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Table of Content

    30 June 2016, Volume 21 Issue 6
    Original Articles
    Long-term follow-up study of genotype 1 patients with HCV-related compensated cirrhosis treated with pegylated interferon alpha-2a and ribavirin
    ZHANG Cao-geng, XIANG Xiao-gang, LIU Ke-hui, CAO Zhu-jun, XIE Qing, WANG Hui
    2016, 21(6):  434-437. 
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    Objective To investigate the effect and clinical outcomes on combination treatment of pegylated interferon alpha-2a and ribavirin (PR) for hepatitis C virus (HCV) genotype 1 patients with compensated cirrhosis.Methods In our parallel retrospective cohort study, HCV genotype 1 patients with HCV related compensated cirrhosis received PR therapy and symptomatic treatment with colony-stimulating factors (CSF). And the patients undertook a long-term follow-up for 5 years. The efficacy and recurrence rate of antiviral therapy were evaluated. Transient elastography (TE) was used in liver stiffness measurement (LSM). The occurrences of clinical events, including hepatic encephalopathy, ascites, gastrointestinal bleeding, hepatocellular carcinoma (HCC) and death, was compared between sustained virological response (SVR) group and non-sustained virological response (NSVR) group. Results Fifty-four HCV genotype 1 patients with HCV related compensated cirrhosis completed the PR therapy, and 34 (64.81%) achieved SVR. Fourteen among 23 patients(65.22%) achieved SVR after the first antiviral therapy, so did 9/14 (64.29%) patients after the second, 8/13 (76.92%) after the third, 2/3 (66.67%) after the forth and 1/1 (100%) after the fifth. Only one case relapsed at 6 weeks after achievement of SVR. During the antiviral treatment period, LSM improved to varying degrees, which showed a significant statistical difference in SVR groups (P=0.0004). During the long-term follow-up, the LSM of SVR group showed a further decline and kept at a low level. However, there was no improvement of LSM in NSVR group. During the follow-up for 60 months on average, there were 3 cases developing HCC in NSVR group, while 0 in SVR group. Incidence of clinical events, such as ascites [P=0.0168, RR=0.2353 (95%CI 0.0390-1.422)] and HCC [P=0.0391, RR=0.0000], between the two groups showed significant difference.Conclusion PR therapy can effectively restrain virus replication for HCV genotype 1 patients with HCV related compensated cirrhosis. Combination therapy with CSF can improve treatment compliance. Patients who failed in the previous treatments can acquire SVR via repeated or extended course of PR treatments. Acquisition of SVR can decrease recurrence rate and occurrence of clinical events, and improve progression of cirrhosis.
    Clinical value and significance of dynamic enhanced CT in diagnosis of hepatic sinusoidal obstructive syndrome
    SUN Hui-fang, ZHANG Hui-yu, DING Chang-mao, WANG Bo, GAO Jian-bo
    2016, 21(6):  438-440. 
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    Objective To investigate the value of dynamic enhanced computed tomography (CT) in diagnosis of hepatic sinusoidal obstructive syndrome (HSOS).Methods Fifty-one patients definitely diagnosed with HSOS, Budd-Chiari syndrome (BCS) and liver cirrhosis by biopsy or imaging were retrospectively analyzed. Dynamic enhanced CT and Baltimore standard were performed in these patients respectively, and comparisons were conducted. Results In HSOS patients, hepatomegaly and hypodensity were observed in non-contrastive CT scan. In terms of arterial phase on dynamic enhanced CT, it showed dilated and tortuous hepatic artery. And on the portal venous phase, it showed map-shaped change, unclear hepatic vein, inferior vena cava, portal vein with halo sign or track sign, flat inferior vena cava in the liver section, and etc. Additionally, enhanced range increased during delay period. In diagnosis of HSOS, CT was more sensitive than Baltimore standard (0.857 vs. 0.500), but less specific than Baltimore (0.811 vs. 0.946). Diagnostic accuracy of CT and Baltimore standard for HSOS was similar, which showed no statistically significant differences (P > 0.05).Conclusion In early diagnosis of HSOS, CT dynamic enhanced is a powerful supplement to Baltimore standard, which is worth attention.
    Sonogram characteristics of ultrasound contrast in diagnosis of primary liver cancer
    XU Juan, ZHAO Ye, LI Jun-zhi
    2016, 21(6):  441-443. 
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    Objective To investigate the sonogram characteristics of ultrasound contrast in diagnosis of primary liver cancer.Methods Twenty-five patients (30 lesions) histologically diagnosed as primary liver cancer in our hospital from March 2015 to March 2014 were enrolled in the study. Contrast-enhanced ultrasound was performed in all those patients, which were compared with conventional ultrasound to evaluate sensitivity between the two diagnostic methods.Results The ultrasound in primary liver cancer manifested single, round or ovoid shaped focal, with majority of homogeneous echoes and minority of heterogeneous echoes, and smooth and clear boundary to normal tissue. In these patients, 19/25 (76%) were diagnosed of hepatocellular carcinoma with sonogram as fast-coming and fast-going, which were negatively correlated with tumor differentiation. The 6/25 (24%) patients were diagnosed of intrahepatic bile duct cell carcinoma with sonogram as fast-coming and fast-going. In arterial phase, lesion images manifested as majority of grid-like enhancements and minority of no enhancement. In portal venous phase, peripheral of lesions were irregular ring-enhanced, and internal of lesions were grid-like enhanced or with no enhancement. Additionally, the irregular enhancement of lesions peripheral was significantly decreased during portal vein phase. The diagnostic sensitivity of contrast-enhanced ultrasound for primary liver cancer was 96% (24/25), which was significantly higher than 72% (18/25) of conventional ultrasound (P<0.05).Conclusion The diagnosis of primary liver cancer by ultrasound contrast can clearly show the characteristics of lesion images, which is more sensitive than conventional ultrasound.
    Clinical analysis on tenofovir disoproxil fumarate therapy for 34 nucleos(t)ide-analogue experienced chronic hepatitis B patients
    QU Li-hong, LIU Lu, ZHENG Jie-fang, ZHAO Hui, WANG Yi-fei, CHENG Jie, SHAO Jian-guo
    2016, 21(6):  444-446. 
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    Objective To evaluate the clinical efficacy of tenofovir disoproxil fumarate (TDF) for nucleos(t)ide-analogue (NAs) experienced chronic hepatitis B (CHB) patients.Method A total of 34 CHB patients who had been previously treated with NAs and received subsequently TDF for 48 weeks were retrospectively investigated. Among the 34 patients, 18 failed to response to primary treatment; 16 developed antiviral drug resistance; 29 were male and 5 female, with average age as 43.3 ± 7.8 years old. Measurement of HBV DNA loading and alanine aminotransferase (ALT) level were carried out at week 0, 12,24 and 48, respectively.The hepatitis B e antigen (HBeAg) seroconversion rate and clinical adverse events rate at week 48 were also recorded.Statistical analyses were performed using standardized mean difference, Student's t-test and one-way analysis of variance.Results During the treatment period, the HBV DNA undetectable rate at week 12, 24, 48 are 35.3%, 67.6% and 94.1%, respectively. The ALT level at week 0, 12, 24, 48 are (63.9±18.9) U/L, (49.8±11.9) U/L, (42.7±7.3) U/L and (35.1±3.9) U/L, respectively, which showed significant differences (F= 36.3, P<0.05). At week 48, ALT normalization rate, HBeAg loss rate and HBeAg seroconversion rate were 91.1%, 25% and 20%, respectively. During the treatment, virus breakthrough rate was 0 and creatine kinase levels were no more than 2 times the upper limit of normal. The serum creatinine (Scr) level at week 0 and 48 are (75.1± 11.1) μmol/L and (76.8± 10.8) μmol/L, which showed no significant difference (t=0.578, P=0.565). All patients showed a normal level of Scr, bone mineral density and serum phosphate throughout the treatment period.Conclusion For NAs experienced CHB patients, TDF can help to efficiently suppress HBV DNA replication and achieve a high rate of ALT normalization with a low rate of adverse events.
    The transcriptional change of mitochondrial genome in mice models for acetaminophen-induced acute liver injury and failure
    MING Ya-nan, LI Chun-min, ZHANG Jing-yi, LIU Xiao-lin, MAO Yi-Min
    2016, 21(6):  447-451. 
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    Objective To explore the relationship between transcription level of mitochondrial DNA (mtDNA) and disease progression in the mice models of acetaminophen (APAP)- induced acute liver injury (AILI) and acute liver failure (ALF), and to find the relative new biomarkers for outcome.Methods Ninety mice were randomly divided into three groups, including control group, AILI group (300 mg/kg) and ALF group (750 mg/kg). After fasting 16 h, all mice were intraperitoneally injected with same volume of saline or different doses of APAP. At different time points of 0, 1, 3, 6 and 12 h, 6 mice randomly selected from each group were sacrificed for blood and liver, respectively. Plasma alanine aminotransferase (ALT), aspartate aminotransferase (AST) and reactive oxygen (ROS) levels were detected, and liver total RNA was extracted for RT-PCR to detect changes in transcription of mitochondrial genome. Results Compared with the control group, ALT and AST levels in AILI and ALF group were significantly increased. In AILI group, ALT peaked at 6-12 h (5000-10000 IU/L), and ALT exceeded 10000 IU/L at 12 h in ALF group, which showed significantly difference (P<0.05). Microbubbles steatosis in three zones was observed in both AILI and ALF groups, and massive hepatic necrosis (MHN) were found merely in ALF group. In 1 h after APAP injection, ROS in ALF group was about 2.5 times as much as that in AILI group, which significantly increased at all time points in both group. Contrasting with control and ALIF groups, COX1 transcriptional level in AILI group increased significantly at 6 h. In AILI and ALF group, CYTB, COX2 and ATP8 reduced significantly at 3 h (P<0.05), COX1,ND1,ND5 and ATP8 significantly decreased at 6 h (P<0.05), and transcription level of other subunits of NADH significantly decreased at 12 h (P<0.05) comparing with those in control group. Furthermore, ATP6 at 6h in ALF group was obviously lower than that in AILI and control group (P<0.05). At 12 h, the majority of mtDNA (CYTB, COX2, ATP8, ND2, ND3, ND5 and ND6 ) had significant differences between AILI and ALF group.Conclusion There are significant difference in mtDNA transcription between AILI and ALF groups. Besides COX1, other mtDNA showed significant decreases in AILI and ALF group compared with those in control group, especially in ALF group. mtDNA transcriptional changes may have great potential as biological makers to predict outcomes of AILI.
    Safety and efficacy of radiofrequency endometrial ablation operation for abnormal uterine bleeding in liver cirrhosis patients
    LIU Qing, LI Xiu-lan, LIU Ji-juan, SONG Xiao-hong, JIANG Xiao-ying, WANG Ming
    2016, 21(6):  452-455. 
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    Objective To investigate safety and efficacy of radiofrequency endometrial ablation operation for abnormal uterine bleeding in liver cirrhosis.Methods Twenty six patients with cirrhosis and abnormal uterine bleeding in our hospital from April 2012 to May 2015 were enrolled, and received radiofrequency endometrial ablation operation. Results The procedures was completed successfully in all the patients.The mean operation time was (61.0±18.9)s (ranged from 37 to 108 s).During the operation, the blood loss was less than 15m1, no complications occurred.No significant difference of variables related to liver disease between variables obtained at 1 month post-NovaSure treatment with those obtained at baseline in the cirrhotic(P> 0.05). There are significant improvement of anemia, fatigue, dysphoria and QoL scores was observed at after the therapy compared to those at baseline (P< 0.001). The rate of amenorrhoea was 88.5%(23/26)、95.2%(20/21)、100%(19/19) and 92.9%(13/14), and the rate of efficacy satisfaction was 100%(26/26)、100%(21/21)、100%(19/19) and 100(14/14), and the satisfaction rates was 100%、100%、100% and 92.31% at months 1,3,6, and 12, respectively.Conclusion Radiofrequency endometrial ablation operation shows good efficacy and safety in the treatment of abnormal uterine bleeding in patients with liver cirrhosis.