Objective: To explore the relationship between liver controlled attenuation parameters (CAP) and body fat mass and its distribution. Methods: From May to December 2018, 978 adult patients visited at the fatty liver center of the Third People's Hospital of Changzhou were treated. The patient's liver controlled attenuation parameters were measured by transient elastography and the body fat mass and its distribution were measured by bioelectrical impedance technology. Pearson’s correlation coefficient was adopted to describe the correlation between liver CAP value and body mass index (BMI), body fat mass index (BFMI), trunk fat mass index (TFMI), limbs fat mass index (LFMI) and visceral fat area (VFA). Receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to evaluate BMI, BFMI, TFMI, LFMI and VFA to differentiate the cut-off points and efficacy of CAP for diagnosing grading of fatty liver changes in S0-1 and S2-3. Results: In 653 cases of male, S0 ~ S3 accounted for 4.90%, 3.37%, 22.36% and 69.37%, respectively, and in 325 cases of females, S0 ~ S3 accounted for 7.38%, 6.46%, 13.23% and 72.92%, respectively. Female patients had more visceral, trunk and limbs fat than male (P < 0.01). Body mass, body fat mass, body fat percentage, BMI, BFMI, TFMI, LFMI, and VFA were increased in male and female patients with increasing liver fat grade (P < 0.01). CAP values ​​of male and female patients were positively correlated with BMI, BFMI, TFMI, LFMI and VFA. Percentage of body fat mass increased with increasing liver fat grade (male: F = 13.42, P < 0.001; female: F = 3.22, P = 0.023); while limb fat mass percentage did not increase with liver fat grade (Male: F = 1.13, P = 0.34; female: F = 1.05, P = 0.37). Hepatic steatosis grading (S0 ~ 1 or S2 ~ 3) diagnosed with CAP were distinguished through BMI, BFMI, TFMI, LFMI and VFA. AUC was 0.80 ~ 0.82 in males (P < 0.01), and 0.75 ~ 0.78 in females (P < 0.01). Conclusion The liver CAP value is positively correlated with the body's limbs, trunk and visceral fat, and has a strong correlation with trunk and visceral fat. BMI, BFMI, TFMI, LFMI and VFA up to some extent can identify the CAP diagnosis of grading of fatty liver changes in S0-1 and S2-3.

Objective: To study the correlation between the level of serum Chitinase-3-like protein 1 (CHI3L1) and the significant liver fibrosis and liver cirrhosis in patients with chronic liver disease, and to evaluate its diagnostic value. Methods: 165 patients with chronic liver disease were selected, liver histopathological examination was performed to detect serum CHI3L1 concentration. Four indexes of hepatic fibrosis (type III procollagen, collagen IV, laminin, hyaluronic acid), aspartate aminotransferase/platelet ratio index (APRI) and FIB-4 (fibrosis- 4) scores were based on the pathological findings of liver biopsy and compared the advantages and disadvantages of serum CHI3L1 with other methods for the diagnosis of hepatic fibrosis and liver cirrhosis. A multivariate regression analysis model was created, and receiver operating characteristic curve was analyzed. Results: The level of serum CHI3L1 increased with increase of fibrosis stage and was highest in liver cirrhosis stage. In the period of S0 to 1, the levels of S2 to 3 and S4 were 62.82 (41.40 ~ 87.20), 70.94 (48.47 to 122.60) and 141.06 (78.18 ~ 197.40), and there were statistically significant differences between the groups (P < 0.001). The area under the curve for the diagnosis of significant liver fibrosis was 0.68 (0.60 to 0.77), and 0.74 (0.65 to 0.83) for cirrhosis in CHI3L1. Multivariate regression analysis showed that CHI3L1 was an independent predictor of significant fibrosis and cirrhosis. The combined diagnostic model based on CHI3L1, collagen IV and FIB-4 scores further improved the diagnostic value. The area under the curve for the diagnosis of significant fibrosis and cirrhosis was 0.79 (0.72 to 0.86) and 0.80 (0.73 to 0.87), respectively. Conclusion CHI3L1 has a good diagnostic value in patients with chronic liver disease with significant fibrosis and liver cirrhosis. The diagnostic model in combination with other markers like Collagen IV and FIB-4 scores could further improve the diagnostic value and is worthy of further study.

Objective To evaluate the cost-effectiveness of entecavir and lamivudine in treatment of early stage acute on chronic liver failure (ACLF),and analyze the predictive factors.Methods Forty nine patients with early ACLF were enrolled.Of which,28 patients were treated with entecavir,and 21 patients were treated with lamivudine.Mortality,length of hospital stay,cost,liver function,coagulation function,and model for end-stage liver disease (MELD) score were compared between two groups.Pharmacoeconomic evaluation was taken using cost-effectiveness analysis and cost minimization analysis.Results Mortality,length of hospital stay and cost had no significant difference between two groups.Ratio of costeffectiveness in lamivudine group was higher than that in entecavir group.Cox analysis showed that primary peritonitis and MELD score at the end of the second week were the main predictive factors.Conclusions Entecavir cannot improve the survival rate of early stage ACLF compared to lamivudine,but may provide economic benefit to patients with early stage ALCF.

Hepatitis B virus (HBV)-related liver failure is an end-stage liver disease with a high mortality.Biomarkers,which are of interest,are helpful for diagnosis and treatment of liver failure.The purpose of this review is to highlight the recent advances in this field.Although many new biomarkers can improve the prognostic efficacy,the dynamic biochemical function of liver and kidney as well as the function of coagulation are still the most practical and common indexes for the development and prognosis evaluation of liver failure.

AIM:To investigate the role of p38 MAPK/ATF-2 pathway in C-relative protein ( CRP)-induced endothelial cell activation.METHODS:Human coronary artery endothelial cells ( HCAEC) were cultured and were used between passages 3 and 7.CRP served as a stimulus for endothelial cell activation.Western blotting was performed to de-termine the expression and phosphorylation of eNOS, p38 and ATF2.ELISA was carried out to detect the levels of ICAM-1, VCAM-1 and MCP-1 released from HCAEC.Pharmacological p38 inhibitors SB203580 and SB202190 were used to de-termine the effect of p38/ATF-2 pathway.RESULTS:CRP reduced the p-eNOS level in a concentration-dependent man-ner and induced the release of ICAM-1, VCAM-1 and MCP-1.The p38/ATF-2 pathway was activated by CRP treatment. SB203580 and SB202190 partially rescued p-eNOS level and suppressed the secretion of ICAM-1, VCAM-1 and MCP-1. CONCLUSION:p38MAPK/ATF-2 pathway participates in CRP-induced endothelial activation.

[ ABSTRACT] AIM:To investigate the effects of microRNA-378*( miR-378*) on the survival and apoptosis of human mesenchymal stem cells ( hMSCs ) .METHODS: The expression of miR-378* was determined by microRNA arrays and quantitative real-time PCR ( qRT-PCR) .H2 O2 was used to induce hMSCs apoptosis.By transfection of miR-378*mimic or inhibitor, we up-regulated or down-regulated miR-378* expression in hMSCs.The effect of miR-378*and connective tissue growth factor ( CTGF) on hMSC survival and apoptosis were detected by MTT, LDH, caspase-3/7 and TUNEL assays.RESULTS:The expression of miR-378*was up-regulated in the old hMSCs compared with the young hMSCs.H2 O2 increased the expression of miR-378*, decreased the expression of CTGF.Up-regulation of miR-378*re-sulted in increasing apoptosis and decreasing survival of hMSCs.Conversely, down-regulation of miR-378*resulted in de-creasing cell apoptosis and increasing survival.The regulation of miR-378*on hMSC apoptosis and survival was attenuated by inhibiting the expression of miR-378* and CTGF together.Direct repression of CTGF expression inhibited the hMSC survival and increased apoptosis.CONCLUSION:miR-378*enhances apoptosis of hMSCs by repressing the expression of CTGF.

Objective To investigate the correlation of hepatitis B virus (HBV) markers between umbilical cord blood and maternal serum.Methods A total of 340 HBsAg positive mothers who delivered at the Third People' s Hospital of Changzhou during August 2009 and November 2010 were included in the study.HBV markers in the maternal serum before childbirth and umbilical cord blood after birth were quantitatively detected.The neonates received 3 doses of hepatitis B vaccine and 2 doses of hepatitis B immunoglobulin (HBIG),and followed up for 12 months.Measurement data were expressed as median (M),and Kruskal-Wallis test and Spearman correlation analysis were performed.Results There were 175HBeAg-positive and 165 HBeAg-negative mothers,and a total of 341 infants were delivered.The positive rates of HBsAg,anti-HBs,HBeAg,anti-HBe and anti-HBc in maternal serum were 100.00％,0.0％,51.47％,38.82％ and 99.41％,respectively; while those in umbilical cord bloods were 14.66％,0.59％,26.69％,39.88％ and 95.31％,respectively.HBsAg concentration in maternal serum of HBsAg-positive umbilical cord blood group was higher than that of HBsAg-negative umbilical cord blood group (419.40∶ 387.95,x2 =4.592,P ＜ 0.05) ; while HBsAg concentration in umbilical cord blood of HBeAg-positive maternal serum was higher than that of the HBeAg-negative maternal serum group (0.04 ∶ 0.01,x2 =5.674,P ＜ 0.05).Anti-HBe and anti-HBc in umbilical cord blood were positively correlated with those in maternal serum (r =0.838,0.764,P ＜ 0.01).Seven out of 62 (11.29％) infants were infected with HBV in HBeAg-positive maternal serum group; while no infant infected in HBeAg-negative matemal serum group.Conclusion The higher maternal serum HBsAg concentration,the greater the risk of perinatal transmission,and infants born by HBeAg-positive mothers are of high risk of HBV infection.

The medical education has long paid great attention to students' specialized knowledge education and neglected the humanities education for all-around development excessively. Diagnostics is a bridge curriculum between basic medicine and clinical medicine. Enhancing the quality education by fully combining the process of diagnostics teaching plays an important role in qualified medical talents training.