Comparison between models for detecting hepatocellular carcinoma in patients with chronic liver diseases of various etiologies: ASAP score versus GALAD score.

BACKGROUND: Diagnostic panels based on multiple biomarkers and clinical characteristics are considered more favorable than individual biomarker to diagnose hepatocellular carcinoma (HCC). Based on age, sex, alpha-fetoprotein (AFP), and protein induced by vitamin K absence II (PIVKA-II) with/without AFP-L3, ASAP and GALAD models are potential diagnostic panels. The diagnostic performances of these two panels were compared relative to HCC detection among patients with various etiologies of chronic liver diseases (CLDs). METHODS: A multicenter case-control study recruited CLDs patients with and without HCC from 14 Chinese hospitals. The etiologies of CLDs included hepatitis B virus (HBV), hepatitis C virus (HCV), alcoholic liver disease (ALD), and nonalcoholic fatty liver disease (NAFLD). Using area under the receiver operating characteristic curve (AUC) values, the diagnostic performances of ASAP and GALAD models were compared to detect HCC among patients with various etiologies of CLDs. RESULTS: Among 248 HCC patients and 722 CLD controls, the ASAP model demonstrated the highest AUC (0.886) to detect HCC at any stage, outperforming the GALAD model (0.853, P = 0.001), as well as any individual biomarker (0.687-0.799, all P < 0.001). In the subgroup analysis of various CLDs etiologies, the ASAP model outperformed the GALAD model to HCC independent of CLDs etiology. In addition, the ASAP model performed better in detecting early-stage (BCLC stage 0/A) HCC versus the GALAD model. CONCLUSIONS: Despite using one less laboratory variable (AFP-L3), the ASAP model demonstrated better diagnostic performance than the GALAD model to detect all-stage HCC among patients with various etiologies of CLDs-related HCC.

The Endothelial Nitric Oxide Synthase Gene T-786C Polymorphism Increases Myocardial Infarction Risk: A Meta-Analysis.

BACKGROUND Polymorphisms of the endothelial nitric oxide synthase (eNOS) gene are reportedly associated with myocardial infarction (MI) risk. However, definitive evidence of this association is lacking. In this study, we investigated the potential association of eNOS gene polymorphisms with MI risk by conducting a meta-analysis of studies evaluating this association. MATERIAL AND METHODS PubMed, Web of Knowledge, ScienceDirect, China National Knowledge Infrastructure (CNKI), WanFang, and Database of Chinese Scientific and Technical Periodicals (VIP) were searched for relevant studies. Pooled odds ratios (OR) with 95% confidence interval (CI) were calculated to evaluate the association of eNOS gene T-786C and 4b4a polymorphisms with MI risk. RESULTS Fifteen studies with 8,067 controls and 4,923 MI cases were included in the final meta-analysis. In the overall analysis, T-786C (rs2070744) polymorphism was associated with MI risk (p<0.05, OR=1.69, 95% CI: 1.53-1.86 for T vs. C; p<0.05, OR=2.76, 95% CI: 2.03-3.75 for TT vs. CC; p<0.05, OR=1.74, 95% CI 1.56-1.95 for TT vs. (CT + CC); p<0.05, OR=2.43, 95% CI: 1.79-3.30 for (CT + TT) vs. CC). In addition, a significant association between 4b4a VNTR polymorphism and MI risk was observed. On sub-group analyses by ethnicity, a significant increase in MI risk was observed separately for Asian and Caucasian populations for T-786C polymorphism, but not for the 4b4a polymorphism. CONCLUSIONS In this meta-analysis, T-786C polymorphism of the eNOS gene was associated with the risk of MI, especially in the Asian populations.

Thyroid Hormone Reference Intervals among Healthy Individuals In Lanzhou, China.

BACKGRUOUND: The common reference intervals (RIs) for thyroid hormones currently used in China are provided by equipment manufacturers. This study aimed to establish thyroid hormone RIs in the population of Lanzhou, a city in the subplateau region of northwest China, and compare them with previous reports and manufacturer-provided values. METHODS: In total, 3,123 individuals (1,680 men, 1,443 women) from Lanzhou, an iodine-adequate area of China, perceived as healthy were selected. The Abbott Architect analyzer was used to determine the serum concentration of thyroid hormones. The 95% RI was estimated using the 2.5th and 97.5th percentiles as the lower and upper reference limits, respectively. RESULTS: The serum levels of thyroid-stimulating hormone (TSH), total triiodothyronine (TT3), antithyroglobulin (ATG) antibody, and antithyroid peroxidase (ATPO) antibody levels were significantly correlated with sex (P<0.05). TSH, total thyroxine (TT4), and ATPO levels were significantly correlated with age (P<0.05). The serum levels of TSH, ATG, and ATPO in men were significantly lower than in women; in contrast, the serum TT3 level was significantly higher in men than in women (P<0.05). Serum TSH, TT3, TT4, and ATG levels differed across age groups (P<0.05), but no such variation was observed for ATG levels (P>0.05). The established RIs of TSH, ATG, and ATPO in this study differed between sexes (P<0.05). The thyroid hormone RIs established herein were inconsistent with the manufacturer-provided values. CONCLUSION: The RIs of thyroid hormones in the healthy population of Lanzhou were inconsistent with those in the manufacturer's manual. Validated sex-specific values are required for diagnosing thyroid diseases.

Clinical significance of serum oxidative stress and serum uric acid levels before surgery for hepatitis B-related liver cancer.

BACKGROUND: The incidence and mortality of liver cancer are among the highest of all malignant tumors in China. The high recurrence rate after conventional hepatectomy is worrying. There is a lack of effective prognostic indicators for liver cancer. AIM: To explore the clinical significance of preoperative serum oxidative stress and serum uric acid (UA) levels in hepatitis B-related liver cancer. METHODS: The medical records of 110 hepatitis B-related liver cancer patients who underwent hepatectomy in Gansu Provincial Hospital were retrospectively analyzed. Recurrence in patients within 3 years after surgery was determined. The logistic regression model and Pearson or Spearman correlation were used to analyze the correlation between oxidative stress level and UA, and the recurrence of hepatitis B-related liver cancer. RESULTS: Compared with the non-recurrence group, the levels of superoxide dismutase (SOD) and glutathione (GSH) in the recurrence group were lower and the levels of malondialdehyde (MDA) and UA were higher (all P < 0.05). UA, SOD, MDA, and GSH were risk factors for postoperative recurrence in hepatitis B-related liver cancer patients (P < 0.05). UA was positively correlated with MDA (r = 0.395, P < 0.001) and negatively correlated with GSH (r = -0.204, P = 0.032). The area under the receiver operating characteristic curve (AUC) of SOD, MDA, GSH, and UA in predicting the prognosis was 0.276, 0.910, 0.199, and 0.784, respectively (all P < 0.001). CONCLUSION: The preoperative serum SOD, GSH, MDA, and UA levels had significant predictive effects on postoperative recurrence of hepatitis B-related liver cancer.

[Drug resistance of methicillin resistant Staphylococcus strains in burn ward and relative analysis].

OBJECTIVE: To study the distribution and drug resistance of methicillin resistant Staphylococcus strains in various specimens of inpatients in burn wards, and to provide reference for clinical treatment. METHODS: Bacteria were isolated from specimens of wound exudate, blood, sputum, and bronchoalveolar lavage fluid etc., which were collected from patients hospitalized in our burn wards from January 2008 to December 2010. The bacteria were routinely cultured and identified. Drug resistance of the Staphylococci to 15 antibiotics commonly used in clinic was identified by K-B disk diffusion method. Data were processed with statistical software WHONET 5.5. The homology of 40 strains of methicillin resistant Staphylococcus aureus (MRSA) was analyzed by pulsed-field gel electrophoresis (PFGE). RESULTS: Altogether 386 strains of Staphylococcus were isolated, including 196 strains of Staphylococcus aureus and 190 strains of coagulase negative Staphylococcus. The mean annual isolation rates of MRSA and methicillin resistant coagulase negative Staphylococcus (MRCoNS) were respectively 73.00% (143/196) and 74.20% (141/190). The resistance rates of MRSA and MRCoNS to ß-lactams drugs, such as penicillin, oxacillin, cefazolin, and cefuroxime were 100.00% in every year. No Staphylococcus strains resistant to vancomycin, teicoplanin, or linezolid were found. Three different PFGE patterns A, B, and C were identified among 40 MRSA strains, including 33 strains of type A (30 strains in sub-type A1 and 3 strains in sub-type A2), 6 strains of type B (respectively 3 strains in sub-types B1 and B2), and 1 strain of type C. CONCLUSIONS: The isolation rates of MRSA and MRCoNS were high in our burn wards from January 2008 to December 2010. All of them showed strong drug resistance property, and they were multidrug resistant. The most prevalent strain was PFGE type A.

[Study of plasmid-mediated 16S rRNA methylase genes and drug-resistant transferability of Acinetobacter baumannii isolated from burn ward].

OBJECTIVE: To investigate the drug-resistance of Acinetobacter baumannii (Ab) isolated from patients in burn ward, and study the incidence of 16S rRNA methylase genes mediated high-level aminoglycoside drug-resistance and its mechanism of transfer. METHODS: A total of 40 Ab clinical isolates were collected from burn ward in Gansu Province People's Hospital from May 2006 to Dec. 2007. The sensitivity of Ab for 20 antibiotics were determinated by K-B agar diffusion. The minimal inhibitory concentrations (MIC) of amikacin, gentamicin, tobramycin, netilmicin, isepamicin and kanamycin against Ab strains were determinated by agar dilution. Five kinds of 16S rRNA methylase genes including armA, rmtA, rmtB, rmtC, rmtD were amplified by PCR, the positive PCR-products were purified and sequenced, and the plasmid were extracted by alkaline lysis. The transferability of drug-resistance were determinated by conjugation and plasmid transformation tests. RESULTS: The drug-resistance rates of Ab against six aminoglycosides antibiotics was 72.5%, 72.5%, 70.0%, 67.5%, 70.0%, 70.0%, respectively. Twenty five strains were resistant to six aminoglycosides antibiotics (62.5%), among which 10 isolates were armA-positive (40.0%); rmtA, rmtB, rmtC and rmtD-positive isolates were not found. Ten transformants and 10 conjugates showed high-level resistance against aminoglycosides antibiotics, all of which the value of MIC > or = 256 microg/mL carried armA gene. CONCLUSIONS: The drug-resistance of Ab clinical isolates have high drug-resistance. 16S rRNA methylases gene exists in Ab and locates in plasmid chromosome.

[Detection of integron, homology and genotype of carbapenemases in multi-drug resistant Acinetobacter Baumannii isolated from burn wound].

OBJECTIVE: To investigate the relationship among antibiotic resistance, integron, homology of multi-drug resistant Acinetobacter Baumannii isolated from burn ward. METHODS: Thirty-one strains of multi-drug resistant Acinetobacter baumannii were isolated from samples of burn wound exudate in hospitalized patients of Gansu Province People's Hospital. The minimum inhibitory concentrations (MIC) of these strains against 11 antibiotics was examined by agar dilution method. Homology of these strains was analyzed by pulse-field gel electrophoresis (PFGE). Class 1, 2 and 3 integrase, integron genes and genotype of carbapenemases were amplified by PCR and verified by DNA sequencing. RESULTS: Acinetobacter baumannii were highly resistant to all antibiotics except imipenem, meropenem, cefoperazone-sulb-actam, piperacillin-tazobactam (antibiotic resistance rate was 45.2%, 48.4%, 48.4%, 41.0%, respectively). All strains were classified into 3 types of clones (A, B, C clone included 18, 7, 6 strains respectively) based on PFGE pattern. Integrons of 20 strains of Acinetobacter Baumannii harbored aadA1, aadA5, aacA4, aac3, catB8, aacC1, aac (6')-Ib, drfA17 and drf8 gene. CONCLUSION: Multi-drug resistance Acinetobacter baumannii (major in clone A) spread widely in burn ward of Gansu Province People's Hospital. Integrons of Acinetobacter baumannii mediated drug resistance against aminoglycoside antibiotics, chloramp-phenicol. All carbapenem-resistant Acinetobacter Baumannii can produce OXA-23 carbapenemase.

[Investigation of 728 strains of infectious bacteria in burn ward and analysis of their antibiotic resistance].

OBJECTIVE: To study the infectious strains of bacteria in our burn ward in recent 5 years, and analyze their antibiotic resistance. METHODS: Bacteria were isolated from the wound excretions of 306 burn patients hospitalized during 2001 to 2006 for analyzing their strains and their antibiotic resistance. RESULTS: 378 strains were Grams positive bacteria, among them Staphylococcus aureus was the predominant strain. Further analysis showed that methicillin resistant staphylococcus aureus (MRSA) ranked the first in occurrence, followed by methicillin-resistance Staphylococcus epidermidis (MRSE) and Enterococcus fecalis, 338 strains were Gram negative bacteria, and among them Acinetobacter baumannii was predominant, and Enterobacter cloacae and Pseudomonas aeruginosa ranked the 2nd and 3rd. Twelve strains were fungi. CONCLUSION: Drug resistance to antibiotics in our burn ward may be related to the beta-lactamases from acinetobacter baumannii and multiple-drug-resistance of MRSA.

[The isolation of acinetobacter strain from burn wound and the analysis of its antibiotic resistance].

OBJECTIVE: To investigate the distribution and drug resistance of acinetobacter isolated from burn wounds. METHODS: The acinetobacter strains were isolated and identified by routine methods. Based on the recommendation of NCCLS, AmpC enzyme was determined by cefoxiti three-dimensional test, ESBLs by disk diffusion method and bacterial susceptibility by Kirby-Bauer agar diffusion method. RESULTS: Among the 69 strains of acinetobacter clinically isolated from burn wounds, 52 were baumannii (75.6%). The acinetobacter strains were identified to be highly resistant to 17 kinds of antibiotics. The drug resistance rate of beta-lactamase-producing strains (68.25%) was higher than that of non-beta-lactamase-producing strains (20.33%). The strains isolated in our burn ward exhibited multiple drug resistance which was mainly due to the production of many kinds of beta-lactamases. Among the 38 strains of beta-lactamase-producing acinetobacter, those producing AmpC beta-lactamase (AmpC BLA) accounted for 42.1%. CONCLUSION: Acinetobacter strain was one of the pathogens in burn wound infection, and its isolation and identification of its drug resistance could be beneficial to the doctors to make right choice of antibiotics.