Objective:To explore the value of tacrolimus blood concentration and other related indexes in evaluating early postoperative infection in patients with liver transplantation.Methods:Patients with complete medical records who underwent liver transplantation in the First Affiliated Hospital of Nanjing Medical University from January 2014 to December 2019 were screened. Cohort study was used, and demographic data, laboratory test results, tacrolimus blood concentration and other data of patients with liver transplantation were collected. All patients with postoperative infection were divided into four groups, inculding two to four weeks, five to 12 weeks, 13 to 52 weeks and >52 weeks groups, and uninfected patients in each group were matched 1∶1 according to age ± 3 years old. Independent sample t test and rank sum test were used to analyze the differences in clinical data between postoperative infected and uninfected patients with liver transplantation patients. Logistic regression analysis was used to explore the influencing factors of infection in the early postoperative period (two to four weeks after operation). The relative safe value of tacrolimus blood concentration in the early postoperative period was evaluated by receiver operating characteristic curve. Results:A total of 150 patients with infection after liver transplantation were included, including 65 patients in the two to four weeks group, 31 patients in the five to 12 weeks group, 27 patients in the 13 to 52 weeks group, and 27 patients in the >52 weeks group. There were 52, 30, 32, and 39 uninfected patients in the four groups, respectively. There were 247 males (81.52%) in 303 patients with liver transplantation, and the age ranged from 10 to 78 years old. Hepatitis B cirrhosis and hepatocellular carcinoma were the main primary diseases, accounting for 41.91%(127/303) and 47.52%(144/303), respectively. The tacrolimus blood concentration and alanine aminotransferase in patients with infection in the two to four weeks group were (11.46±4.94) μg/L and 118.20(38.80, 215.80) U/L, respectively, which were both higher than those in the uninfected group ((7.12±2.33) μg/L and 39.40(23.40, 142.70) U/L, respectively). The differences were both statistically significant ( t=6.26, Z=2.66, respectively, both P<0.05). Sputum sources accounted for the largest number of samples, accounting for 61.6%(98/159). A total of 174 pathogens were isolated, of which gram-negative bacteria (55.2%(96/174)) were the majority, mainly Klebsiella pneumoniae (20.1%(35/174)) and Acinetobacter baumannii (13.8%(24/174)). Multivariate analysis showed that tacrolimus blood concentration (odds ratio ( OR)=1.634, 95% confidence interval ( CI) 1.298 to 2.058, P=0.001) was a risk factor for infection at two to four weeks after liver transplantation, while lymphocyte count ( OR=0.165, 95% CI 0.057 to 0.474, P=0.010) was a protective factor. The area under the curve of tacrolimus blood concentration in evaluating the infection at two to four weeks after liver transplantation was 0.817. The cut-off value was 8.7 μg /L ( P<0.05), with the sensitivity of 0.708 and the specificity of 0.846. Conclusions:The main site of infection in patients with liver transplantation is respiratory system. Gram-negative bacilli are the main pathogens. When tacrolimus blood concentration is below 8.7 μg/L at two to four weeks after liver transplantation, the probability of infection in the early postoperative period may be reduced.

Objective:To explore the predictive value of nutrition risk screening score 2002 (NRS-2002) and L3 skeletal muscle index (L3-SMI) for mortality within 90 days in patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF).Methods:A retrospective analysis was conducted on 162 cases with HBV-ACLF who were diagnosed and treated at the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2023. Patients were divided into a survival and death group according to the 90-day survival status following diagnosis, and the clinical data between the two groups were compared. Binary logistic regression analysis was used to screen out the influencing factors related to the occurrence of mortality events. The receiver operating characteristic (ROC) curve was plotted to compare the predictive value of NRS-2002 and L3-SMI for mortality within 90 days in patients with HBV-ACLF.Results:There were statistically significant differences in lymphocyte count (LY), platelet (PLT), total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, international normalized ratio (INR), total bilirubin (TBil), urea, model for end-stage liver disease (MELD) score, NRS-2002 score, and L3-SMI between the death and the survival group ( P<0.05). Multivariate analysis showed that higher levels of INR [odds ratio ( OR)=4.412, 95% confidence interval ( CI): 1.974-9.959, P<0.001], TBil ( OR=1.004, 95% CI: 1.001-1.007, P<0.05), MELD score ( OR=1.148, 95% CI: 1.071-1.232, P<0.001), NRS-2002 score ( OR=1.526, 95% CI: 1.194-1.950, P<0.05), and lower levels of LY ( OR=0.351, 95% CI: 0.103-0.755, P<0.01), and L3-SMI ( OR=0.902, 95% CI: 0.854-0.953, P<0.001) were independent risk factors for 90-day mortality in patients with HBV-ACLF. The ROC curve showed that AUCL3-SMI was 0.706 and AUCNRS-2002 was 0.712. Multivariate logistic analysis showed that the optimal cutoff point for the prediction of 90-day mortality was 0.5. The area under the ROC curve was 0.841 (95% CI: 0.763-0.926), which was significantly higher than the single application of the MELD, NRS-2002, and L3-SMI indicators. Conclusion:The 90-day mortality risk has a correlation with low L3-SMI and high NRS-2002 scores in patients with HBV-ACLF. The SNM model has a certain predictive value for mortality within 90 days in patients with HBV-ACLF.

Objective:To explore the antiviral activity of the small-molecule compound AM679 in hepatitis B virus (HBV) replication and infection cell models.Methods:The positive regulatory effect of AM679 on EFTUD2 expression was validated by qPCR and Western blotting. HepAD38 and HepG2-NTCP cells were treated with AM679 (0.5, 1, and 2 nmol/L). Negative control, positive control, and AM679 combined with the entecavir group were set up. HBV DNA intra-and extracellularly, as well as the expression levels of intracellular HBV total RNAs and 3.5kb-RNA changes, were detected with qPCR. Hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) levels were measured in the cell supernatant by an enzyme-linked immunosorbent assay (ELISA). The t-test method was used for the statistical analysis of the mean difference between groups.Results:EFTUD2 mRNA and protein expression levels were significantly increased in HepAD38 and HepG2-NTCP cells following AM679 treatment, with a statistically significant difference ( P ?

Objective:To explore the predictive value of nutrition risk screening score 2002 (NRS-2002) and L3 skeletal muscle index (L3-SMI) for mortality within 90 days in patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF).Methods:A retrospective analysis was conducted on 162 cases with HBV-ACLF who were diagnosed and treated at the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2023. Patients were divided into a survival and death group according to the 90-day survival status following diagnosis, and the clinical data between the two groups were compared. Binary logistic regression analysis was used to screen out the influencing factors related to the occurrence of mortality events. The receiver operating characteristic (ROC) curve was plotted to compare the predictive value of NRS-2002 and L3-SMI for mortality within 90 days in patients with HBV-ACLF.Results:There were statistically significant differences in lymphocyte count (LY), platelet (PLT), total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, international normalized ratio (INR), total bilirubin (TBil), urea, model for end-stage liver disease (MELD) score, NRS-2002 score, and L3-SMI between the death and the survival group ( P<0.05). Multivariate analysis showed that higher levels of INR [odds ratio ( OR)=4.412, 95% confidence interval ( CI): 1.974-9.959, P<0.001], TBil ( OR=1.004, 95% CI: 1.001-1.007, P<0.05), MELD score ( OR=1.148, 95% CI: 1.071-1.232, P<0.001), NRS-2002 score ( OR=1.526, 95% CI: 1.194-1.950, P<0.05), and lower levels of LY ( OR=0.351, 95% CI: 0.103-0.755, P<0.01), and L3-SMI ( OR=0.902, 95% CI: 0.854-0.953, P<0.001) were independent risk factors for 90-day mortality in patients with HBV-ACLF. The ROC curve showed that AUCL3-SMI was 0.706 and AUCNRS-2002 was 0.712. Multivariate logistic analysis showed that the optimal cutoff point for the prediction of 90-day mortality was 0.5. The area under the ROC curve was 0.841 (95% CI: 0.763-0.926), which was significantly higher than the single application of the MELD, NRS-2002, and L3-SMI indicators. Conclusion:The 90-day mortality risk has a correlation with low L3-SMI and high NRS-2002 scores in patients with HBV-ACLF. The SNM model has a certain predictive value for mortality within 90 days in patients with HBV-ACLF.

Objective:To investigate the efficacy and safety profile of different doses of magnesium isoglycyrrhizinate in the treatment of chronic liver disease with elevated alanine aminotransferase (ALT).Methods:Computer retrieval of literature was conducted in the CNKI, Wanfang, and PubMed databases from the establishment of the databases until February 2023. The Cochrane risk of bias assessment tool was used to evaluate the quality of the included literature after screening the literature and extracting the data. RevMan 5.4 and Stata 15.0 software were used to analyze the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), total effective rate, and incidence of adverse events.Results:Finally, 10 articles were selected, including a total of 1 522 cases. All the included studies were of good quality and at low risk of bias. Meta-analysis results showed that compared with 100 mg/d magnesium isoglycyrrhizinate injection, 200 mg/d magnesium isoglycyrrhizinate injection had significantly reduced patients' ALT [ MD = -30.73, 95% confidence interval ( CI): -52.52 ~ -8.94, Z = 2.76, P = 0.006; I2 = 98%, P < 0.001], AST ( MD = -34.30, 95% CI: -57.78 ~ -10.82, Z = 2.86, P = 0.004; I2 = 99%, P < 0.001) and TBil ( MD = -15.37, 95% CI: -27.66 ~ -3.09), Z = 2.45, P = 0.01; I2 = 98%, P < 0.001) levels. The total effective rate reported in seven articles showed no heterogeneity among the studies ( I2 = 0.0%, P = 0.98). The total effective rate was higher in 200 mg/d magnesium isoglycyrrhizinate injection than that of 100 mg/d magnesium isoglycyrrhizinate injection ( OR = 3.49, 95% CI: 2.05 ~ 5.95, Z = 4.59, P < 0.001), and there was no statistically significant difference in adverse reactions. Conclusion:200 mg/d magnesium isoglycyrrhizinate injection can more rapidly and effectively improve the levels of ALT, AST, and TBil in patients with chronic liver disease, with an increased total effective rate and a good safety profile.

Objective:To study the predictive value of the systemic immune inflammation index (SII) on the overall survival rate of patients after Whipple surgery for pancreatic ductal adenocarcinoma (PDAC).Methods:The clinical data of patients with PDAC who underwent Whipple surgery at the First Affiliated Hospital of Zhengzhou University from January 1, 2010 to December 31, 2017 were retrospectively analyzed, and the SII value was calculated. The best cut-off value of SII was 900, and all patients were divided into the low SII group (SII≤900) and the high SII group (SII>900) using 900 as the dividing point. The Kaplan-Meier method was used to draw survival curves and the log-rank test was used. The overall survival of the two groups of patients were analyzed. The Cox risk regression model was used to perform univariate analysis of the various clinicopathological parameters, and multivariate analysis for the statistically significant indicators.Results:Of 135 patients enrolled into this study, there were 78 males and 57 females, aged 28.0-76.0 (56.6±8.8) years. There were 92 patients in the low SII group, aged (56.9±9.2) years with 53 males and 39 females; and 43 patients in the high SII group, aged (56.1±7.9) years, with 25 males and 18 females. The median survival of the low SII group and the high SII group were 32.7 months (95% CI: 28.4-37.0) and 24.4 months (95% CI: 21.4-27.4), respectively. The survival of patients with PDAC in the low SII group was significantly higher than that in the high SII group ( P<0.05). On univariate survival analysis, postoperative overall survival of patients with PDAC was significantly associated with high SII ( HR=2.047, 95% CI: 1.354-3.096), R 1 margin ( HR=2.595, 95% CI: 1.663-4.048), a positive rate of lymph node>20% ( HR=3.244, 95% CI: 1.888-5.573), and positive regional lymph node (N1) ( HR=3.061, 95% CI: 1.993-4.702), all P<0.05. Multivariate Cox regression analysis showed that high SII ( HR=1.672, 95% CI: 1.094-2.555), R 1 resection margin ( HR=2.167, 95% CI: 1.274-3.685), and a positive rate of lymph node>20% ( HR=2.631, 95% CI: 1.309-5.285) to be independent risk factors affecting overall survival ( P<0.05). Conclusion:SII was an independent prognostic factor available before surgery for patients with PDAC. It has some guiding significance in predicting overall survival in patients after Whipple surgery for PDAC.

Objective To explore the effect of platelet-rich plasma (PRP) on the generation of reactive oxygen species (ROS) and the phenotypes of photo-aging fibroblasts.Methods A photoaging cell model by repeating UVB irradiation was treated using appropriate concentration of PRP;Cell morphology and the rate of aging dying were observed under inverted microscope 24 hours later after establishment of the cell model;The expression of ROS between experimental and control group was detected using fluorescence microscope after single UVB irradiation.The relative intensity of fluorescence was analyzed using flow cytometry.Results PRP could ameliorate the large and sprawl appearance of photoaging fibroblasts obviously,reduce the generation of ROS as well as decrease the relative intensity of ROS.Conclusions PRP can decrease the level of intracellular oxidative stress caused by UVB irradiation,reduce the generation of ROS and ameliorate the senescence-like phenotypes of pho toaging fibroblasts.

[Abstract ] Objective The role of serum Pygo2 expression in children with non-alcoholic fatty liver disease(NAFLD) in the disease process and whether it can be used to evaluate the degree of liver fibrosis still remain unknown .The article aimed to detect Pygo 2 expression in the peripheral blood of children with NAFLD and ana-lyze its relationship with traditional serum hepatic fibrosis index in or-der to evaluate the clinical significance of Pygo 2 measurement in chil-dren with NAFLD . Methods We enrolled 120 cases of childhood obesity and 18 healthy controls in Anhui Provincial Hospital and the First Affiliated Hospital of Nanjing Medical University from September 2014 to February 2016.The cases of childhood obesity were di-vided into simple obesity group ( n=44, no diffuse fatty liver under liver ultrasound detection ) , NAFL group ( n=35, diffuse fatty liver with normal liver function under liver ultrasound detection ) and NASH group ( n=41, diffuse fatty liver with abnormal liver function under liver ultrasound detection ) .The peripheral serum was collected from all patients and healthy controls .ELISA was used to detect serum Pygo2 expression and radioimmunoassay was used to detect the serum hyaluronia acid (HA), procollagen type Ⅲ(PCⅢ), pro-collagen type Ⅳ(CⅣ) and laminin(LN) levels.Finally the serum ALT and γ-GT levels were measured with totally automatic enzymat-ic method. Results Pygo2 expression in NAFL group [52.1(12.3)μg/L] and NASH group[78.3(50.0)μg/L] increased signifi-cantly compared with simple obesity group [43.2(18.7)μg/L](P<0.05).Pygo2 expression in NASH group increased significantly compared with control group [41.7(16.8)μg/L] and NAFL group (P<0.001).The serum hepatic fribrosis and inflammation markers ( HA, PC, ALT, C III and IV gamma-GT) levels gradually increased in the obese children .There were statistically positive correla-tions between serum Pygo2 and HA, PCⅢ, CⅣ, ALT or γ-GT (P<0.001).In particular, more significant positive correlations were found between serum Pygo2 and HA, CⅣor γ-GT (r=0.708, P<0.001;r=0.589, P<0.001;r=0.674, P<0.05). Conclusion The degree of liver fibrosis worsens with the increase of Pygo 2 expression and Pygo 2 is in remarkable correlation with conventional he-patic fibrosis serum makers ( HA, C IV) orγ-GT, which shows Pygo 2 expression can be taken as the clinical evaluation index of liver fibrosis in children with NAFLD .

BACKGROUND/AIMS: The Wnt/beta-catenin signaling pathway has been reported to play an important role in liver fibrosis. This study was designed to investigate whether mesoderm-specific transcript homologue (Mest), a strong negative regulator of Wnt/beta-catenin signaling, could inhibit liver fibrosis. METHODS: pcDNA-Mest was transfected into hepatic stellate cells (HSCs) and rats. Rats were randomly divided into four groups: normal group (normal saline), treatment group (pcDNA-Mest+CCl4), control group (pcDNA-neo+CCl4), and model group (normal saline+CCl4). Changes in liver pathology were evaluated by hematoxylin and eosin and Masson's trichrome staining. The levels of alanine transaminase, aspartate transaminase, lactic dehygrogenase, hyaluronic acid, and laminin in the serum and hydroxyproline in the liver were detected by biochemical examination and radioimmunoassay, respectively. The expression and distribution of beta-catenin, alpha-smooth muscle actin (alpha-SMA), Smad3, and tissue inhibitor of metalloproteinase type I were determined, and the viability of the HSCs was tested. RESULTS: Our data demonstrate that Mest alleviated CCl4-induced collagen deposition in liver tissue and improved the condition of the liver in rats. Mest also significantly reduced the expression and distribution of beta-catenin, alpha-SMA and Smad3 both in vivo and in vitro, in addition to the viability of HSCs in vitro. CONCLUSIONS: We found that Mest attenuates liver fibrosis by repressing beta-catenin expression, which provides a new therapeutic approach for treating liver fibrosis.
Animals ; Carbon Tetrachloride/toxicity ; Cells, Cultured ; Hepatic Stellate Cells/physiology ; Liver Cirrhosis, Experimental/*physiopathology ; Male ; Proteins/*physiology ; Random Allocation ; Rats, Wistar ; Transfection ; Wnt Signaling Pathway/*physiology ; beta Catenin/metabolism

Objective To explore the principle of diagnosis and treatment of early postoperative inflammatory ileus. Method To retrospectively analyse the clinical data and treatment results of early postoperative inflammatory ileus. Results 15 cases after fasting, decompression, nutritional support, somatostatin and dexamethasone, and other conservative treatment were cured. Conclusion Early postoperative inflammatory ileus usually occurred in 2 weeks, has a typical performance of the obstruction, conservative treatment is effective.