The association between circulating oestradiol levels and severity of liver disease in males with hepatitis B virus infection

Role of routine check-up in the prognosis of patients with pancreatic cancer: A puzzling phenomenon

BACKGROUND

The high coverage of annual routine health check-up in China is a unique phenomenon throughout the world. However, its clinical value is controversial. In this cohort study, we chose pancreatic cancer as a disease model to explore the role of routine check-up in the prognosis of patients with pancreatic cancer.

METHODS

Data from 157 patients who were diagnosed with pancreatic cancer between January 2010 and April 2014 were collected. Patients were divided into two groups depending on how their disease was detected. Group A (n = 85): Patients were diagnosed with pancreatic cancer in clinic visits. Group B (n = 72): Patients were diagnosed with pancreatic cancer in routine check-ups. We compared their prognosis.

RESULTS

The tumor stage in group B was earlier than that in group A. The 1-year survival rate in group B was significantly higher than that in group A (74.6% vs. 42.4%, P < 0.001), while the 3- and 5-year survival rates of the two groups showed no significant difference (P > 0.05). The difference of overall survival time between the two groups was not significant (22.0 vs. 9.0 months, P = 0.078).

CONCLUSIONS

The stage of pancreatic cancer diagnosed in routine check-ups was earlier and therefore, the intervention was earlier which improved short-term survival rate. However, early intervention did not improve overall survival in the long-term.

Clinical characteristics and outcomes of patients with hepatic veno-occlusive disease induced by Gynura segetum: A retrospective study

OBJECTIVE

Hepatic veno-occlusive disease (HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of specific therapies. The aim of the study was to delineate the clinical characteristics and outcomes and explore the potential prognostic factors of HVOD.

METHODS

This was a single-center retrospective study. Eighty-nine HVOD patients were screened from the First Affiliated Hospital of Zhejiang University with an ingestion history of G. segetum before developing symptoms from January 2009 to May 2018. The enrolled patients were divided into the survivor and death groups according to the clinical follow-up that ended on September 1, 2019. The demographic variables and clinical data of the patients were recorded. A binary logistic regression analysis and receiver operating characteristic curve were conducted to identify the prognostic factors and assess the prognostic value for predicting death, and a survival analysis was performed to evaluate the clinical outcomes.

RESULTS

Sixty-four patients were eligible for further analysis. Most patients showed abdominal distension and were positive for migrating dullness in the abdomen (P = 0.740 and P = 0.732, respectively). The patients who died had higher levels of model for end-stage liver disease score, and higher prothrombin time than those who survived (both P < 0.001). All HVOD patients in both the survival and death groups showed ascites with abnormal imaging presentations of the liver parenchyma and hepatic blood vessels. Unexpectedly, we found that hydrothorax was detected in 21 (65.63%) patients in the death group and 19 (59.38%) patients in the survivor group during hospitalization, which was rarely mentioned in previous studies. Furthermore, international normalized ratio (INR) and creatinine are found to be potential independent prognostic factors for predicting death. Six severe patients achieved clinical improvements and survived after liver transplantation.

CONCLUSION

HVOD can be induced by the ingestion of G. segetum, and INR combined with creatinine has prognostic value for predicting death. Liver transplantation may be an effective treatment option for severe HVOD patients.

Effects of sex hormones on liver tumor progression and regression in Myc/xmrk double oncogene transgenic zebrafish

Hepatocellular carcinoma (HCC) shows clear sex disparity with men being more prone to developing HCC and having higher mortality than women. Previous studies have indicated that sex hormones play important roles in HCC initiation and development, but the effects of sex hormones on HCC in clinical trials remain inconsistent. Using zebrafish liver tumor model co-induced by oncogenes Myc and xmrk, we observed similar sex disparity between male and female zebrafish in liver tumor progression and regression; i.e. male Myc/xmrk transgenic zebrafish developed HCC significantly faster and regressed HCC significantly slower than female Myc/xmrk transgenic zebrtafish. To investigate the effects of sex hormones on liver tumor progression and regression, Myc/xmrk fish were treated with either androgen or estrogen, we observed that androgen promoted HCC progression and retarded HCC regression in females, while estrogen attenuated HCC progression and accelerated HCC regression in males. Furthermore, androgen promoted cell proliferation while estrogen inhibited it. Overall, the present study suggested that sex hormones affected liver tumor progression and regression in the Myc/xmrk transgenic zebrafish.

A case report on indirect transmission of human rabies

At present, virus infection is still a common threat to public health in developing countries. Human rabies remains a matter of great global concern with a case-fatality of almost 100%. The rabies virus belongs to the neurotropic type of virus of the Lyssavirus genus, and the disease presents as a deteriorating encephalomyelitis and is endemic throughout much of the world, particularly in Africa and Asia. Previous data have shown that, globally, approximately 59 000 human deaths are caused by rabies per year. Fortunately, human rabies can be treated through the timely administration of post-exposure prophylaxis (PEP). These days immunization using the rabies vaccine has become standard practice for individuals who have suffered bites or scratches from an animal, or who have been exposed to the body fluids of an infected animal. However, we have recently encountered a case of human rabies which arose through a rare transmission method, and we believe that lessons can and should be learnt from this incident.

Significance of changes in thyroid and gonadal function in patients with chronic liver diseases

AIM: To investigate the changes in thyroid and gonadal function in patients with chronic liver diseases and to explore the relationship between serum thyroid and gonadal hormone levels and severity of chronic liver diseases.

METHODS: Serum thyroid and gonadal hormone levels were measured by chemiluminescence method in 162 male cases with chronic liver diseases. Patients with chronic liver diseases were divided into a cirrhosis group and a non-cirrhosis group, and cirrhosis was graded by Child-Pugh score (A, B, C).

RESULTS: Thyroid dysfunction was present in ~13% of patients with chronic liver diseases. Serum total T3 and free T3 levels in patients with chronic liver diseases were significantly lower than those of the control group (1.73 nmol/L ± 0.38 nmol/L vs 2.59 nmol/L ± 0.46 nmol/L, 4.09 pmol/L ± 1.35 pmol/L vs 5.23 pmol/L ± 1.56 pmol/L, P < 0.01). Cirrhotic patients had significantly lower serum total T3 and free T3 levels than non-cirrhotic patients (0.96 nmol/L ± 0.33 nmol/L vs 1.84 nmol/L ± 0.32 nmol/L, 3.02 pmol/L ± 1.10 pmol/L vs 4.33 pmol/L ± 1.42 pmol/L, P < 0.01). Serum total T3, T4 and free T3 and T4 levels in cirrhotic cases with Child-Pugh B or C grade were significantly lower than those of Child-Pugh A grade cases. Chronic liver diseases were more serious in patients with low T3 syndrome than in those without. Approximately 42% of patients with chronic liver diseases had secondary gonadal dysfunction. Serum testosterone levels were significantly lower and estrogen levels were significantly higher in patients with chronic liver disease than in the control group (4.36 ng/mL ± 2.12 ng/mL vs 7.85 ng/mL ± 3.31 ng/mL, 45.53 pg/mL ± 18.79 pg/mL vs 32.26 pg/mL ± 12.19 pg/mL, P < 0.01). Serum testosterone levels were significantly lower and estrogen levels were significantly higher in cirrhotic cases with Child-Pugh B and C grades than in Child-Pugh A grade cases. Chronic liver diseases were more serious in patients with secondary gonadal dysfunction than in those without.

CONCLUSION: Thyroid and gonadal dysfunction is present in patients with chronic liver diseases, so the determination of thyroid and sex hormones has important value for the evaluation of severity and prognosis of the disease.

Relationship between clinical parameters and degree of liver fibrosis and risk factors for significant liver fibrosis in patients with chronic hepatitis B: A Logistic regression analysis

AIM: To investigate the relationship between the severity of fibrosis and clinical parameters in patients with chronic hepatitis B (CHB), and to analyze risk factors for significant liver fibrosis in CHB patients.

METHODS: A total of 76 biopsy-proven CHB cases treated from January 2012 to July 2015 at the Second Hospital Affiliated to Kunming Medical University were included in the study. Gender, age, blood count variables including white blood cells, hemoglobin (HB), platelet count (PLT), red blood cell distribution width (RDW), mean platelet volume (MPV), as well as albumin (ALB), globin (GLO), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TB), prothrombin time (PT) and serum HBV DNA were recorded. Relationship between these parameters and liver fibrosis stage and risk factors for significant liver fibrosis were analyzed.

RESULTS: With the increase in the severity of liver fibrosis, white blood cells, HB, PLT, and ALB gradually decreased, and RDW, GLB, AST, PT, GGT increased; all of these parameters had significant differences between the S1-S4 groups (P < 0.05). Spearman correlation analysis showed that there was a positive correlation between ALT, AST, GGT, TB, GLO, PT, RDW, MPV, age and liver stage of fibrosis, and a negative correlation between liver stage of fibrosis and ALB, white blood cells, HB, and PLT. In logistic regression analysis, PLT was identified as an independent risk factor for significant liver fibrosis in CHB.

CONCLUSION: ALT is not predictive of liver fibrosis stage. PLT is an independent risk factor for significant liver fibrosis in CHB. Liver histopathology can be recommended for CHB patients with older age, lower PLT, even though ALT is normal or only mildly elevated.

Assessment of thyroid and gonadal function in liver diseases

INTRODUCTION

Liver is involved with the synthesis of carrier proteins and metabolism of various hormones and liver diseases may, therefore, be associated with various endocrine disturbances. This study was conducted to assess thyroid and gonadal function in subjects with acute hepatitis (AH), chronic liver disease (CLD), and those who had undergone liver transplantation (LT).

MATERIALS AND METHODS

Patients with AH, CLD with Child-Pugh stage A (CLD-1) and Child-Pugh stage B or C (CLD-2), and LT seen at our tertiary level hospital were assessed clinically, biochemically, and for thyroid and gonadal functions besides 25 healthy controls.

RESULTS

Thyroid dysfunction and hypogonadism were present in 14 (16%) and 24 (28%) patients with liver diseases respectively. Among thyroid dysfunction, the commonest was sick euthyroid syndrome six (7%), followed by subclinical hypothyroidism in three patients (3.5%), subclinical hyperthyroidism and thyrotoxicosis in two patients each (2.3%) and overt hypothyroidism in one patient. Among patients with LT and AH groups, the only abnormality was significantly lower total T3 compared with healthy controls. The CLD2 group had significantly lower levels of all thyroid hormones compared with controls and CLD1 group. Hypogonadism was commonest in patients with CLD-2 (14; 50%) followed by LT (3; 33%), CLD-1 (4; 20%), and AH (3; 14%). Hypogonadism was predicted by older age, lower levels of serum albumin, total cholesterol, and triglycerides and higher levels of plasma glucose, serum bilirubin, aspartate transaminases, and international normalized ratio. Gonadal functions showed recovery following LT.

CONCLUSIONS

Thyroid dysfunction and hypogonadism form an important part of the spectrum of acute and CLD, and patients with LT. Deterioration of synthetic functions of liver disease predicts presence of hypogonadism.