Risk factors for complications of pancreatic extracorporeal shock wave lithotripsy.

BACKGROUND AND STUDY AIMS: Extracorporeal shock wave lithotripsy is recommended as treatment for stones in chronic pancreatitis. The aim of this study was to investigate the risk factors for complications of pancreatic extracorporeal shock wave lithotripsy (P-ESWL). PATIENTS AND METHODS: Patients with painful chronic pancreatitis and pancreatic stones (> 5 mm diameter) who were treated with P-ESWL between March 2011 and June 2013 were prospectively included. Adverse events after P-ESWL were classified as complications and transient adverse events, depending on severity. The major complications of P-ESWL included post-ESWL pancreatitis, bleeding, infection, steinstrasse, and perforation. Multivariate analyses based on univariate analysis were performed to detect risk factors of overall and moderate-to-severe complications. RESULTS: A total of 634 patients underwent 1470 P-ESWL procedures. The overall complication rate was 6.7 % of all procedures. Complications occurred in 62 patients (9.8 %) after the first ESWL procedure. The risk factors for complications were pancreas divisum (odds ratio [OR] 1.28) and the interval between diagnosis of chronic pancreatitis and P-ESWL (OR 1.28). Protective factors were male sex (OR 0.50), diabetes (OR 0.45), and steatorrhea (OR 0.43). Male sex, the only identified predictor for moderate-to-severe complications, was a protective factor (OR 0.19). For the second P-ESWL procedure, complications occurred in 22/409 patients (5.4 %). Complication and asymptomatic hyperamylasemia after the first ESWL session were significantly associated with higher risk for complications after the second ESWL session (P < 0.05). CONCLUSIONS: Patient-related factors were important in determining a high risk of P-ESWL complications when no procedure-related factors were identified. Patients suffering from complications after the first ESWL session were also likely to experience complications in subsequent P-ESWL sessions.

A prediction model for prognosis of nephrotic syndrome with tuberculosis in intensive care unit patients: a nomogram based on the MIMIC-IV v2.2 database.

Background: Currently, a scarcity of prognostic research exists that concentrates on patients with nephrotic syndrome (NS) who also have tuberculosis. The purpose of this study was to assess the in-hospital mortality status of NS patients with tuberculosis, identify crucial risk factors, and create a sturdy prognostic prediction model that can improve disease evaluation and guide clinical decision-making. Methods: We utilized the Medical Information Mart for Intensive Care IV version 2.2 (MIMIC-IV v2.2) database to include 1,063 patients with NS complicated by TB infection. Confounding factors included demographics, vital signs, laboratory indicators, and comorbidities. The Least Absolute Shrinkage and Selection Operator (LASSO) regression and the diagnostic experiment the receiver operating characteristic (ROC) curve analyses were used to select determinant variables. A nomogram was established by using a logistic regression model. The performance of the nomogram was tested and validated using the concordance index (C-index) of the ROC curve, calibration curves, internal cross-validation, and clinical decision curve analysis. Results: The cumulative in-hospital mortality rate for patients with NS and TB was 18.7%. A nomogram was created to predict in-hospital mortality, utilizing Alb, Bun, INR, HR, Abp, Resp., Glu, CVD, Sepsis-3, and AKI stage 7 days. The area under the curve of the receiver operating characteristic evaluation was 0.847 (0.812-0.881), with a calibration curve slope of 1.00 (0.83-1.17) and a mean absolute error of 0.013. The cross-validated C-index was 0.860. The decision curves indicated that the patients benefited from this model when the risk threshold was 0.1 and 0.81. Conclusion: Our clinical prediction model nomogram demonstrated a good predictive ability for in-hospital mortality among patients with NS combined with TB. Therefore, it can aid clinicians in assessing the condition, judging prognosis, and making clinical decisions for such patients.

Rare tuberculosis in recipients of allogeneic hematopoietic stem cell transplantation successfully treated with contezolid-a typical case report and literature review.

Background: Tuberculosis (TB) is a rare but potentially devastating complication in hematopoietic stem cell transplantation (HSCT) recipients. Myelosuppression-related antibiotics should be used cautiously in patients with hematological malignancies, especially those undergoing bone marrow transplantation and receiving bone marrow suppression therapy. Although linezolid has become the recommended drug for severe TB, its hematological toxicity is still an obstacle to its clinical application. Contezolid is a new representative of oxazolidinones in clinical development, showing superior anti-infection efficacy, but there have been no reports on the treatment of post-HSCT TB. Case presentation: We reported a patient with acute lymphoblastic leukemia suffered from pulmonary TB infection after HSCT. During anti-TB treatment, the patient had a poor response to linezolid-containing regimen, and developed side effects such as gingival bleeding and thrombocytopenia, so the administration was switched to contezolid. After 15 days of continuous treatment, the patient's platelet increased to 58×109/L, and he was discharged in stable condition. During subsequent anti-TB treatment with contezolid for more than 7 months, the platelets remained stable, and no hematological adverse reactions and no symptoms of peripheral neuropathy were observed. Moreover, repeat imaging showed that the bilateral lung lesions were significantly reduced, indicating a good outcome for the patient. Conclusion: This was the first successful case of post-HSCT TB patients treated with contezolid-containing antibiotic management strategies, which exhibited remarkable efficacy and good safety in this deadly disease.

[The effects of the plasma levels of serotonin and neuropeptide on ventilated patients with Yitongshu acupuncture points injection].

OBJECTIVE: To evaluate the change in the plasma levels of serotonin (5-hydroxytryptamine) and neuropeptide (beta-endorphin, beta-EP) after injection of Yitongshu into Zusanli points in patients under mechanical ventilation. METHODS: Twenty-eight patients undergoing mechanical ventilation were randomly divided into two groups: midazolam combined with fentanyl group (control group, n=14) and midazolam combined with fentanyl and Yitongshu group (Yitongshu group, n=14). The drugs were given to the patients continuously intravenously with an injection pump in an even rate, with the dosage adjusted to reach the sedative target of visual analog score (VAS)< or =3-4 and Ramsay 2-4. Yitongshu injection (4 ml) was injected into the Zusanli point on both sides 11 hours or 23 hours after administration of the durgs in Yitongshu group. The hemodynamic and respiratory parameters, including mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), pulse oxygen saturation (SpO(2)), oxygenation index (PaO(2)/FiO(2)) and pressure airway (Paw), were recorded, and the sedation levels (VAS and Ramsay) were evaluated before sedation and 1, 12, 24 hours after sedation in these patients. The plasma levels of 5-hydroxytryptamine and beta-EP were examined before sedation, 12 hours and 24 hours after sedation. RESULTS: Compared with that before sedation, HR and VAS score were significantly lower, and Ramsay score was significantly higher in both groups. MAP was significantly lower at 1 hour, and RR at 12 hours and 24 hours , as well as the Paw at 24 hours, and the PaO(2)/FiO(2) was significantly higher at 24 hours. The level of 5-hydroxytryptamine at 12 hours and 24 hours in Yitongshu group [(101.45+/-14.67) ng/L, (104.86+/-11.74) ng/L] was significantly higher than that in control group [(61.57+/-10.62) ng/L, (59.86+/-8.64) ng/L, both P<0.05]. But the level of beta-EP showed no difference between two groups [control group: (162.72+/-38.44) ng/L at 12 hours, (151.83+/-24.54) ng/L at 24 hours; Yitongshu group: (169.35+/-28.10) ng/L at 12 hours, (159.41+/-15.89) ng/L at 24 hours, both P>0.05]. CONCLUSION: Yitongshu injection can reduce the plasma level of 5-hydroxytryptamine in ventilated patients, but with no effect on beta-EP.

Prognostic nomogram for hepatocellular carcinoma with fibrosis of varying degrees: a retrospective cohort study.

BACKGROUND: Hepatocellular carcinoma (HCC) is a common and biologically aggressive malignancy linked to cirrhotic and pre-cirrhotic changes in the liver. We analyzed degrees of fibrosis in affected patients as indices of survival, to establish an effective prognostic nomogram. METHODS: Eligible patients with HCC and hepatic fibrosis, of varying degrees, were selected from the Surveillance, Epidemiology, and End Results (SEER) database for propensity score matching (PSM). The prognostic value of data was determined using Kaplan-Meier and Cox proportional hazards model. A nomogram based on variables derived from multivariate analyses was established and subjected to internal validation. Its predictive accuracy was tested by concordance index (C-index) and calibration plots. RESULTS: In this propensity score-matched cohort, advanced fibrosis/cirrhosis (vs. none-to-moderate fibrosis) correlated with poorer survival [hazard ratio (HR): 1.131, 95% confidence interval (CI): 1.032-1.240; P=0.009]. Multivariate analysis identified the following as independent risk factors for HCC: age >63 years, higher fibrosis score, American Joint Cancer Committee (AJCC) stages T3-4, distant metastasis (M1), tumor size >1 cm, major vascular invasion, and elevated alpha-fetoprotein (AFP) level. A nomogram that integrated these factors offered a superior prognostic prediction for HCC patients (C-index: 0.749, 95% CI: 0.7485-0.7495) relative to conventional tumor staging the AJCC tumor-node-metastasis (TNM) staging system (0.730). In calibration plots, optimal agreement between nomogram-predicted and observed survival was evident. CONCLUSIONS: Increased fibrosis was an independent risk factor for survival of HCC patients. A prognostic nomogram integrating fibrosis score and other independent risk factors offered more accurate depictions in this regard.

Effects of Anticoagulants on Experimental Models of Established Chronic Liver Diseases: A Systematic Review and Meta-Analysis.

Objective: The role of anticoagulants in chronic liver diseases is inconclusive. A meta-analysis was thus undertaken to evaluate treatment-related survival and antifibrotic effects in animal models of chronic liver diseases. Methods: A systematic search of the literature took place (up to November 2020), screening for preclinical studies that evaluated anticoagulant effects in animal models of chronic liver diseases. We assessed the quality of methods and the certainty of evidence. Data on outcomes were extracted and pooled into random-effects models. Results: Sixteen studies proved eligible, each assessing anticoagulant use in animals with chronic liver diseases. Generally, the pooled evidence demonstrated that the administration of anticoagulants is preventive against fibrogenesis, as indicated by METAVIR fibrosis scores (risk ratio = 0.66, 95% confidence interval: 0.47 to 0.94), portal pressure determinations (mean difference = -1.39, 95% confidence interval: -2.33 to -0.44), inflammatory activity (mean difference = -169.69, 95% confidence interval: -257.64 to -81.74), and indices of hepatic injury, specifically alanine aminotransferase (mean difference = -82.7, 95% confidence interval: -107.36 to -58.04), aspartate aminotransferase (mean difference = -186.12, 95% confidence interval: -254.90 to -117.33), albumin (mean difference = 0.59, 95% confidence interval: 0.16 to 1.01), and total bilirubin (mean difference = -0.96, 95% confidence interval: -1.46 to -0.46), and it had no impact on animal survival (risk ratio = 1.03, 95% confidence interval: 0.94 to 1.13). Conclusions: Our assessments indicate that in animal models of chronic liver diseases, anticoagulants may alleviate the degree of fibrosis evaluated by the METAVIR score system, portal pressure, inflammatory activity, and serum indices of hepatocellular injury, without impacting survival. High-quality experimental studies are still required.

A Preclinical Porcine Model of Portal Vein Thrombosis in Liver Cirrhosis.

BACKGROUND: This study aimed at presenting a novel method of developing a porcine model of portal vein thrombosis (PVT) in cirrhosis by intravenous administration of thrombin and insertion of a fibered coil. We further investigated changes of biochemical parameters, coagulation, and proinflammatory cytokine expression in the cirrhosis-PVT group. METHODS: Twelve male pigs were randomized into the control group (n = 3) and cirrhosis group (n = 9). In cirrhotic pigs, three were randomly selected to establish PVT by ultrasound-guided percutaneous puncture of the main portal vein (MPV) followed by intravenous thrombin administration and fibered coil insertion. Thrombosis in the MPV was detected by abdominal enhanced computer tomography (CT). The changes of hepatic function, coagulation system, and inflammation cytokines were compared among normal, cirrhosis, and cirrhosis with PVT groups. RESULTS: As manifested by the presence of a filling defect in MPV on portal venous-phase CT angiography, fibrin thrombi were formed in the MPV in cirrhotic pigs within one week and persisted for four weeks. Five weeks after surgery, abnormal liver functions occurred in association with PVT formation in cirrhosis. Both coagulation and thromboelastography parameters showed that cirrhosis-PVT pigs exhibited a procoagulant state through hyperfunction of platelets and clotting factors. Interleukin 6 (IL-6) as a potential inflammatory marker stimulated PVT-mediated inflammation activation in cirrhosis. CONCLUSIONS: Our study provides in vivo evidence that intravenous injection of a coil and thrombin into MPV under interventional guided devices enables a feasible method in thrombus creation. Further exploration and validation of large-sample cases are required to characterize utilities of this model.

LncRNA TUG1 regulates autophagy-mediated endothelial-mesenchymal transition of liver sinusoidal endothelial cells by sponging miR-142-3p.

Accumulating evidence indicates that competing endogenous RNA networks play a critical role in cirrhosis progression. However, their biological role and regulatory mechanisms in liver sinusoidal endothelial cells (LSECs) have not been explored. Here, we exposed LSECs to starvation and lipopolysaccharide (LPS) treatment and assessed changes in TUG1 and miR-142-3p expression, autophagy, and endothelial-mesenchymal transition (EndMT). We confirmed the effects of targeted binding between miR-142-3p and TUG1 or ATG5 by luciferase activity and radio-immunoprecipitation assay. Using an in vivo rat model of cirrhosis, we evaluated autophagy and EndMT in LSECs by immunofluorescence co-localization and immunohistochemical staining. The diagnostic efficiency of miR-142-3p and LPS were determined by receiver-operating characteristic curve analysis. We found that LSECs survived starvation by activating autophagy. LPS treatment enhanced autophagy and promoted EndMT of LSECs by upregulating TUG1. Our rat model of cirrhosis confirmed that serum LPS level, autophagy, and EndMT were increased in LSECs. TUG1 was highly expressed in LSECs, and TUG1 knockdown suppressed ATG5-mediated autophagy and EndMT of LSECs. TUG1 regulated ATG5 via shared miR-142-3p response elements. miR-142-3p was expressed at low levels in LSECs and negatively regulated autophagy and EndMT by reducing ATG5 expression. Our results suggest that TUG1 promotes LPS-induced autophagy and EndMT of LSECs by functioning as an endogenous sponge for miR-142-3p and promoting the expression of ATG5. LPS and miR-142-3p are potential diagnostic and therapeutic targets in cirrhosis.

Low-free triiodothyronine is associated with poor prognosis of portal hypertension in cirrhosis.

BACKGROUND AND AIMS: The role of thyroid function in the portal hypertension development and prognosis remains unclear. This study aimed to investigate the correlation between serum-free triiodothyronine (fT3) levels and the outcomes of cirrhotic portal hypertension. METHODS: A total of 385 cirrhotic patients with confirmed portal hypertension underwent computed tomography angiography and thyroid function test at a tertiary care referral center from January 2009 to December 2017. The patients were assigned to the low-fT3 (n = 98) and normal-fT3 groups (n = 287). RESULTS: Child-Pugh (8.88 ± 0.22 vs. 7.09 ± 0.12, P < 0.001) and model for end-stage liver disease (MELD) scores (14.75 ± 0.57 vs. 10.59 ± 0.23, P < 0.001) significantly increased in the low-fT3 group. The hemoglobin level correlated with fT3 (R = 0.299, P < 0.0001) and fT4 (R = 0.310, P < 0.0001), while only fT3 significantly correlated with the albumin level (R = 0.537, P < 0.001). The Kaplan-Meier analysis indicated that the two-year survival rate was 74.51% in the low-fT3 group vs. 94.25% in the normal-fT3 group (P < 0.0001). The Cox regression analysis demonstrated that the serum level of fT3 [hazard ratio: 0.478; 95% confidence interval (CI) 0.391-0.758; P = 0.002] and prothrombin time (hazard ratio: 2.247; 95% CI: 1.316-3.838; P = 0.003) were independent prognostic factors in cirrhotic patients. CONCLUSION: The low fT3 level was associated with poor prognosis and the progression of cirrhotic portal hypertension.

Candidate lncRNA-miRNA-mRNA network in predicting hepatocarcinogenesis with cirrhosis: an integrated bioinformatics analysis.

PURPOSE: This study aimed to explore the potential competing endogenous RNA (ceRNA) network in forecasting HCC development in patients with cirrhosis through a comprehensive bioinformatic analysis. METHODS: Data mining from GEO and TCGA databases was employed to dig a spectrum of differentially expressed mRNA, lncRNA and miRNA profiles. Their expression was confirmed by RT-PCR in matched HCC cohorts (n = 6/group). The ceRNA network was constructed by co-expression analysis. Their reciprocal regulations and their roles in epithelial-to-mesenchymal transition (EMT) process were validated by gain- and loss-of-function experiments at the cellular level. Kaplan-Meier method was applied to reveal prognostic values. RESULTS: By intersecting differentially expressed genes (DEGs) in GEO and TCGA data sets and Pearson correlation analysis, 20 mRNAs, 24 miRNAs and 41 lncRNAs were identified. Of these, FOXD2-AS1, BLVRA and CYTH2 were markedly upregulated in HCC tissues and HCC cells with high metastatic potential (MHCC97H) compared with their adjacent normal/cirrhotic tissues and L02 and MHCC97L cells. However, dysregulated miR-139-5p exhibited the opposite expression pattern. Using miRanda algorithms, FOXD2-AS1, BLVRA and CYTH2 showed potential binding sites for miR-139-5p. FOXD2-AS1 knockdown induced a marked increase in miR-139-5p and EMT inhibition. The loss of miR-139-5p led to an increase in BLVRA and CYTH2 expression and EMT process. Conversely, miR-139-5p overexpression suppressed BLVRA and CYTH expression and EMT process. FOXD2-AS1, miR-139-5p, BLVRA and CYTH2 highly correlated with prognosis in patients with HCC. CONCLUSION: FOXD2-AS1/miR-139-5p/BLVRA or CYTH2 axis might be the underlying molecular mechanism that dissects HCC development caused by cirrhosis.

[Changes in expressions of the myocardial Toll-like receptor 4, tumor necrosis factor-alpha and interleukin-6 mRNA in rat with sepsis].

OBJECTIVE: To investigate the relationship between apoptosis of myocardial cell in the rats with sepsis and the expressions of Toll-like receptor 4 (TLR4), tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) mRNA, and the protective effect of glutamine (Gln) against apoptosis of myocardial cell. METHODS: Rat model of sepsis was reproduced by peritoneal injection with lipopolysaccharide (LPS), and the animals were divided into control group, LPS group and Gln group. Rats in each group were further divided into four subgroups, 0, 6, 12 and 24 hours ( n =6). Apoptosis of myocardial cells was surveyed, and TLR4, TNF-alpha and IL-6 mRNA expressions were assessed with reverse transcription-polymerase chain reaction (RT-PCR). The pathological changes in myocardial cells were observed. RESULTS: Myocardial apoptosis rate in LPS group was higher. Compared with the control group, expressions of TLR4 mRNA, TNF-alpha mRNA and IL-6 mRNA were significantly higher at all time points after LPS administration in the LPS group and the Gln group (all P<0.05). Compared with the LPS group, the rate of myocardial apoptosis in Gln group was lower, and expression of TLR4 mRNA in the Gln group was significantly lower at 12 hours and 24 hours; the expression of TNF-alpha mRNA was obviously lower at 6 hours and 24 hours; the expression of IL-6 mRNA in the Gln group was significantly lower at 12 hours (all P<0.05). CONCLUSION: TLR4, TNF-alpha and IL-6 gene expressions play extremely important role in apoptosis of myocardial cell in the rat with sepsis. Gln can affect apoptosis-related gene expressions, thus alleviating the apoptosis of myocardial cell.

Properties of Polylactic Acid Reinforced by Hydroxyapatite Modified Nanocellulose.

Polylactic acid (PLA) is one of the most promising bio-based materials, but its inherent hydrophobicity limits its application. Although nanocellulose (NCC) is a desirable reinforcement for PLA, the poor interface compatibility between the two has been a challenge. In this work, hydroxyapatite (HAP) modified NCC was prepared, and the obtained NCC/HAP reinforcement was used to prepare PLA/NCC-HAP composites. Different ratios of NCC to HAP were studied to explore their effects on the mechanical and thermodynamic properties of the composites. When the ratio of NCC to HAP was 30/70, the tensile strength and tensile modulus of the composite film reached 45.6 MPa and 2.34 GPa, respectively. Thermogravimetric analysis results indicate that thermal stability of the composites was significantly improved compared with pure PLA, reaching 346.6 °C. The above revelations show that NCC/HAP significantly improved the interface compatibility with PLA matrix.

Extracorporeal Shock Wave Lithotripsy for Chinese Patients With Pancreatic Stones: A Prospective Study of 214 Cases.

OBJECTIVES: This study aims to evaluate prospectively the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) in Chinese patients. METHODS: A total of 214 patients with painful chronic pancreatitis and pancreatic stones who underwent ESWL followed by endoscopic retrograde cholangiopancreatography from March 2011 to February 2012 in Changhai Hospital were enrolled. The main pancreatic duct clearance rate and complications were recorded prospectively. Symptoms, weight, quality of life, and pancreatic function were assessed before and after ESWL and endotherapy. RESULTS: A total of 473 ESWL procedures were performed in 214 patients. Stones were fragmented in all cases. Complete clearance of main pancreatic duct stones and successful endoscopic decompression were achieved in 155 (72.4%) and 188 (90.8%) of 214 patients, respectively. Complications were observed after 20 sessions (20 of 473, 4.23%). Follow-up (n = 195) after 18.5 ± 3.3 months showed that complete and partial pain relief were achieved in 71.3% and 24.0% of the patients, respectively. The scores for the quality of life (5.8 ± 1.7 vs 8.1 ± 1.2, P < 0.05) and mental health from the Medical Outcomes Study 36-Item Short-Form General Health Survey questionnaire (62.2 ± 21.5 vs 68.5 ± 16.4, P < 0.05) improved after ESWL. CONCLUSIONS: Thus, ESWL is a safe and effective method to treat Chinese patients with pancreatic stones. This procedure can significantly improve the success rate of endotherapy.