Objective To investigate the frequency and determinants of liver stiffness measurement (LSM) failure by means of FibroScan in “real-life” Chinese patients. Methods A total of 38,464 “real-life” Chinese patients in 302 military hospital of China through the whole year of 2013, including asymptomatic carrier, chronic hepatitis B, chronic hepatitis C, liver cirrhosis (LC), alcoholic liver disease, autoimmune liver disease, hepatocellular carcinoma (HCC) and other, were enrolled, their clinical and biological parameters were retrospectively investigated. Liver fibrosis was evaluated by FibroScan detection. S probe (for children with height less than 1.20 m) and M probe (for adults) were used. LSM failure defined as zero valid shots (unsuccessful LSM), or the ratio of the interquartile range to the median of 10 measurements (IQR/M) greater than 0.30 plus median LSM greater or equal to 7.1 kPa (unreliable LSM). Results LSM failure occurred in 3.34% of all examinations (1286 patients out of 38,464), among them, there were 958 cases (2.49%) with unsuccessful LSM, and 328 patients (0.85%) with unreliable LSM. Statistical analyses showed that LSM failure was independently associated with body mass index (BMI) greater than 30 kg/m2, female sex, age greater than 50 years, intercostal spaces (IS) less than 9 mm, decompensated liver cirrhosis and HCC patients. There were no significant differences among other diseases. By changing another skilled operator, success was achieved on 301 cases out of 1286, which reduced the failure rate to 2.56%, the decrease was significant (P<0.0001). Conclusions The principal reasons of LSM failure are ascites, obesity and narrow of IS. The failure rates of HCC, decompensated LC, elder or female patients are higher. These results emphasize the need for adequate operator training, technological improvements and optimal criteria for specific patient subpopulations.
The 2014-2015 Ebola epidemic was considered to be the largest and most complex outbreak, which caused 11,310 reported deaths. The epidemic disease can cause a mental health crisis, however, there is only a small amount of scientific literature available related to this health issue so far. We evaluated the psychological symptoms of 161 participants including Ebola survivors and healthcare workers in Sierra Leone, analyzed the impact of job classification, education level on psychological status. We found that the order of total general severity index (GSI) scores from high to low was EVD survivors, SL medical staff, SL logistic staff, SL medical students, and Chinese medical staff. There were 5 dimensions (obsession-compulsion, anxiety, hostility, phobic anxiety, and paranoid ideation) extremely high in EVD survivors. GSI were associated with university education negatively. We believed our information is necessary to develop the comprehensive emergency response plan for emerging infectious disease outbreak.
Objective To determine the usefulness of transient elastography(FibroScan) combined with other serologic markers in diagnosing liver fibrosis.Methods The study enrolled 313 patients with hepatitis B virus(HBV) infection for routine biochemical examination,FibroScan,and liver biopsy.A Receive Operating Characteristic(ROC) curve was drawn and the area under the curve was analyzed to determine the cutoff value,sensitivity,specificity,positive predictive value,and negative predictive value of FibroScan,APRI,and FIB-4 for diagnosing different stages of liver fibrosis.Results FibroScan,APRI,and FIB-4 were used to diagnose moderate liver fibrosis.The areas under the curve(AUROC) were 0.791,0.792,and 0.796;the cutoff values were 9.3,0.65,and 1.15 kPa;the sensitivities were 55.1%,62.3%,and 69.1%;and specificities were 94.8%,88.3%,and 89.7%,respectively.For diagnosing liver cirrhosis,the AUROC were 0.947,0.911,and 0.953;the cutoff values were 15.4,1.14,and 2.96 kPa;the sensitivities were 90.0%,96.0%,and 88.0%;and the specificities were 87.8%,79.8%,and 92.8%,respectively.FibroScan combined with APRI or FIB-4 was used to diagnose moderate liver fibrosis,and the AUROC was 0.836,which is obviously higher than the AUROC(0.791,P < 0.05) obtained using FibroScan alone.Conclusion The combination of FibroScan with APRI or FIB-4 significantly improves the sensitivity of diagnosing moderate liver fibrosis without significantly reducing the specificity.It can be used as an alternative of liver biopsy,and in determining whether patients with transaminase levels less than twice the normal value need antiviral treatment or not.
Galectins are a family of soluble proteins which can specifically recognize the structure of β-galactoside.It is widely distributed in normal and diseased tissues, and plays an important role in cell adhesion, cell apoptosis, inflammatory response, tumor metastasis and other related processes.Galectin is a promising target for the treatment of many diseases, such as tumor, inflammation and neurological diseases.Herein, the synthesis and biological activities of small galectin inhibitors derived from D-galactose are reviewed according to the difference of derivatization sites, which are expected to provide research thought for designing galectin inhibitors with high affinity and high selectivity, and afford reference for development of new drug candidates targeting galectins.
Objective The rtL229 mutations in the reverse-transcriptase (RT) domain of hepatitis B virus (HBV) polymerase have been reported to have the ability to enhance the replication capacity of lamivudine (LAM)-resistant strains. This study aimed to investigate the evolution and phenotypic characteristics of rtL229 mutations. Methods The clinical characteristics of one representative patient with chronic hepatitis B who had received LAM treatment were retrospectively analyzed. HBV RT genes isolated from different serum samples were amplified by nested PCR, and clonal sequencing (>20 clones/sample) was done to analyze the evolution of rtL229F mutations. Meanwhile, the amplified HBV RT genes bearing different mutation patterns (wild-type, rtM204I, and rtL229F+rtM204I, respectively) were cloned into 1.1-fold HBV vector (pTriEx-mod-1.1) to generate replication-competent viral constructs. The recombinant constructs were transfected into HepG2 cells, which were cultured in the presence or absence of nucleos(t)ide analogs. Supernatant HBV DNA products were quantitated using real-time PCR . Results rtL229F mutation was secondary to rtM204I mutation during LAM treatment, and it regressed to wild-type strains together with rtM204I mutation after LAM withdrawal. Phenotypic assay showed that the single rtL229F mutation had no impact on the drug-susceptibility of HBV to nucleos(t)ide analogs, but could enhance the drug resistance of LAM-resistant rtM204I strain. Conclusion The rtL229F site mutation might be a compensatory mutation of LAM resistance, which is associated with suboptimal response to LAM treatment, and it still is susceptible to the treatment of adefovir dipivoxil, entecavir and tenofovir in vitro.
BACKGROUND Pulmonary lymphoepithelioma-like carcinoma (PLELC) is a rare type of non-small-cell lung cancer. Stomach lymphoepithelioma-like carcinoma (LELC) metastasis secondary to PLELC has not been reported recently. CASE SUMMARY A 64-year-old female was admitted to our hospital for a regular gastroscopy examination with a 6-year history of surgical resection for left PLELC. Positron emission tomography/computed tomography suggested high accumulation of 18F-fludeoxyglucose in the gastric cardia region. Upper gastrointestinal endoscopy confirmed a large mass at the stomach fundus. Immunohistochemistry (IHC) of the biopsy suggested metastatic stomach LELC. Proximal gastrectomy showed that this 6.5 cm × 5.0 cm mass was located in the stomach fundus near the cardia. Histopathological examination showed a poorly differentiated carcinoma with prominent lymphoplasmacytic infiltration. IHC demonstrated that the tumor was positive for CK (AE1/AE3), p63, p40, p53, Ki-67 (70%), and EGFR (3+) and negative for CK7, CK20, Her2, and CD10. In situ hybridization analysis showed positive staining Epstein-Barr virus-encoded RNA. Tumor programmed cell death ligand 1 (PD-L1) expression score was 98%, and the combined positive score was 100, with no evidence of microsatellite instability. Thus, the patient was unequivocally diagnosed with metastatic stomach LELC secondary to pulmonary LELC. After discharge, this patient underwent PD-1 inhibitor treatment (toripalimab, 240 mg) every 3 wk for ten cycles, and she has had no tumor recurrence. CONCLUSION For gastric LELC metastasis, PD-1 inhibitor therapy could become a new therapeutic approach, though there is still no evidence from large data sets to support this.
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