Joint Detection of Serum Vitamin D, Body Mass Index, and Tumor Necrosis Factor Alpha for the Diagnosis of Crohn's Disease

OBJECTIVE

Vitamin D (VD) deficiency was reported to contribute to the progression of Crohn's disease (CD) and affect the prognosis of CD patients. This study investigated the role of serum VD, body mass index (BMI), and tumor necrosis factor alpha (TNF-α) in the diagnosis of Crohn's disease.

METHODS

CD patients (n=76) and healthy subjects (n=76) were enrolled between May 2019 and December 2020. The serum 25-hydroxyvitamin D [25(OH)D] levels, BMI, and TNF-α levels, together with other biochemical parameters, were assessed before treatment. The diagnostic efficacy of the single and joint detection of serum 25(OH)D, BMI, and TNF-α was determined using receiver operating characteristic (ROC) curves.

RESULTS

The levels of 25(OH) D, BMI, and nutritional indicators, including hemoglobin, total protein, albumin, and high-density lipoprotein cholesterol, were much lower, and the TNF-α levels were much higher in the CD patients than in the healthy subjects (P<0.05 for all). The areas under the ROC curve for the single detection of 25(OH)D, BMI, and TNF-α were 0.887, 0.896, and 0.838, respectively, with the optimal cutoff values being 20.64 ng/mL, 19.77 kg/m², and 6.85 fmol/mL, respectively. The diagnostic efficacy of the joint detection of 25(OH)D, BMI, and TNF-α was the highest, with an area under the ROC curve of 0.988 (95%CI: 0.968-1.000).

CONCLUSION

The joint detection of 25(OH)D, TNF-α, and BMI showed high sensitivity, specificity, and accuracy in CD diagnosis; thus, it would be effective for the diagnosis of CD in clinical practice.

Deep vein thrombosis in a patient with Cronkhite-Canada syndrome: a complex case report

BACKGROUND

Cronkhite-Canada syndrome (CCS) is a rare disease characterized by generalized gastrointestinal polyps, ectodermal abnormalities and variable gastrointestinal symptoms. Few cases to date have described complications with deep vein thrombosis (DVT). Here we reported a rare case of CCS concomitant with DVT. The patient's clinical details, endoscopic findings, safety, and efficacy are reported.

CASE PRESENTATION

A 58-year-old patient was admitted to our hospital with recurrent diarrhea, overall abnormal appearance, including hyperpigmentation, hair loss and onychodystrophy, and multiple polyps distributed along the gastrointestinal tract except the esophagus. After considerable assessment, the patient was diagnosed with CCS. She was also diagnosed with concurrent DVT, nephrotic syndrome, and infectious enteritis during the course of disease. After treatment with a combination of methylprednisolone, mesalazine, antibiotics, rivaroxaban, and nutritional support during the 24 months of following the patient in this case, the clinical manifestations and endoscopic findings reached complete remission two years after the diagnosis.

CONCLUSION

To our knowledge, this study is the first case of CCS complicated with DVT reported in China. Although rare, it is important to consider that DVT may occur after CCS and that it is vital to conduct careful follow-up.

Oxidized low-density lipoprotein stimulates CD206 positive macrophages upregulating CD44 and CD133 expression in colorectal cancer with high-fat diet

BACKGROUND

Oxidized low-density lipoprotein (ox-LDL), which is abnormally increased in the serum of colorectal cancer (CRC) patients consuming a high-fat diet (HFD), may be one of the risk factors for the development of CRC. Ox-LDL exerts a regulatory effect on macrophages and may influence CRC through the tumor microenvironment. The role of ox-LDL in CRC remains unclear.

AIM

To investigate the role of ox-LDL through macrophages in HFD associated CRC.

METHODS

The expression of ox-LDL and CD206 was detected in colorectal tissues of CRC patients with hyperlipidemia and HFD-fed mice by immunofluorescence. We stimulated the macrophages with 20 μg/mL ox-LDL and assessed the expression levels of CD206 and the cytokines by cell fluorescence and quantitative polymerase chain reaction. We further knocked down LOX-1, the surface receptor of ox-LDL, to confirm the function of ox-LDL in macrophages. Then, LoVo cells were co-cultured with the stimulated macrophages to analyze the CD44 and CD133 expression by western blot.

RESULTS

The expression of ox-LDL and the CD206 was significantly increased in the stroma of colorectal tissues of CRC patients with hyperlipidemia, and also upregulated in the HFD-fed mice. Moreover, an increased level of CD206 and decreased level of inducible nitric oxide synthase were observed in macrophages after ox-LDL continuous stimulation. Such effects were inhibited when the surface receptor LOX-1 was knocked down in macrophages. Ox-LDL could induce CD206+ macrophages, which resulted in high expression of CD44 and CD133 in co-cultured LoVo cells.

CONCLUSION

Ox-LDL stimulates CD206+ macrophages to upregulate CD44 and CD133 expression in HFD related CRC.

[A multicenter randomized controlled study of bismuth-containing quadruple therapy followed by Jing-Hua-Wei-Kang in the treatment of patients newly diagnosed with Helicobacter pylori infection and dyspepsia]

Objective: To investigate the Helicobacter pylori (H. pylori) eradication rate and improvement of dyspepsia in patients who were newly diagnosed with H. pylori infection and dyspepsia and treated by bismuth-containing quadruple therapy followed by Jing-Hua-Wei-Kang(JHWK). Methods: Patients who were newly diagnosed with dyspepsia and H. pylori infection and treated in 16 medical centers in China between December 1, 2017 and September 30, 2019 were randomly divided into two groups. The experimental group received bismuth-containing quadruple therapy (esomeprazole+amoxicillin+furazolidone+colloidal bismuth pectin capsule, 14 days), followed by JHWK (30 days), and the course of treatment was 44 days in total. In the control group, the administration regimen was bismuth-containing quadruple therapy (esomeprazole+amoxicillin+furazolidone+colloidal bismuth pectin capsule, 14 days). The main outcome measure was H. pylori eradication rate, while the secondary outcome measures were dyspepsia symptom changes and adverse events during the treatment and the 1st month after treatment. Results: A total of 1 054 patients were included in the study. There were 522 cases enrolled in the experimental group, including 224(42.91%) men and 298(57.09%) women, and the age was 53(26, 73) years old; 532 cases enrolled in the control group, including 221(41.54%) men and 311(58.46%) women, and the age was 46(22, 71) years old. Based on PP analysis, it was found that the H. pylori eradication rate in the experimental group was significantly higher than those in the control group (93.85% vs 87.88%, P=0.001). In the group of all enrolled patients, the symptom dyspepsia after H. pylori eradication was significantly improved compared with that before treatment [4(4, 7) vs 15(10, 22), P<0.001], so was the superior and middle abdominal pain [1(1, 4) vs 4(1, 8), P<0.001], the postprandial fullness [1(1, 4) vs 4(4, 9), P<0.001], the early satiety [1(1, 1) vs 4(1, 4), P<0.001], and the heartburn [1(1, 1) vs 1(1, 4), P<0.001]. The symptom dyspepsia after treatment was significantly improved compared with that before treatment in the experimental, the control groups, the successful and the unsuccessful H. pylori eradication groups. The superior and middle abdominal pain after treatment was signifcantly improved than that before treatment [1(1, 2) vs 1(1, 4), P<0.001], so were the postprandial fullness [1(1, 3) vs 1(1, 4), P=0.002] and the dyspepsia[4(4, 7) VS 7(4, 10), P<0.001]. There was no statistically significant difference in the incidence of adverse events between the experimental group and the control group (1.34% vs 0.38%, P=0.09). Conclusions: Compared with bismuth-containing quadruple therapy, bismuth-containing quadruple therapy followed by JHWK significantly improves the H. pylori eradication rate without increasing the incidence of adverse events. H. pylori eradication therapy can improve symptoms of patients with H. pylori infection and dyspepsia.

[Pepsin and bile acids detection in saliva for the diagnosis of gastroesophageal reflux disease]

Objective: To identify the value of the detection of pepsin and bile acids in saliva for the diagnosis of gastroesophageal reflux disease(GERD). Methods: From January 2018 to June 2019, 104 GERD patients and 43 healthy people in Guangdong Provincial People's Hospital were recruited. The 104 patients of GERD group were divided into four sub-groups, including esophageal symptoms GERD group, extraesophageal symptoms GERD group, anxiety or depression group, non-anxiety and non-depression group. Saliva was collected on waking in morning and 2 h after finishing lunch. The concentration of the total pepsin(TPP) and total bile acids(TBA) from saliva was detected by ELISA method. Receiver operating characteristics analysis was used to identify the sensitivity and specificity of the saliva pepsin and bile acids detection. Results: The concentration of TPP in morning waking samples and postprandial samples in the GERD group was 27.1(9.7,50.3) μg/L and 32.4(14.0,58.7) μg/L, the concentration of TBA in postprandial samples was (18.4±2.3)μmol/L, and these levels were significantly higher than that of the control group [7.0(5.1, 9.1) μg/L, 7.4(5.2, 9.4) μg/L, (12.6±5.0)μmol/L](P<0.01). The concentration of TBA in morning waking samples had no significant difference between these two groups(P>0.05). The concentration of TPP and TBA had no significant difference among the four GERD sub-groups(P>0.05).Pepsin in postprandial saliva samples had moderate diagnostic value for GERD, when the saliva pepsin concentration in postprandial samples was higher than 41.33 μg/L, it had a sensitivity of 82.8% and a specificity of 73.3%. The bile acids in saliva had no significant diagnostic value for GERD. Conclusions: Pepsin detection in saliva has a high level of sensitivity and specificity for diagnosing GERD. However, bile acids in saliva has no significant diagnostic value for GERD.

BARX2 expression is downregulated by CpG island hypermethylation and is associated with suppressed cell proliferation and invasion of gastric cancer cells

BarH-like homeobox 2 (BARX2), a homeobox gene, is associated with several types of cancers. The present study aimed to determine whether DNA methylation downregulates BARX2 expression and whether BARX2 is associated with suppression of gastric carcinogenesis. BARX2 protein expression in normal and cancerous gastric tissues and various gastric cancer (GC) cell lines was detected using immunohistochemical and western blot assays. BARX2 mRNA levels were detected using both reverse transcription-polymerase chain reaction (RT-PCR) and quantitative PCR (qPCR). Promoter hypermethylation in GC cells was detected using methylation-specific PCR or bisulfite DNA sequencing PCR. Effects of BARX2 expression on GC cell proliferation, clonal formation, and migration were evaluated after lentivirus-BARX2 transfection. The effect of stable BARX2 transfection on tumor formation was assessed in a nude xenograft mouse model. BARX2 was strongly expressed in the normal gastric mucosa, but weakly or not expressed in GC tissues and most GC cell lines. BARX2 expression was negatively correlated with DNMT (a marker for DNA methylation) expression in the gastric tissues. The BARX2 promoter fragment was hypermethylated in the GC cell lines. Overexpression of BARX2 significantly inhibited GC cell proliferation, clonal formation, and migration. Stable BARX2 transfection inhibited tumor formation in xenograft mice, which was correlated with decreased expression of E-cadherin, proliferation markers, and matrix metalloproteinases. In conclusion, BARX2 expression is aberrantly reduced in GC, which is associated with increased DNA methylation of its promoter. BARX2 inhibits GC cell proliferation, migration, and tumor formation, suggesting that BARX2 acts as a tumor suppressor in gastric carcinogenesis.

[Injury of small intestinal mucosa in rats induced by aspirin and clopidogrel and the protective effect of teprenone]

The purpose of this study was to investigate the injury of aspirin and clopidogrel on small intestinal mucosa in rats and the protective effect of teprenone. The study found that aspirin and clopidogrel could cause intestinal mucosal injury in rats, which was even worse with dual drugs. The mechanism of mucosal injury included free radical injury induced by aspirin and decreased synthesis of vascular endothelial growth factor (VEGF) by clopidogrel. Teprenone may repair intestinal mucosa via boosting VEGF level.

Consensus on the digestive endoscopic tunnel technique

With the digestive endoscopic tunnel technique (DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria (MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal (GI) tract. At present, the tunnel technique application range covers the following: (1) Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis; (2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and (3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment. The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism, and significance of DETT, prevention of infection and concepts of DETT-associated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract (indications and contraindications, procedures, pre- and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).

Potential involvement of heat shock proteins in pancreatic-duodenal homeobox-1-mediated effects on the genesis of gastric cancer: A 2D gel-based proteomic study

AIM

To identify functional proteins involved in pancreatic-duodenal homeobox-1 (PDX1)-mediated effects on gastric carcinogenesis.

METHODS

A PDX1-overexpressed model was established by transfecting gastric cancer cell line SGC7901 with pcDNA3.1(+)-PDX1 vector (SGC-PDX1). Transfection with empty pcDNA3.1 vector (SGC-pcDNA) served as control. Comparative protein profiles of the two groups were analyzed by two-dimensional electrophoresis based-proteomics (2DE gel-based proteomics). The differential proteins identified by 2DE were further validated by qRT-PCR and immunoblotting. Finally, co-immunoprecipitation was used to determine any direct interactions between PDX1 and the differential proteins.

RESULTS

2DE gel proteomics identified seven differential proteins in SGC-PDX1 when compared with those in SGC-pcDNA. These included four heat shock proteins (HSPs; HSP70p1B, HSP70p8, HSP60, HSP27) and three other proteins (ER60, laminin receptor 1, similar to epsilon isoform of 14-3-3 protein). Immunoblotting validated the expression of the HSPs (HSP70, HSP60, HSP27). Furthermore, their expressions were lowered to 80%, 20% and 24%, respectively, in SGC-PDX1, while PDX1 exhibited a 9-fold increase, compared to SGC-pcDNA. However, qRT-PCR analysis revealed that mRNA levels of the HSPs were increased in SGC-PDX1, suggesting that the expression of the HSPs was post-translationally regulated by the PDX1 protein. Finally, co-immunoprecipitation failed to identify any direct interaction between PDX1 and HSP70 proteins.

CONCLUSION

This study demonstrates the potential involvement of HSPs in PDX1-mediated effects on the genesis of gastric cancer.

Conversion therapy and suitable timing for subsequent salvage surgery for initially unresectable hepatocellular carcinoma: What is new?

AIM

To review the conversion therapy for initially unresectable hepatocellular carcinoma (HCC) patients and the suitable timing for subsequent salvage surgery.

METHODS

A PubMed search was undertaken from 1987 to 2017 to identify articles using the keywords including “unresectable” “hepatocellular carcinoma”, ”hepatectomy”, ”conversion therapy”, “resection”, “salvage surgery” and “downstaging”. Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction.

RESULTS

Liver volume measurements [future liver remnant (FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests (scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing complications, morbidity or mortality. The requirements for performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR (sFLR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The indications of any combinations of conversion therapies and the subsequent salvage surgery time still need to be carefully and comprehensively evaluated.

CONCLUSION

Conversion therapy is recommended for the treatment of initially unresectable HCC, and the suitable subsequent salvage surgery time should be reappraised and is closely related to its previous therapeutic effect.

CD8+CD28+/CD8+CD28- T cell equilibrium can predict the active stage for patients with inflammatory bowel disease

BACKGROUND/AIM

The balance of blood CD8⁺CD28⁺/CD8⁺CD28^- T cells has been verified to be vital for patients with ulcerative colitis (UC), but their role in inflammatory bowel disease (IBD) remains unknown. This investigation aimed to evaluate the efficiency of the balance in predicting the active stage in IBD patients.

METHODS

Fifty-three IBD subjects, including 31 UC and 22 Crohn's disease (CD) patients, were enrolled, and their peripheral blood CD8⁺CD28⁺ and CD8⁺CD28^- T cell levels were tested using flow cytometry. The risk factors related to prognosis were compared between UC and CD patients. A 1-year follow-up was performed for all the IBD patients, and the CD8⁺ T cells and their ratio were compared at the 3rd, 6th, 9th, and 12th months during follow-up. The sensitivity and specificity of the CD8⁺ T cell level and balance were analyzed through receiver operator characteristic (ROC) curves. The cumulative remission lasting rates (CRLRs) under the different factors were analyzed using the Kaplan-Meier method.

RESULTS

Higher prescription rates of immunosuppressants, steroids, probiotics, and biological agents (BAs) were found in CD subjects in comparison to UC subjects (P=0.005, 0.024, 0.034, and 0.001), as was a higher active rate during follow-up (95.5% of CD patients vs 67.7% of UC patients, P=0.035). The CD8⁺CD28⁺ T cell level and the CD8⁺CD28⁺/CD8⁺CD28^- T cell ratio were significantly higher in UC patients than in CD patients, but the reverse was true for CD8⁺CD28^- T cells during follow-up at the 9th and 12th month (all P<0.05). The diagnostic models of the initial CD8⁺CD28⁺ and CD8⁺CD28^- T cell numbers and the CD8⁺CD28⁺/CD8⁺CD28^- T cell ratio in predicting the active stage were found to be significant, with areas under the curves (AUCs) of 0.883, 0.098, and 0.913 for UC subjects (with 95% CI: 0.709-0.940, 0.009-0.188, and 0.842-1.003; P=0.001, 0.00, and 0.000) and 0.812, 0.078, and 0.898 for CD subjects (with 95% CI: 0.683-0.957, 0.003-0.158, and 0.837-0.998; P=0.003, 0.00, and 0.000). The cut-off values showed that when the ratios were 1.30 for UC and 1.22 for CD patients, the best sensitivity and specificity were observed, with 91.6% and 89.0% for UC and 88.5% and 85.1% for CD, respectively. The CRLRs were significantly higher in female, non-BA-treated, non-surgical IBD subjects when compared to male, BA-treated, surgical subjects (P=0.031, 0.000, and 0.000). The number of CD8⁺CD28⁺ and CD8⁺CD28^- T cells and the CD8⁺CD28⁺/CD8⁺CD28^- T cell ratio were correlated with BA treatment and surgery (all P<0.05).

CONCLUSION

The CD8⁺CD28⁺/CD8⁺CD28^- T cell balance, expected to be a novel immunologic marker, presented a satisfactory efficiency with high sensitivity and specificity in predicting the active stage in UC and CD patients, and the balance was closely related to the use of BAs and surgery.

Clinical characteristics of upper gastrointestinal tract polyps: An analysis of 2 376 cases

AIM: To analyze the clinical characteristics of esophagus-gastro-duodenal polyps.

METHODS: Clinical data for patients with esophagus-gastro-duodenal polyps who were treated at our hospital over the past decade were retrospectively analyzed. The sites and histological types of polyps were identified to investigate the association of the polyps with factors including Helicobacter pylori (H. pylori) infection, gender, age, and epigastric symptoms.

RESULTS: A total of 2 376 patients with polyps were enrolled, including 691 (29.08%) males and 1 685 (70.92%) females. 68.01% (1 616/2 376) of patients were more than 40 years old. Main symptoms included epigastric upset (41.96%, 997/2 376) and epigastric pain (39.26%, 932/2 376). The polyps were mainly located in the corpus and body (64.39%), duodenum (12%), antrum (11.57%), cardiac (8.88%) and other sites (14.09%). Patients with antral polyps or cardic polyps had a higher frequency of H. pylori infection (41.44% and 33.07%).

CONCLUSION: Upper gastrointestinal tract polyps are usually benign and tend to occur in patients more than 40 years old and females. Main symptom is epigastric upset and main pathological type is fundic gland polyps. H. pylori infection might be associated with the development of antral polyps and cardiac polyps.

Construction of a reporter vector regulated by the Pdx1 promoter and evaluation of the effect of DNA methylation on Pdx1 promoter activity in gastric cancer cells

AIM: To construct a reporter vector regulated by the Pdx1 promoter to determine the effect of DNA methylation on the promoter activity of Pdx1 gene.

METHODS: PCR amplification was performed to obtain nine potential Pdx1 promoter fragments, which were then cloned into the pGL3-basic vector to obtain recombinant pGL3-Pdx1 constructs. Promoter activity of different Pdx1 fragments in gastric cancer cells was detected by luciferase assay to identify the potential promoter area. The activity of the Pdx1 promoter with or without SssI methylase treatment was also evaluated by luciferase assay.

RESULTS: Luciferase assay showed that three fragments (F383, F720 and F1039), all of which contained the F383 sequence, had stronger promoter activity than pGL3-basic control. The promoter activity of these three fragments decreased significantly after SssI methylase treatment (all P < 0.05).

CONCLUSION: A luciferase reporter gene system containing the Pdx1 promoter was successfully constructed. F383 is the potential core area of the Pdx1 promoter. These results provide a basis for studying the epigenetic mechanism of Pdx1 gene silencing in gastric cancer.

Glucocorticoids and gastric mucosal lesions

Hench found glucocorticoids (GCs), defined their roles in controlling rheumatic diseases, and thereby won the 1950 Nobel Prize in physiology and medicine. In the next few decades GCs were widely used in clinical practice; however, they were associated with some side effects, such as gastric mucosal lesions. Currently, it is still controversial whether GC use is a risk factor for peptic ulcer disease and upper gastroduodenal bleeding. This review aims to elucidate the potential role of GCs in inducing gastric mucosal lesions and to highlight possible mechanisms involved.

[Expression of NK cells receptor NKG2D from peripheral blood in patients with primary hepatic carcinoma and its clinical significance]

OBJECTIVE

To investigate the expression of NK cells receptor NKG2D from peripheral blood in patients with primary hepatic carcinoma and the relationship between NKG2D expression and cytotoxicity of NK cells.

METHODS

Flow cytometry was used to determine the number of NK cells and the expression of NK cells receptor NKG2D from peripheral blood in patients with primary hepatic carcinoma (20 cases), hepatitis B cirrhosis (23 cases), hepatitis B (20 cases) and healthy control (20 cases). The microplate reader was used to detect cytotoxicity of NK cells in all cases.

RESULTS

Among killing rate of NK cell for K562 cell, the expression rate of NKG2D in NK cells, the number of NKG2D(+)NK cells, NKG2D expression level of NK cells and the number of NK cells, the liver cancer group [(25 +/- 7)%, 6%, 0.7 x 10(7)/L, 15, (1.1 +/- 0.6) x 10(8)/L] decreased significantly as compared with the healthy group [(63 +/- 7)%, 36%, 8.3 x 10(7)/L, 116, (2.7 +/- 1.1) x 10(8)/L] and the hepatitis B group [(41 +/- 8)%, 16%, 2.8 x 10(7)/L, 49, (1.9 +/- 1.1) x 10(8)/L] (P < 0.05); and there was a slight decrease as compared with the hepatitis B cirrhosis group [(29 +/- 10)%, 7%, 0.6 x 10(7)/L, 29, (1.5 +/- 1.2) x 10(8)/L] (all P > 0.05 except NKG2D expression level of NK cells P < 0.05). The activity of NK cells showed a obvious positive correlation with the number of NK cell and the positive rate of NKG2D in NK cells, the number of NKG2D(+)NK cells and NKG2D expression level of NK cells (r = 0.657, 0.770, 0.927, 0.734, all P < 0.01).

CONCLUSION

The cytotoxicity and the NKG2D expression of NK cells decreased significantly from peripheral blood in patients with primary hepatic carcinoma. The activity of NK cells was closely related to the NKG2D expression level of NK cells. Enhancing the NKG2D expression level of NK cell may provide a new idea for adoptive immunotherapy of primary hepatic carcinoma.

Short and long term efficacy of high intensity focused ultrasound therapy for advanced hepatocellular carcinoma

BACKGROUND

The aim of this study was to investigate the short and long term efficacy of high intensity focused ultrasound therapy (HIFU) in patients with advanced hepatocellular carcinoma (HCC).

METHODS

Patients with surgically unresectable HCC received either HIFU plus supportive treatment (HIFU group, n = 151) or supportive treatment only (control group, n = 30), according to their willingness. Short term efficacy, including improvement in tumor imaging parameters, decrease in serum alpha-fetoprotein (AFP) levels, symptom relief (i.e. Karnofsky Performance Status and numerical rating scales) and response rates, and long term efficacy, including an increase in survival rates and improvement of quality of life (QOL), was monitored.

RESULTS

Tumor imaging parameters, serum AFP levels and symptom scores improved significantly in the HIFU group compared with the control group (all P < 0.05). In the HIFU group, a complete and a partial response were achieved in 28.5% (n = 43) and 60.3% (n = 91) of cases, respectively, while the rates were 0% and 16.7% (n = 5), respectively, in the control group. The overall response rate (88.8%) was significantly greater in the HIFU group (16.7%) than in the control group (P < 0.01). In addition, the 1- and 2-year survival rates were 50.0% and 30.9%, respectively, in the HIFU group, which were significantly greater than those (3.4% and 0%, respectively) in the control group (both P < 0.01). The QOL score was 83.1 +/- 8.0 at 3 months after HIFU, which was significantly greater than the pre-HIFU score (67.7 +/- 5.9) and the score at 3 months after treatment (69.0 +/- 8.5) in the control group (both P < 0.05). No severe complications occurred during and after HIFU.

CONCLUSION

HIFU is an effective and safe ablation therapy with satisfactory short and long term efficacy for patients with advanced HCC.

Efficacy of high intensity focused ultrasound in treatment of hepatocellular carcinoma and its influential factors

AIM: To observe the efficacy of high intensity focused ultrasound (HIFU) in the treatment of hepatocellular carcinoma (HCC) and investigate the prognostic factors affecting the overall survival.

METHODS: A total of 104 patients with HCC were treated with HIFU and the efficacy was evaluated by the following indexes: tumor size, number, metastasis, alpha fetoprotein (AFP) levels before and after HIFU treatment, hepatic function before HIFU treatment, Child-Pugh classifications, TNM stages and variations in color Doppler sonography.

RESULTS: After HIFU treatment, the remission rates for clinical symptoms and liver function were 83.2% (80/104) and 82.7% (86/104), respectively, and the patients with AFP decreased by more than 50% covered a percentage of 62.5% (65/104). After HIFU, color Doppler sonography manifested coagulative necrosis and tumor blood supply reduction or disappearance in the target region. The survival rates of patients were 59.5% (3-6 mo), 38.7% (12 mo) and 25.6% (24 mo). The therapeutic effects of HIFU were correlated with AFP levels, TNM stages and treatment combined with transcatheter arterial chemoembolization and metastasis before treatment.

CONCLUSION: HIFU is effective and feasible in the treatment of HCC, and its efficacy is associated with the pretherapeutic AFP levels, TNM stages and treatment combined with transcatheter arterial chemoembolization and metastasis.

Prevalence of subclinical hepatic encephalopathy in cirrhotic patients in China

AIM

Subclinical hepatic encephalopathy (SHE) is a common complication of liver diseases. The aim of this study was to find out the normal value of psychometric test and to investigate the prevalence of SHE in Chinese patients with stabilized hepatic cirrhosis.

METHODS

Four hundred and nine consecutive cirrhotic patients without overt clinical encephalopathy were screened for SHE by using number connection test part A (NCT-A) and symbol digit test (SDT). SHE was defined as presence of at least one abnormal psychometric test. The age-corrected normal values were defined as the mean+/-2 times standard deviation (2SD), and developed in 356 healthy persons as normal controls. Four hundred and sixteen patients with chronic viral hepatitis were tested as negative controls to assess the diagnostic validity of this test battery.

RESULTS

There was no significant difference in NCT scores and SDT quotients between healthy controls and chronic hepatitis group (P>0.05). In all age subgroups, the NCT and SDT measurements of cirrhotic patients differed significantly from those of the controls (P<0.05). When mean+/-2SD of SDT and NCT measurements from healthy control group was set as the normal range, 119 cirrhotic patients (29.1%) were found to have abnormal NCT-A and SDT tests, 53 (13.0%) were abnormal only in SDT and 36 (8.8%) only in NCT-A. Taken together, SHE was diagnosed in 208 (50.9%) cirrhotic patients by this test battery. The prevalence of SHE increased from 39.9% and 55.2% in Child-Pugh's grade A and B groups to 71.8% in Child-Pugh's grade C group (P<0.05). After the adjustment of age and residential areas required from the tests, no correlation was found in the rate of SHE and causes of cirrhosis, education level and smoking habit.

CONCLUSION

Psychometric tests are simple and reliable indicators for screening SHE among Chinese cirrhotic patients. By using a NCT and SDT battery, SHE could be found in 50.9% of cirrhotic patients without overt clinical encephalopathy. The prevalence of SHE is significantly correlated with the severity of liver functions.

[Long-term efficacy of lactulose in patients with subclinical hepatic encephalopathy]

OBJECTIVE

To observe the long-term clinical efficacy of lactulose in patients with subclinical hepatic encephalopathy (SHE) and the natural history of this disease.

METHODS

Patients with SHE diagnosed with psychometric tests (number connection test and digit symbol test) were randomly allocated to control group (Cg), short-term (Stg) and long-term treatment group (Ltg), respectively. Lactulose (15 - 90 ml/day) was orally given to 21 patients in Stg for 8 weeks, and 22 in Ltg for 24 weeks.The drug was not given to 21 patients in Cg. Psychometric test, somatosensory evoked potentials (SEP) and venous blood ammonia concentration (BA) were investigated before and after treatment at 8 week intervals for 6 months of follow-up.

RESULTS

In Ltg, psychometric tests were significantly improved, BA was lowered and N(50) peak latency in SEP was not prolonged as compared with those in Cg, in which psychometric tests and N(50) peak latency gradually worsened during the follow-up. After 8 weeks of treatment, psychometric tests, BA and N(50) peak latency were significantly improved in Stg, but at week 24 they were deteriorated after cessation of treatment. The development of clinical hepatic encephalopathy was more frequent in Cg (40%) and Stg (30%) than in Ltg (5%). One patient each was not followed up after week 24 in Cg and Stg, respectively and 2 patients in Ltg stopped lactulose because of severe diarrhea.

CONCLUSIONS

In patients with SHE, long-term treatment with lactulose could lower BA, improve psychometric tests, prevent SEP from getting worse, and eventually cut down the occurrence rate of clinical hepatic encephalopathy.