Background/Aims: Existing hepatocellular carcinoma (HCC) prediction models are derived mainly from pretreatment or early on-treatment parameters. We reassessed the dynamic changes in the performance of 17 HCC models in patients with chronic hepatitis B (CHB) during long-term antiviral therapy (AVT). Methods: Among 987 CHB patients administered long-term entecavir therapy, 660 patients had 8 years of follow-up data. Model scores were calculated using on-treatment values at 2.5, 3, 3.5, 4, 4.5, and 5 years of AVT to predict threeyear HCC occurrence. Model performance was assessed with the area under the receiver operating curve (AUROC). The original model cutoffs to distinguish different levels of HCC risk were evaluated by the log-rank test. Results: The AUROCs of the 17 HCC models varied from 0.51 to 0.78 when using on-treatment scores from years 2.5 to 5. Models with a cirrhosis variable showed numerically higher AUROCs (pooled at 0.65–0.73 for treated, untreated, or mixed treatment models) than models without (treated or mixed models: 0.61–0.68; untreated models: 0.51–0.59). Stratification into low, intermediate, and high-risk levels using the original cutoff values could no longer reflect the true HCC incidence using scores after 3.5 years of AVT for models without cirrhosis and after 4 years of AVT for models with cirrhosis. Conclusions The performance of existing HCC prediction models, especially models without the cirrhosis variable, decreased in CHB patients on long-term AVT. The optimization of existing models or the development of novel models for better HCC prediction during long-term AVT is warranted.

Objective:Hepatic amyloidosis is a metabolic disease with a low incidence rate. However, because of its insidious onset, the rate of misdiagnosis is high, and it usually progresses to a late stage when it is diagnosed. This article analyzes the clinical features of hepatic amyloidosis by combining clinical pathology in order to improve the clinical diagnosis rate.Methods:Clinical and pathological data of 11 cases of hepatic amyloidosis diagnosed at the China-Japan Friendship Hospital from 2003 to 2017 were summarized and analyzed retrospectively.Results:The clinical manifestations of 11 cases mainly included abdominal discomfort (4/11), hepatomegaly (7/11), splenomegaly (5/11), fatigue (6/11), etc. Biochemical test results showed that most patients' alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transferase, total bilirubin, direct bilirubin, and total bile acids, accompanied by hypoalbuminemia were elevated, while some patients' 24-h urinary protein, creatinine, and blood urea nitrogen were elevated.Conclusion:All patients had slightly elevated aspartate transaminase levels (within 5 times the upper limit of normal), and 72% had slightly elevated alanine transaminase. Alkaline phosphatase and γ-glutamyl transferase levels were significantly raised in all cases, with the highest result for γ-glutamyl transferase being 51 times the upper limit of normal. Damage to the hepatocytes has an effect on the biliary system as well, leading to symptoms such as portal hypertension and hypoalbuminemia [(0.54~0.63) × upper limit of normal value, 9/11]. Amyloid deposits within the artery wall (54.5% of patients) and portal vein (36.4% of patients) were also indicative of vascular injury. A liver biopsy should be recommended for patients with unexplained elevated transaminases, bile duct enzymes, and portal hypertension in order to establish a definitive diagnosis.

Objective: To explore the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection who received entecavir alone or in combination with anluohuaxianwan for 78 weeks. Methods: Patients with chronic HBV infection were randomly treated with entecavir alone or in combination with anluohuaxian for 78 weeks. Ishak fibrosis score was used for blind interpretation of liver biopsy specimens. The improvement in liver fibrosis condition before and after the treatment was compared. Student's t test and non-parametric test (Mann-Whitney U-Test and Kruskal-Wallis test) were used to analyze the measurement data. The categorical variables were analyzed by Chi-square test method and Spearman’s rank correlation coefficient was used to test bivariate associations. Results: Liver fibrosis improvement rate after 78 weeks of treatment was 36.53% (80/219) and the progression rate was 23.29% (51/219). The improvement of liver fibrosis was associated to the degree of baseline fibrosis and treatment methods (P < 0.05). The improvement rate of hepatic fibrosis in patients treated with anluohuaxianwan combined with entecavir at baseline F < 3 (54.74%, 52/95) was significantly higher than that in patients treated only with entecavir (33.33%, 16/48), P = 0.016 and the progression rate of hepatic fibrosis (13.68%, 13/95) was lower than that in patients treated alone (18.75%, 9/48), P = 0.466. In patients with baseline F < 3, the proportion of patients with improved and stable liver fibrosis in the combined treatment group (68.1%, 32/47) was higher than that in the treatment group alone (51.7%, 15/29). Conclusion Combined anluohuaxianwan and entecavir treatment can significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection. Furthermore, it has the tendency to improve the stability rate and reduce the rate of progression of liver fibrosis.

Objective To study clinical efficacy of ganciclovir in the therapy of infectious mononucleosis in adults.Methods 66 adults with infectious mononucleosis in a hospital from January 2010 to December 2014 were studied retrospectively,according to drug therapy,patients were divided into ganciclovir therapy group(n=31)and symptomatic therapy group(n=35),clinical features before therapy,therapeutic efficacy,and Epstein-Barr virus(EBV)DNA negative conversion time were analyzed.Results The time of defervescence,sore throat improvement,EBV-DNA negative conversion,subside of enlarged lymph node,and transaminase recovery in ganciclovir therapy group were all shorter than symptomatic therapy group(all P<0.05).Blood routine recovery time between two groups was not significantly different(P>0.05).Conclusion Ganciclovir has a good antiviral effect on the therapy of adult infectious mononucleosis,it can rapidly relieve patients from clinical symptoms including fever,sore throat and so on.

OBJECTIVETo analyze the reason of biochemical suboptimal response in CHB patients with complete virological response after more than 2 years standard treatment with Nucleos(t)-ide analogs (NUCs).To evaluate the efficacy and safety profiles of bicyclol tablets plus on the basis of the original treatment and lifestyle intervention. in CHB patients complicated with fatty liver.

METHODSIn 40 patients with chronic hepatitis B meeting the inclusion criteria,the liver biopsy was conducted.And patients complicated with fatty liver were treated with bicyclol tablets (25 mg, t.i.d) additional consecutive 48 weeks. The changes of serum biochemistry indexes and liver fibrosis index were observed before and after treatment.

RESULTSAmong 40 patients, 27 were complicated with fatty liver(69.23%), fatty degree in liver cell and liver inflammatory were closely related to the advanced fibrosis (x² =4.746, P=0.029; x² =5.072, P=0.024). The expression of HBsAg in serum and liver tissue showed no correlation with the advanced fibrosis (x² = 0.273, P=0.601; x² = 0.020, P =0.887) After bicyclol tablets treatment, serum biochemistry of patients complicated with fatty liver significantly decreased (F=58.045, P =0.000), plasma GST-PX significantly increased (t=15.109, P =0.000), plasma MDA significantly decreased (t=-10.786, P=0.000); LSM significantly decreased (t=2.255, P=0.036; t =5.376, P =0.002).

CONCLUSIONFor the antiviral purpose of guide treatment, CHB patients treated with Nucleos(t)-ide analogs (NUCs) with biochemical suboptimal response, other risk factors should be considered as early as possible. Bicyclol plus lifestyle intervention was effective for chronic hepatitis B combined fatty liver patients with poor biochemical responses.

Antiviral Agents ; Fatty Liver ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic ; Humans ; Liver Cirrhosis

Objective: To explore the effect of oxidative stress injury on the mechanism of vascular smooth muscle cell (VSMC) calciifcation induced by calcium and phosphorus in experimental rats.
Methods: The VSMC calcification was induced by incubating the cells with calcium chloride (CaCl2) andβ-sodium glycerophosphate (β-GP) for 8 days, and the cells were divided into 4 groups: ① Control group, ② Calcification group,③ Calciifcation+H2O2 group, ④ Calciifcation+catalase group. The calcium nodule formation and calcium deposition in VSMC were detected by Alizarin red staining and o-cresolphthalein complexone method, the reactive oxygen species (ROS) was detected by DCFH-DA probe staining and the protein expression of Runx2 was examined by Western blot analysis.
Results: Compared with Control group, Calciifcation group showed the higher ROS production, more calcium nodule and calcium deposition, higher Runx2 protein expression;while compared with Calciifcation group, the above indexes were even higher in Calciifcation+H2O2 group, P<0.05. The ROS production, calcium nodule, calcium deposition and Runx2 protein expression were lower in Calciifcation+catalase group than those in Calciifcation group and Calciifcation+H2O2 group, but still higher than that in Control group. The protein expression of Runx2 was similar between Calciifcation+catalase group and Control group, P>0.05.
Conclusion: CaCl2 andβ-GP treatment may induce VSMC calciifcation via activating ROS-Runx2 signal pathway in experimental rats.

Objective: To explore the effects of Vitamin K2 (VK2) on theaortic artery calciifcation and oxidative stress injury in experimental rats.
Methods: A total of 24 rats were divided into 4 groups:①Control group,②6-week calciifcation group,③12-week calciifcation group and④6-week calciifcation + 6-week VK2 group;n=6 in each group. The arterial calciifcation was induced by warfarin (WFN) treatment. The calcium nodule and deposition in rat’s theaortic artery were detected by Alizarin red staining and o-cresolphthalein complexone method, the reactive oxygen species (ROS) were measured by DHE probe staining and the morphological changes of mitochondria in smooth muscle cells were detected by transmission electron microscopy.
Results: Calciifcation nodule formed in both 6-week and 12-week calciifcation groups, the calciifcation deposition and ROS were higher than Control group,P<0.01. Compared with both calcification groups, the above indexes were decreased in 6-week calciifcation + 6-week VK2 group,P<0.01. Both calciifcation groups showed mitochondria swelling with unclear structure and cytoplasm vacuoles degeneration in vascular smooth muscle cells. The vascular smooth muscle cell volumes were similar between Control group and 6-week calcification + 6-week VK2 group, and no cytoplasm vacuoles degeneration was observed.
Conclusion: Warfarin induced aortic calciifcation is related to oxidative stress injury which may cause the ultra-micro structural damage in smooth muscle cells; VK2 may reduce the oxidative stress injury and improve the condition of vessel calciifcation in experimental rats.

OBJECTIVETo evaluate the correlation of liver hardness testing

RESULTSobtained by FibroTouch and FibroScan and the liver pathological stage.

METHODSSeventy-five patients with chronic hepatitis B who presented to our clinic between January 2011 and April 2013 were examined with FibroTouch and FibroScan to evaluate the degree of liver fibrosis. Forty-six of those patients also underwent liver biopsy examination.

THE RESULTSfrom technology-based testing and histopathological evaluation of the biopsy were compared by statistical analysis to determine the consistency of FibroTouch and FibroScan in regard to histological stage.

RESULTSAnalysis by paired t-test showed that the

RESULTSfrom FibroTouch and FibroScan were not significantly different (t = -0.17, P =0.8616), and the correlation coefficient from Pearson's correlation analysis was 0.9949 (P less than 0.05), suggesting that the two technologies'

RESULTSare correlated. Based on the histopathology

RESULTSfor liver fibrosis stage, the FibroTouch diagnosis of liver fibrosis more than or equal to S 1 had a receiver operating characteristic (ROC) area under the curve (AUC) of 0.889, diagnosis of liver fibrosis more than or equal to S2 had a ROC AUC of 0.941, diagnosis of liver fibrosis more than or equal to S3 had a ROC AUC of 0.908, and diagnosis of liver fibrosis more than or equal to S4 had a ROC AUC of 0.911.

CONCLUSIONCompared to FibroScan, FibroTouch has a better ability for detecting liver fibrosis and a better consistency with liver pathological stage determined by histopathological analysis.

Adult ; Aged ; Area Under Curve ; Biopsy ; Case-Control Studies ; Elasticity Imaging Techniques ; instrumentation ; Female ; Hepatitis B, Chronic ; pathology ; Humans ; Liver ; pathology ; Male ; Middle Aged ; Prospective Studies ; Young Adult