feasibility of pretreatment nonenhanced magnetic resonance imaging (MRI) in predicting insufficient biochemical response to ursodeoxycholic acid (UDCA) in patients with primary biliary cholangitis (PBC).
Objective
To investigate the differences in the biochemical and pathological features and therapeutic response between the elderly-onset autoimmune hepatitis (AIH) and young-onset AIH.
Methods
From October 2013 to November 2016, a total of 87 consecutive AIH patients diagnosed by liver biopsy were enrolled and divided into elderly-onset group (≥60 years) and the young-onset group (<60 years). The biochemical and pathological features and therapeutic response of the two groups were compared. Mann-Whitney test and chi square test were performed for statistical analysis.
Results
As AIH diagnosed, the proportion of liver cirrhosis detected by imaging examination of elderly-onset group and the young-onset group were 67.7%(21/31) and 35.7%(20/56), respectively, the former was higher than the latter, and the difference was statistically significant (χ2=8.214, P=0.004). The proportion of patients complicated with extrahepatic autoimmune diseases of the elderly-onset group was 9.7%(3/31), which was lower than that of the young-onset group (28.6%, 16/56), and the difference was statistically significant (χ2=4.173, P=0.041). The median levels of alanine aminotransferase (ALT) and albumin of the elderly-onset group were 50.0 U/L (22.0 U/L, 193.0 U/L) and 34.8 g/L (31.3 g/L, 40.5 g/L), which were lower than those of the young-onset group (146.0 U/L (43.8 U/L, 390.5 U/L), 39.4 g/L (35.8 g/L, 44.6 g/L), and the differences were statistically significant (Z=-2.109, -2.092; both P 0.05). After treatment, among 17 patients of elderly-onset group, seven patients obtained biochemical remission and the median time to remission was 3.2 months; among 37 patients of young-onset group, 18 patients (48.6%) obtained biochemical remission and the median time to remission was 2.3 months. There was no significant difference in the percentage of patients achieved biochemical remission and the median time between the two groups (both P>0.05).
Conclusion
The percentage of complicated with extrahepatic autoimmune diseases of elderly-onset group is lower than that of young-onset group, which indicates that age-associated immune dysfunction may involve in the genesis and development of elderly-onset AIH.
Key words:
Hepatitis, autoimmune; Elderly; Biochemistry; Pathology; Prognosis
Abstract The use of fatty livers in liver transplantation has emerged as a crucial strategy to expand the pool of donor livers; however, fatty livers are more sensitive to ischemia‒reperfusion injury (IRI). Excessive congenital inflammatory responses are crucial in IRI. Hypothermic oxygenated perfusion (HOPE) is a novel organ preservation technique that may improve marginal donor liver quality by reducing the inflammatory response. Tissue factor pathway inhibitor-2 (TFPI2) and CAP-Gly domain-containing linker protein 1 (CLIP1) exhibit modulatory effects on the inflammatory response. However, the underlying mechanisms of HOPE in fatty liver and the effects of TFPI2 and CLIP1 in fatty liver IRI remain unclear. Here, we aimed to explore the impact of HOPE on the inflammatory response in a rat model of fatty liver IRI and the mechanisms of action of TFPI2 and CLIP1. HOPE significantly reduces liver injury, especially the inflammatory response, and alleviates damage to hepatocytes and endothelial cells. Mechanistically, HOPE exerts its effects by inhibiting TFPI2, and CLIP1 can rescue the damaging effects of TFPI2. Moreover, HOPE promoted the ubiquitination and subsequent degradation of Toll/interleukin-1 receptor domain-containing adapter protein (TIRAP) by regulating the binding of R24 of the KD1 domain of TFPI2 with CLIP1, thereby negatively regulating the TLR4/NF-κB-mediated inflammatory response and reducing IRI. Furthermore, TFPI2 expression increased and CLIP1 expression decreased following cold ischemia in human fatty livers. Overall, our results suggest that targeting the inflammatory response by modulating the TFPI2/CLIP1/TIRAP signaling pathway via HOPE represents a potential therapeutic approach to ameliorate IRI during fatty liver transplantation.
<b><i>Background:</i></b> There is limited evidence on the treatment response of primary biliary cholangitis (PBC) with autoimmune hepatitis (AIH) features but not meet the criteria of PBC-AIH syndromes. The aim of this study was to elucidate the clinical characteristics of PBC patients with features of AIH. <b><i>Methods:</i></b> We included patients with diagnostic criteria of PBC. All patients were treated with ursodeoxycholic acid (UDCA) and without immunosuppressive agents for >1 year. The biochemical response was evaluated at 1 year after the treatment of UDCA. <b><i>Results:</i></b> Among 432 patients with PBC, 166 (38.4%) patients did not achieve biochemical response within 1 year of UDCA treatment. Nonresponders had a lower albumin level and higher immunoglobulin G, alanine transaminase (ALT), alanine aminotransferase (AST), alkaline phosphatase, glutamyl transpeptidase and total bilirubin levels (<i>p</i> < 0.05). The response rates were significantly lower in patients with elevated level of IgG or ALT or AST. Moreover, the higher the IgG or AST level was, the lower the response rate was in patients with PBC, regardless of cirrhosis. For patients with cirrhosis, there was no differences among patients with different levels of ALT. Patients in the PBC with AIH features group had a significant lower response rate than patients in the PBC-only group. Among the 139 patients who underwent liver biopsy, 54 were nonresponsive to UDCA and 48 (88.9%) shown mild interface hepatitis. <b><i>Conclusion:</i></b> In conclusion, PBC patients with AIH features had a worse response to UDCA therapy.
Funding informationSupported by the National Natural Science Foundation of China (81770568) and 1·3·5 project for disciplines of excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (2019HXFH025). To the editor, It was with great interest that we read the article by von Meijenfeldt et al.[1] In this study, the results showed MPO‐DNA complexes, as a special marker for neutrophil extracellular traps (NETs), were independent predictors of transplant‐free survival in patients with severe acute liver injury (ALI) or acute liver failure (ALF). This is an intriguing study; however, several points need a deep discussion. First, the authors showed that patients with acetaminophen (APAP) etiology had significantly lower plasma levels of MPO‐DNA complexes than patients with other etiologies. The timing of blood sampling due to rapid admission may be one of the reasons, as previous studies have revealed that neutrophil activation has been rarely observed at or before the peak of APAP‐induced ALI.[2] Moreover, a growing number of evidence have showed that neutrophils activation can also coordinate the resolution of inflammation, implying that there were two faces of neutrophil activation.[2] Hence, the role of neutrophil activation and NETs in APAP‐induced ALI and ALF remains unclear, even though innate immunity including neutrophils and macrophage activation has been found to be involved in this setting.[3,4] Second, it is not clear whether NETs can activate coagulation in liver diseases.[5] Hence, more in‐depth analysis about NETs and coagulation in this research may provide a more comprehensive understanding and is encouraged. First, plasma markers of thrombosis (e.g., plasma thrombin‐antithrombin complexes, D‐dimer levels), which were usually available in most clinical practice, could be recorded and analyzed. More importantly, as the interaction of NETs with platelets and coagulation factors may contribute to the formation of thrombi, colocalization of H3citB and platelets in the liver tissues by immunofluorescence could help determine whether there was an interaction between NETs with platelets in severe ALI and ALF. In conclusion, these data emphasize the need to classify the role of etiology and coagulation in NETs formation in severe ALI or ALF. CONFLICT OF INTEREST Nothing to report.
Objective
To sum up the experiences in liver transplantations from donation after brain death (DBD), and compare the clinical effect, complications and influential factors with international situation.
Methods
The retrospective descriptive study was adopted. All the data of 66 DBD liver donors and the matched recipients from authors’ affiliations during June 2010 and June 2013 were collected. Original articles, meta-analysis and data reports with high academic influence were read and data were analyzed with SPSS 22.0.
Results
The incidence of serious complications, vascular complications and biliary complications during the first year among 66 recipients was 21.2%, 10.6%, and 6.1%, respectively. Compared to international situation, graft 1-, 3-, and 5-year survival rate was similar (P>0.05) (83%, 80% and 73% respectively), similar to that of recipients. There was no statistically significant difference in primary nonfunction and vascular complications between our center and other centers. As for biliary complications, morbidity was lower in our center (P 0.05), though the 1-year survival rate was slightly lower (P<0.05).
Conclusion
These findings provide evidence that patient’s prognosis under DBD liver transplantation in our center is acceptable, and long-term survival rate has reached international level. Still, 1-year survival rate of recipients is unsatisfactory. In order to achieve a good clinical efficacy, we need to find out disadvantages during donor maintenance, recipient selection, surgical procedure and postoperative management.
Key words:
Liver transplantation; Organ donation; Complication; Survival rate
Computer virus is one of the main potential safety hazards to network data and application system of expressway tolls.With the development of expressway in our province,the traditional and commercialized anti-virus software is not powerful enough to counteract the increasing of computer virus.For this,the paper analyzes the strategy of computer anti-virus and safety-keep on charge and transmission for expressway based on the overall establishment of tolls network.
As one of the commonest postoperative complications after liver transplantation, fungal infection has a high incidence and mortality. Nowadays, the development of the organ transplantation technique in China has already entered into the era of donation after citizen's death (DCD). Donors of DCD are mainly derived from the patients after brain death, cardiac death or death of both brain and cardiac. These donors usually suffer from long-term hypotension, ischemia, anoxia and secon-dary recessive or dominant infections during emergency treatment. Hence, preventing the fungal infections in donor organs and recipients after transplantation plays an important role in improving the success rate of liver transplantation. This review focuses on the clinical significance of preventing fungal infection in DCD of liver transplantation.
Key words:
Fungal infection; Liver transplantation; Risk factors; Prophylaxis
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