[Gastrointestinal complications of liver cirrhosis]

Liver cirrhosis is the end-stage of chronic liver disease and can affect the function of multiple organs. Gastrointestinal tract damage resulting from cirrhosis is more common in clinic, which may cause gastroparesis, affect the digestion and absorption of nutrients, and destroy the intestinal mucosal barrier function. In addition, it may be accompanied by a series of gastrointestinal complications that affect the patient's prognosis. Clinically, more attention should be paid to early monitoring, early diagnosis and early treatment of cirrhosis-related gastrointestinal complications so to control the progression of liver cirrhosis condition, reduce advanced stage complications, and improve patient's quality of life.

[Impact of cessation of antiviral therapy at delivery on postpartum liver function in mothers with chronic hepatitis B virus infection]

Objective: To investigate the impact of immediate cessation of antiviral therapy on postpartum liver function and the factors influencing postpartum abnormality in mothers with chronic hepatitis B virus infection. Methods: A retrospective cohort study was conducted. One hundred eighty-eight pregnant women with HBV DNA level > 2×106 IU/ml were enrolled from June 2014 to June 2018. Demographic information and clinical data of liver function and HBV DNA load during gravidity, intrapartum and postpartum period were collected. According to the antiviral treatment recommendations during pregnancy, the women were divided into three groups, namely, tenofovir (TDF), telbivudine (LdT) and control group. Liver function abnormalities among the three groups were compared within 6 months after delivery, and the factors influencing abnormal liver function were analyzed by unconditional logistic regression. Results: Of the 188 cases, 72 cases were in the TDF group, 80 cases in the LdT group, and 36 cases in the control group. Pregnant women in the TDF and LdT groups received oral TDF (300 mg/d) and LdT (600 mg/d) from 28 ± 4 weeks of gestation till delivery. Among the 188 patients, 30 (16.0%) had abnormal postpartum liver function abnormality. The incidence of postpartum liver function abnormality [alanine aminotransferase (ALT) > 2 × upper limit of normal (ULN)] in the TDF, LdT, and control groups was 19.4%, 12.5%, and 16.7%, respectively. The postpartum peak levels of ALT (median, range) in the three groups were 34.5 (12.0-946.0) U/L, 37.5 (12.0-733.8) U/L, and 39.0 (7.0-513.0) U/L, respectively. There was no significant difference between the two indexes among the three groups (P > 0.05). There was no statistically significant difference in the degree of postpartum liver function abnormalities between the three groups (P = 0.944). Most of the liver function abnormalities were mild to moderate (2 × ULN≤ALT < 10 × ULN), and usually resolved spontaneously or by treatment. Univariate and multivariate analysis showed that baseline ALT level during pregnancy was an independent factor associated with postpartum liver function abnormality (OR = 1.031, CI 95%: 1.005-1.058; χ(2) = 5.340, P = 0.021), whereas age, antiviral therapy, HBeAg-positivity, baseline HBV DNA levels, gravidity, parity, preterm delivery and delivery mode were not significantly associated with postpartum liver function abnormality. Conclusion: Cessation of antiviral therapy after delivery did not significantly increase the risk of postpartum liver function abnormality in pregnant women with chronic HBV infection. The ALT level during pregnancy is a factor influencing postpartum liver function abnormality.

[Action for shield project promoting zero mother-to-child transmission of hepatitis B virus]

The World Health Organization(WHO)has set the goal to eliminate viral hepatitis as a public health threat by 2030, and the key to achieve this ambitious goal lies on the standardized and precise management of pregnant women and their infants by effectively blocking mother-to-child transmission (MTCT) of hepatitis B virus (HBV). Standardized management includes screening and antiviral intervention during pregnancy, infant immunization, and evaluation of immune effect, breastfeeding and mode of delivery. The results of randomized controlled clinical trials and real-world data have confirmed that the comprehensive prevention strategy based on combined immune prophylaxis of neonates can effectively block MTCT of HBV. It is one of the key links to eliminate viral hepatitis in our country, and to formulate a new strategy in line with the public health needs at home and abroad and thereby promote the implementation and application of standardized management process to improve the public's awareness of the disease.

[Screening the mimic antigen epitopes of triosephosphate isomerase of Schistosoma japonicum Chinese strain (Sjc-Tpi) with random phage peptide library]

OBJECTIVE

To screen the mimic antigen epitopes of the triose phosphate isomerase of Schistosoma japonicum Chinese strain (SjC-TPI) and investigate their immunogenicity.

METHODS

The random phage peptide library (PH.D.-12) was screened with the purified antibody(IgG) against SjC-TPI to get the positive phage which contained the mimic antigen epitopes of SjC-TPI, and the immuno-characterization of the mimic antigen epitopes were investigated.

RESULTS

Two mimic antigen epitopes (M1, M2) of SjC-TPI were obtained. The immuno-sera of mice (Kunming strain) against the positive phages could recognize both the SjC-TPI and the protein of the positive phages. The DNA sequencing data showed no homology between the sequences of the deduced amino acid of the two mimic antigen peptides and the amino acid of SjC-TPI.

CONCLUSION

The two mimic antigen epitopes of SjC-TPI obtained are imitative epitopes of the configuration antigen of SjC-TPI.

[Protective immunity induced by 23 kDa membrane protein DNA vaccine of Schistosoma japonicum Chinese strain in mice]

OBJECTIVE

To develop 23 kDa membrane protein DNA vaccine of Schistosoma japonicum Chinese strain and test its protective efficacy in infected C57BL/6 mice.

METHODS

The full length cDNA encoding SjC23 amplified from pUC19-SjC23 subcloned into pcDNA3.1. 48 female mice were divided into three groups: A, B and C. Group A (control group) was each immunized i.m. with 100 micrograms of pcDNA3.1; group B (SjC23 group) was each immunized i.m. with 100 micrograms of pcDNA3.1-SjC23; group C (SjC23 + IL-12) was each immunized i.m. with a mixture of 100 micrograms of pcDNA3.1-SjC23, 100 micrograms of pcDNA3.1-p35 and 100 micrograms of pcDNA-p40, followed by two boosts of the same DNA once every two weeks. All the mice were challenged with 45 cercariae at week 8, killed and perfused for worms at week 14. The expression of SjC23 and p35, p40 in muscle tissue was determined by immuno-histochemical method. By the culture of spleen cells, the production of IL-2, IL-4, IL-10 and IFN-gamma after the stimulation of rSjC23-HD was determined two weeks before and after challenge. Anti-SjC23 antibodies were tested by Western blotting.

RESULTS

SjC23 and p35, p40 were all expressed on the membrane and in the plasma of muscle cells of the infected mice. Significant increase of IL-2 and IFN-gamma in SjC23 and SjC23 + IL-12 groups was observed before and after challenge. Western blotting showed that after the third immunization (before challenge) 8 out of 10 sera from SjC23 group and 9 out of 10 sera from SjC23 + IL-12 group were positive. The worm reduction rate in SjC23 group and SjC23 + IL-12 group was 26.9% and 35.4%, respectively; the number of eggs in liver tissue was reduced by 22.2% and 28.4%, respectively.

CONCLUSION

pcDNA3.1-SjC23 DNA vaccine could induce partial protection against Schistosoma japonicum in C57BL/6 mice.