An Automatic Method for Elbow Joint Recognition, Segmentation and Reconstruction.

Elbow computerized tomography (CT) scans have been widely applied for describing elbow morphology. To enhance the objectivity and efficiency of clinical diagnosis, an automatic method to recognize, segment, and reconstruct elbow joint bones is proposed in this study. The method involves three steps: initially, the humerus, ulna, and radius are automatically recognized based on the anatomical features of the elbow joint, and the prompt boxes are generated. Subsequently, elbow MedSAM is obtained through transfer learning, which accurately segments the CT images by integrating the prompt boxes. After that, hole-filling and object reclassification steps are executed to refine the mask. Finally, three-dimensional (3D) reconstruction is conducted seamlessly using the marching cube algorithm. To validate the reliability and accuracy of the method, the images were compared to the masks labeled by senior surgeons. Quantitative evaluation of segmentation results revealed median intersection over union (IoU) values of 0.963, 0.959, and 0.950 for the humerus, ulna, and radius, respectively. Additionally, the reconstructed surface errors were measured at 1.127, 1.523, and 2.062 mm, respectively. Consequently, the automatic elbow reconstruction method demonstrates promising capabilities in clinical diagnosis, preoperative planning, and intraoperative navigation for elbow joint diseases.

Maize Endophytic Plant Growth-Promoting Bacteria Peribacillus simplex Can Alleviate Plant Saline and Alkaline Stress.

Soil salinization is currently one of the main abiotic stresses that restrict plant growth. Plant endophytic bacteria can alleviate abiotic stress. The aim of the current study was to isolate, characterize, and assess the plant growth-promoting and saline and alkaline stress-alleviating traits of Peribacillus simplex M1 (P. simplex M1) isolates from maize. One endophytic bacterial isolate, named P. simplex M1, was selected from the roots of maize grown in saline-alkali soil. The P. simplex M1 genome sequence analysis of the bacteria with a length of 5.8 Mbp includes about 700 genes that promote growth and 16 antioxidant activity genes that alleviate saline and alkaline stress. P. simplex M1 can grow below 400 mM NaHCO3 on the LB culture medium; The isolate displayed multiple plant growth-stimulating features, such as nitrogen fixation, produced indole-3-acetic acid (IAA), and siderophore production. This isolate had a positive effect on the resistance to salt of maize in addition to the growth. P. simplex M1 significantly promoted seed germination by enhancing seed vigor in maize whether under normal growth or NaHCO3 stress conditions. The seeds with NaHCO3 treatment exhibited higher reactive oxygen species (ROS) levels than the maize in P. simplex M1 inoculant on maize. P. simplex M1 can colonize the roots of maize. The P. simplex M1 inoculant plant increased chlorophyll in leaves, stimulated root and leaf growth, increased the number of lateral roots and root dry weight, increased the length and width of the blades, and dry weight of the blades. The application of inoculants can significantly reduce the content of malondialdehyde (MDA) and increase the activity of plant antioxidant enzymes (Catalase (CAT), Superoxide Dismutase (SOD), and Peroxidase (POD)), which may thereby improve maize resistance to saline and alkaline stress. Conclusion: P. simplex M1 isolate belongs to plant growth-promoting bacteria by having high nitrogen concentration, indoleacetic acid (IAA), and siderophore, and reducing the content of ROS through the antioxidant system to alleviate salt alkali stress. This study presents the potential application of P. simplex M1 as a biological inoculant to promote plant growth and mitigate the saline and alkaline effects of maize and other crops.

GDSL in Lilium pumilum (LpGDSL) Confers Saline-Alkali Resistance to the Plant by Enhancing the Lignin Content and Balancing the ROS.

In order to explore the response mechanism of Lilium pumilum (L. pumilum) to saline-alkali stress, we successfully cloned LpGDSL (GDSL lipase, Gly-Asp-Ser-Leu) from L. pumilum. The qRT-PCR results indicated that the LpGDSL expression was higher in the leaves of L. pumilum, and the expression of the LpGDSL reached the highest level at 12 h in leaves under 11 mM H2O2, 200 mM NaCl, 25 mM Na2CO3, and 20 mM NaHCO3. The bacteriophage overexpressing LpGDSL was more tolerant than the control under different NaHCO3 contents. Overexpressed and wild-type plants were analyzed for phenotype, chlorophyll content, O2- content, H2O2 content, lignin content, and so on. Overexpressed plants had significantly higher resistance than the wild type and were less susceptible to saline-alkali stress. The yeast two-hybrid and BiFC assays demonstrated the existence of an interaction between LpGDSL and LpBCP. The yeast one-hybrid assay and transcriptional activation assay confirmed that B3 transcription factors could act on LpGDSL promoters. Under saline-alkali stress, L. pumilum will promote the expression of LpGDSL, which will then promotes the accumulation of lignin and the scavenging of reactive oxygen species (ROS) to reduce its damage, thus improving the saline-alkali resistance of the plant.

PS II Subunit P in Lilium pumilum (LpPsbP) Confers Saline-Alkali Resistance to the Plant by Scavenging ROS.

(1) Background: The growth of plants is impacted by salinity and alkali, Lilium pumilum (L. pumilum) is an ornamental plant with strong resistance to salinity and alkali, while the LpPsbP gene is helpful to fully understand the Saline-Alkali tolerance of L. pumilum. (2) Methods: Gene cloning, bioinformatics analysis, expression of fusion protein, determination of physiological indices of plant after Saline-Alkali stress, yeast two-hybrid screening, luciferase complementation assay, chromosome walking to obtain the promoter sequence, and then analyzed by PlantCARE. (3) Results: The LpPsbP gene was cloned and the fusion protein was purified. The transgenic plants had higher Saline-Alkali resistance than the wild type. A total of eighteen proteins interacting with LpPsbP were screened, and nine sites in the promoter sequence were analyzed. (4) Conclusion: Under Saline-Alkali or oxidative stress, L. pumilum will promote the expression of LpPsbP, which will then directly scavenge reactive oxygen species (ROS) in order to protect its photosystem II, reduce its damage, and thus improve the Saline-Alkali resistance of the plant. Moreover, according to some of the literature and the following experiments, two additional speculations are developed on the mechanisms of how two newly found objects, namely jasmonic acid (JA) and FoxO protein, could be involved in ROS scavenging processes were made.

Comparative study of the functional outcomes of combined medial-lateral approach arthrolysis with or without external fixation for severe elbow stiffness.

BACKGROUND: To evaluate and compare the functional outcomes of combined medial-lateral approach open arthrolysis with and without hinged external fixation. METHODS: We retrospectively collected and analyzed the clinical data of patients with severe elbow stiffness who were treated in our institution from January 2018 to January 2019. All of them were treated with combined medial-lateral approach arthrolysis. There were 20 patients who had the hinged external fixation placed and 29 patients without the placement of the external fixation. Their baseline characteristics and functional outcomes were evaluated and compared. RESULTS: The average follow-up time was 28.4 ± 3.7 months. There were no significant differences in the ROM of the elbow, MEPS, VAS, DASH, or complications between the two groups. The operation time and treatment cost of the patients without external fixation were significantly lower than patients with external fixation. CONCLUSION: Combined medial-lateral approach open elbow arthrolysis without external fixation is a safe and effective way to treat elbow stiffness. LEVEL OF EVIDENCE: Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Comparative study of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus treated by open reduction and internal fixation.

BACKGROUND: To evaluate the difference of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus after open reduction and internal fixation. METHODS: We retrospectively analyzed the clinical data of patients with OTA/AO-C distal humerus fractures who were treated in our department from January 2014 to December 2016. The patients were divided into an open fracture group and a closed fracture group. Their baseline characteristics and functional outcomes were analyzed and compared. RESULTS: A total of 64 patients treated by operative fixation were identified (25 open and 39 closed injuries), and the average follow-up time was 35.1 ± 13.6 months. There were no significant differences in the range of motion (ROM) of the elbow, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, complications, hospitalization time, operation time, intraoperative blood loss, or medical costs between the two groups (P > 0.05). CONCLUSION: OTA/AO type C, Gustilo I/II distal humeral open fractures can yield satisfactory clinical results similar to those of closed distal humeral fractures after open reduction and internal fixation. LEVEL OF EVIDENCE: Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Systematic characterization and prediction of post-translational modification cross-talk between proteins.

MOTIVATION: Protein post-translational modifications (PTMs) regulate a wide range of cellular protein functions. Many PTM sites from the same (intra) or different (inter) proteins often cooperate with each other to perform a function, which is defined as PTM cross-talk. PTM cross-talk within proteins attracted great attentions in the past a few years. However, the inter-protein PTM cross-talk is largely under studied due to its large protein pair space and lack of a gold standard dataset, even though the PTM interplay between proteins is a key element in cell signaling and regulatory networks. RESULTS: In this study, 199 inter-protein PTM cross-talk pairs in 82 pairs of human proteins were collected from literature, which to our knowledge is the first effort in compiling such dataset. By comparing with background PTM pairs from the same protein pairs, we found that inter-protein cross-talk PTM pairs have higher sequence co-evolution at both PTM residue and motif levels. Also, we found that cross-talk PTMs have higher co-modification across multiple species and 88 human tissues or conditions. Furthermore, we showed that these features are predictive for PTM cross-talk between proteins, and applied a random forest model to integrate these features with achieving an area under the receiver operating characteristic curve of 0.81 in 10-fold cross-validation, prevailing over using any single feature alone. Therefore, this method would be a valuable tool to identify inter-protein PTM cross-talk at proteome-wide scale. AVAILABILITY AND IMPLEMENTATION: A web server for prioritization of both intra- and inter-protein PTM cross-talk candidates is at http://bioinfo.bjmu.edu.cn/ptm-x/. Python code for local computer is also freely available at https://github.com/huangyh09/PTM-X. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Correlation between modified trochleocapitellar index and post-traumatic elbow stiffness in type C2-3 distal humeral fractures among adults.

BACKGROUND: The purpose of this study was to propose the modified trochleocapitellar index (mTCI), assess its reliability, and evaluate its correlation with post-traumatic elbow stiffness in type C2-3 distal humeral fractures among adults. METHODS: From January 2013 to June 2017, a total of 141 patients with type C2-3 distal humeral fractures were included. The mTCI was calculated as the ratio between the modified trochlear and capitellar angles relative to the humeral axis (mTCI-HA), lateral humeral line (mTCI-LHL), and medial humeral line (mTCI-MHL) from anteroposterior radiographs taken immediately after the operation. The patients were divided into group A (with elbow stiffness) and group B (without elbow stiffness) based on follow-up results. To determine risk factors for elbow stiffness, univariate and logistic regression analyses were performed on each radiographic parameter separately, together with other clinical variables. Interrater reliability was assessed for all measurements. RESULTS: Specific optimal ranges of value were identified for mTCI-HA (0.750-0.875), mTCI-LHL (0.640-1.060), and mTCI-MHL (0.740-0.900), beyond which the likelihood of elbow stiffness significantly increased (P < .001). By multivariate analysis, mTCI-HA (odds ratio [OR] 26.22, 95% confidence interval [CI] 3.39-203.07, P = .002), mTCI-LHL (OR 5.37, 95% CI 2.17-13.28, P < .001), and mTCI-MHL (OR 5.95, 95% CI 1.91-18.56, P = .002) values beyond the optimal ranges were identified as the independent risk factors for elbow stiffness. The interrater reliability of mTCI-HA, mTCI-LHL, and mTCI-MHL was 0.986, 0.983, and 0.987, respectively. CONCLUSION: The mTCI measurement method is reliable. Either too small or too large mTCI values were associated with post-traumatic elbow stiffness among adult patients with type C2-3 distal humeral fractures. The mTCI-HA showed a better predictive value than mTCI-LHL and mTCI-MHL.

Epidemiology of Hepatitis B and Hepatitis C Infections and Benefits of Programs for Hepatitis Prevention in Northeastern China: A Cross-Sectional Study.

BACKGROUND: To investigate the epidemiology of hepatitis B and C infections and the benefits of programs aimed at hepatitis prevention and control in Northeastern China. METHODS: Individuals receiving health examinations were recruited to complete a questionnaire and undergo laboratory tests for hepatitis infection. Data on demographic characteristics, results of hepatitis B virus (HBV) and hepatitis C virus (HCV) serological tests, for HBV and HCV infection were analyzed. RESULTS: Among 227 808 study participants, the hepatitis B surface antigen (HBsAg) and anti-HCV-positive rates were 6.1% and 3.0%, respectively. Among HBsAg-positive participants, 63.8% tested positive for HBV DNA, 20.2% had an abnormal alanine aminotransferase (ALT) level, and 10.7% had cirrhosis. Among anti-HCV-positive participants, 57.2% tested positive for HCV RNA, 29.6% had an abnormal ALT level, and 8.4% had cirrhosis. Among HBsAg- or anti-HCV-positive participants, 47.1% and 32.0%, respectively, were aware of their infection. Among participants infected with HBV or HCV and suitable for antivirus treatment, 23.5% and 16.1%, respectively, had received antivirus treatment. The HBV plus HCV coinfection rate was 0.08%. CONCLUSIONS: The HBsAg-positive rate decreased significantly after implementation of recently introduced HBV control programs in China. However, the anti-HCV-positive rate showed only a slight decrease, indicating that programs for the prevention and control of hepatitis viruses require continued strengthening. CHINESE CLINICAL TRIALS REGISTRATION: ChiCTR-ECS-13004009.

Bacterial Infections in Acute-on-chronic Liver Failure: Epidemiology, Diagnosis, Pathogenesis, and Management.

Acute-on-chronic liver failure (ACLF) is a distinct condition characterized by the abrupt exacerbation of pre-existing chronic liver disease, often leading to multi-organ failures and significant short-term mortalities. Bacterial infection is one of the most frequent triggers for ACLF and a common complication following its onset. The impact of bacterial infections on the clinical course and outcome of ACLF underscores their critical role in the pathogenesis of systemic inflammation and organ failures. In addition, the evolving epidemiology and increasing prevalence of multidrug-resistant bacteria in cirrhosis and ACLF highlight the importance of appropriate empirical antibiotic use, as well as accurate and prompt microbiological diagnosis. This review provided an update on recent advances in the epidemiology, diagnosis, pathogenesis, and management of bacterial infections in ACLF.

Ferric reduction oxidase in Lilium pumilum affects plant saline-alkaline tolerance by regulating ROS homeostasis.

Ferric reduction oxidase (FRO) plays important roles in biotic and abiotic stress. However, the function of ferric reduction oxidase from Lilium pumilum in response to NaHCO3 is unknown. Here we report the functional characterization of ferric reduction oxidase 7 in Lilium pumilum (LpFRO7) in stresses. Under NaHCO3 stress, the LpFRO7 overexpression lines exhibited lower accumulation of reactive oxygen species (ROS), higher activities in antioxidant enzyme (CAT, SOD and POD) and ferrite reductase, resulting in improved tolerance compared to the wild type (WT). In order to determine the functional network of LpFRO7, it was confirmed by EMSA assays, Yeast one-hybrid assays and Dual luciferase reporter assays that LpbHLH115 transcription factor can bind to the promoter of LpFRO7. Yeast two-hybrid assays, BiFC, and LCI assays were performed to prove that LpFRO7 can interact with LpTrx. Combining these findings, we concluded that LpFRO7 affects plant saline-alkaline tolerance by regulating ROS homeostasis.

Biomechanical comparison of three internal fixation configurations for low transcondylar fractures of the distal humerus.

BACKGROUND: We aimed to evaluate the biomechanical stiffness and strength of different internal fixation configurations and find suitable treatment strategies for low transcondylar fractures of the distal humerus. METHODS AND MATERIALS: Thirty 4th generation composite humeri were used to create low transcondylar fracture models that were fixed by orthogonal and parallel double plates as well as posterolateral plate and medial screw (PPMS) configurations (n=10 in each group) using an anatomical locking compression plate-screw system and fully threaded medial cortical screws. Posterior bending (maximum 50 N), axial loading (maximum 200 N) and internal rotation (maximum 10 N·m) were tested, in that order, for each specimen. Stiffness under different biomechanical settings among different configurations were compared. Another 18 sets of fracture models were created using these three configurations (n=6 in each group) and the load to failure under axial loading among different configurations was compared. RESULTS: Under posterior bending, the stiffness of parallel group was higher than orthogonal group (P<0.001), and orthogonal group was higher than PPMS group (P<0.001). Under axial loading, the stiffness of parallel group was higher than orthogonal group (P=0.001) and PPMS group (P<0.001); however, the difference between orthogonal and PPMS group was not statistically significant (P>0.05). Under internal rotation, the stiffness of parallel group was higher than orthogonal group (P=0.044), and orthogonal group was higher than PPMS group (P=0.029). In failure test under axial loading, the load to failure in the orthogonal group was lower than parallel group (P=0.009) and PPMS group (P=0.021), but the difference between parallel group and PPMS group was not statistically significant (P>0.05). All specimens in orthogonal group demonstrated "distal medial failure"; most specimens had "distal medial and trochlear failure" in the parallel group; most specimens exhibited "contact failure" in the PPMS group. CONCLUSION: For treating low transcondylar fractures, the overall stiffness and strength of the parallel configuration were superior to those of the orthogonal and PPMS configurations. Nevertheless, the PPMS configuration can provide adequate stability and stiffness comparable to double-plate configurations under axial loading. Therefore, the PPMS construct may have certain clinical value.

[Clinical antiviral effects of Peg-IFNa-2a in patients with chronic hepatitis B].

OBJECTIVE: To evaluate antiviral effects of Peg-IFNa-2a in patients with chronic hepatitis B. METHODS: 92 chronic hepatitis B patients were enrolled to receive the treatment with Peg-IFNa-2a 180 µg subcutaneous injection once weekly. The patients who did not get early response were divided into 3 groups: group 1, extend the treatment to 72 weeks; group 2, combined with nucleus(s)ide analogue (entecavir or adefovir) treatment; group 3, continue the treatment until 48 weeks. HBV DNA and quantitative HBsAg were assessed at baseline, week 12, 24, 36 and after 24 weeks follow-up. RESULTS: Patients in group 1 had significantly higher SVR rate (78.3%) than patients in group 3 (38.1%, X2=7.33, P<0.05). The mean reduction of HBsAg in group 1 at 24 weeks of post-treatment follow up was higher than that in group 3 (t=2.11, P<0.05). In group 2 the mean reductions of HBV DNA at 24 weeks of post-treatment follow up were (3.9+/-1.1) log10 copy/ml and (3.7+/-1.3) log10 copy/ml respectively with combination of entecavir or adefovir, both of which were significantly higher than that in group 3(t=8.45 and 6.31, P<0.05); the SVR rates in the entecavir group and the adefovir group (83.3% and 85.7%, respectively) were significantly higher than that in group 3 (X2=8.20 and 7.78, P<0.05); the mean reductions of HBsAg in the entecavir group and the adefovir group [(0.8+/-0.5) log10 IU/ml and (0.9+/-0.3) log10 IU/ml, respectively ] were significantly greater than group 3[(0.4+/-0.3) log10 IU/ml, t=3.05 and 4.58, P<0.05]. The level of HBV DNA and C genotype were the main predictors of response. CONCLUSION: Individualizing therapy by prolonging the duration of Peg-IFNa-2a treatment to 72 weeks or adding nucleoside analogues such as entecavir and adefovir in patients without early response may substantially increase the SVR rate and lead to the decrease of HBsAg.

Association between meteorological factors and audiogram configurations in patients with sudden sensorineural hearing loss: a cross-sectional study.

OBJECTIVE: We aimed to determine the association between meteorological factors and sudden sensorineural hearing loss (SSNHL) audiogram configurations. DESIGN: Retrospective review of medical records from 1 October 2007 to 31 December 2018. SETTING: A tertiary hospital. PARTICIPANTS: 510 patients with SSNHL who had data on the exact date of SSNHL onset and underwent audiological evaluation within 14 days were included. PRIMARY AND SECONDARY OUTCOME MEASURES: Daily values of meteorological factors, including maximum and minimum temperature, mean temperature and its day-to-day change, diurnal temperature range, atmospheric pressure, mean and maximum wind speed and relative humidity, and seasonal distributions. RESULTS: Among the 510 patients (259 women (50.8%); mean (SD) age, 46.4 (15.5) years), 108 (21.2%) displayed ascending patterns, 143 (28.0%) displayed descending patterns, 129 (25.3%) displayed flat patterns and 130 (25.5%) displayed profound patterns of audiograms. The diurnal temperature range on the day of SSNHL onset in patients with profound patterns was significantly higher than that in patient with ascending (mean difference (MD), 2.2°C; 95% CI, 0.7°C to 3.7°C; p=0.001) and descending (MD, 1.5°C; 95% CI, 0.1°C to 2.9°C; p=0.031) patterns. The relative humidity was the highest on the day of SSNHL onset in patients with ascending patterns and showed a significant difference compared with that in patients with profound patterns (MD, 8.0%; 95% CI, 0.7% to 15.3%; p=0.026). Seasonal distribution did not differ among patients with different audiogram configurations. CONCLUSIONS: Profound audiogram patterns correlated with high diurnal temperature range, while ascending audiogram patterns correlated with high relative humidity in patients with SSNHL. No correlation was observed between seasons and audiogram configurations.

[Antiviral effects of entecavir in patients with hepatitis B virus-related cirrhosis].

OBJECTIVE: To analyze antiviral effects of entecavir in patients with hepatitis B virus-related cirrhosis. METHODS: 104 patients of hepatitis B virus-related cirrhosis with no previous history of antiviral therapy were treated with entecavir 0.5 mg once daily. 37 patients were taken hepatic histologic examination before and after the treatment. RESULTS: Mean reductions of serum HBV DNA was 5.1 log10 96 weeks after the treatment, HBV DNA became undetectable in 98.1% patients, and ALT became normal in 80.7% patients; HBeAg seroconversion occurred in 13.9% of the 72 HBeAg positive patients; 61.5% of these patients were infected with genotype C HBV, and 26.9% were infected with genotype B HBV. The genotype of HBV was not associated with the therapeutical effect. Child-pugh score was associated with the progression of the disease: the proportion of patients with disease progression was highest in Child-Pugh C grade patients and lowest in Child-Pugh A grade patients. The level of the HBV DNA load was positively correlated with Knodell HAI score at the baseline and 96 weeks after the treatment. CONCLUSION: Entecavir treatment results in suppression of HBV replication and delayed progression of fibrosis in patients with hepatitis B virus-related cirrhosis.

[Clinical antiviral effects of telbivudine in patients with chronic hepatitis B].

OBJECTIVE: To analyze antiviral effects of telbivudine in patients with chronic hepatitis B. METHOD: 72 chronic hepatitis B patients without prior history of antiviral therapy were treated with telbivudine 600mg once daily. RESULTS: At week 4, 37.5% of the patients achieved undetectable HBV DNA, and 33.3% achieved ALT normalization. At week 108, 87.5% of the patients achieved undetectable HBV DNA, and 91.7% achieved ALT normalization. HBeAg seroconversion occurred in 23.9% of the 46 HBeAg positive patients. The rates of undetectable HBV DNA and HBeAg seroconversion at week 108 in the patients with HBV DNA < 3 log(10) copies/ml at week 12 were significant higher than those in patients with HBV DNA >or= 3 log(10) copies/ml. The rate of undetectable HBV DNA at week 108 in the patients with HBV DNA < 3 log(10) copies/ml at week 24 was significantly higher than that in patients with HBV DNA >or= 3 log(10) copies/ml, and the rate of antiviral resistance rate at week 108 in the patients with HBV DNA < 3 log(10) copies/ml at week 24 was significantly lower than that in patients with HBV DNA >or= 3 log(10) copies/ml. Antiviral therapy could significantly improve Child-Pugh score in patients with liver cirrhosis. CONCLUSION: Telbivudine treatment results in suppression of HBV and high HBeAg seroconversion, and improvement of Child-Pugh score in the patients with liver cirrhosis.

Clinical efficacy analysis of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in primary liver cancer and recurrent liver cancer.

PURPOSE: To compare the efficacy of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in primary hepatocellular carcinoma and recurrence of hepatocellular carcinoma after hepatectomy, and analysis the prognostic factors affecting therapeutic outcomes. METHODS: A total of 132 hepatocellular carcinoma patients treated with TACE combined with RFA were divided into primary group (n=89) and recurrent group (n=43). Their clinical date were reviewed. The overall survival (OS), tumor-free survival (TFS) and safety between 2 groups were compared. Prognostic factors were analyzed with univariate and multivariate analyses. RESULTS: OS rates at 1 and 3 years were 94.4% (84/89) and 70.8% (63/89) in the primary group, and TFS were 76.4% (68/89) and 37.1% (33/89), respectively. The OS rates in the recurrent group were 93.0% (40/43) and 65.1% (28/43), and TFS rates were 41.9% (18/43) and 13.9% (6/43), respectively. The OS rates had no significant difference between 2 groups (x2=0.0068, 0.4353, p=0.9342, 0.5094), but the TFS rates in primary group were significantly higher than in the recurrent group (x2=15.2378, 7.4483, p=0.0001, 0.0063). Multivariate analysis identified presence of portosystemic collaterals, AFP level, total bilirubin and Child-Pugh grading as factors affecting OS, and the presence of portosystemic collaterals and AFP level were two unfavorable prognostic factors influencing TFS. CONCLUSIONS: TACE combined with RFA is helpful in improving the survival rate of patients with primary and recurrent hepatocellular carcinoma. Presence of portosystemic collaterals, AFP level,ptotal bilirubin and Child-Pugh grading were the factors affecting OS.

Primary biliary cholangitis associated with drug-induced liver injury and alcoholic liver fibrosis: A case report.

RATIONALE: Primary biliary cholangitis (PBC) is a liver autoimmune disease. If this disease is associated with other liver injury factors, both misdiagnosis and missed diagnosis will easily occur. Therefore, detailed disease history collection and related laboratory examination should be performed on patients with liver injury for unidentified causes. When necessary, liver biopsy should be performed to confirm the histopathological diagnosis. PATIENT CONCERNS: The subject patient was a 63-year-old Chinese male with chronic liver injury who had a drinking history of about 30 years and drank 500 g daily on average and began to take health products and dietary supplements (multivitamins) since June 2014. DIAGNOSES: Drug-induced liver injury (DILI) and alcoholic fatty liver disease (AFLD) were initially considered because the patient had a history of using health products (HP) and dietary supplements (DS) and drinking alcohol. However, he was subsequently considered with PBC based on the findings of anti-mitochondrial antibody positivity and elevated immunoglobulin level. Obstructive jaundice and space-occupying lesion in the liver were excluded by imaging examinations. Liver biopsy was performed to confirm the reasons for liver injury. Histopathological examination was conducted, and the patient was diagnosed with PBC associated with DILI and alcoholic liver fibrosis. INTERVENTIONS: Ursodeoxycholic acid, glycyrrhizic acid, and methylprednisolone (small dose) were used to treat the patient. OUTCOMES: After 2 months, the serum levels of ALT, AST, AKP, GGT, and globulin returned to normal. After 4 months, the patient showed liver injury once again (an increase in ALT, AST, AKP, GGT and GLB) caused by repaglinide administration due to hyperglycemia. Ursodeoxycholic acid and methylprednisolone replaced the repaglinide administration. After 3 weeks, the levels of ALT, AST, AKP, GGT, and GLB returned to normal again. LESSONS: The correct knowledge on PBC and early-stage recognition and diagnosis should be emphasized. When other causes of the liver injury cannot be excluded, liver biopsy is suggested. Histopathological change can be used to further clarify the reasons for liver injury and the principal contradiction as well as to guide the theraputic regimen.

Induction differentiation of rabbit adipose­derived stromal cells into insulin­producing cells in vitro.

Mesenchymal stem cells (MSCs) with the ability to differentiate into insulin­producing cells (IPCs) have become the most promising means of therapy for diabetes mellitus. Adipose­derived stromal cells (AdSCs), having similar characteristics to those of derived MSCs, are known to exhibit extensive proliferation potential and are able to undergo multi­lineage differentiation. Whether AdSCs can differentiate into insulin­producing cells (IPCs), however, has not been sufficiently elucidated. Therefore, the present study sought to investigate the in vitro differentiation of rabbit (r)AdSCs into IPCs, which may provide an abundant source of cells to treat diabetes. rADSCs were obtained from liposuction aspirates and then induced with glucagon­like peptide­1 and nicotinamide to differentiate into insulin­secreting cells. Differentiation was evaluated by the analysis of morphology, dithizone (DTZ) staining, reverse transcription polymerase chain reaction (RT­PCR), western blot analysis and a glucose challenge assay with detection of insulin secretion by ELISA. Morphological phase­contrast microscopic observation revealed typical islet­like cell clusters following 21 days of differentiation. DTZ staining also showed that differentiated cells were positive and undifferentiated cells were negative for insulin production. Furthermore, RT­PCR analysis confirmed the mRNA expression of insulin, PDX1 and GLUT2 in differentiated cells. Western blot analysis showed that insulin was expressed by the differentiated cells. The glucose challenge assay showed that insulin secretion of the IPCs was in a glucose dependent manner. These findings implied that AdSCs are able to differentiate into IPC in vitro, and are therefore promising candidates for the treatment of diabetes.

Helicobacter hepaticus infection in primary hepatocellular carcinoma tissue.

INTRODUCTION: Helicobacter (H.) hepaticus infection causes chronic active hepatitis and induces hepatocellular tumours in A/JCr mice, but evidence of this in humans is scarce. This study aimed to demonstrate the correlation between H. hepaticus and human primary hepatocellular carcinoma (HCC). METHODS: The sera of 50 patients with primary HCC were tested for the presence of anti-H. pylori and anti-H. hepaticus immunoglobulin G (IgG) antibodies. The liver tissues of patients who tested positive for serum antibody were analysed for H. hepaticus-specific 16S rRNA, H. hepaticus cdtB, H. pylori cagA, H. pylori vacA and H. pylori ureC genes using polymerase chain reaction. RESULTS: After the anti-H. pylori antibodies in the serum samples were absorbed by H. pylori antigen, the anti-H. hepaticus IgG serum antibody detection rate was 50.0% in patients with primary HCC. This was significantly higher (p < 0.001) than the detection rate in the benign liver tumour (7.7%) and normal liver tissue (6.3%) groups. Of the 25 primary HCC samples that tested positive for anti-H. hepaticus IgG serum antibody, the H. hepaticus-specific 16S rRNA gene was detected in nine (36.0%) samples. Sequencing showed that the polymerase chain reaction-amplified product exhibited 95.5%-100% homology to the H. hepaticus-specific 16S rRNA gene. Among these nine primary HCC tissue samples, the H. hepaticus cdtB gene was detected in four (44.4%) samples, while no such expression was observed in the benign liver tumour or normal liver tissue groups. CONCLUSION: The present study identified the presence of H. hepaticus infection in patients with primary HCC using serological and molecular biological detection, suggesting that H. hepaticus infection may be involved in the progression of HCC.