[Analysis of the diagnostic efficiency of combining multiple laboratory hematological indicators in alpha-fetoprotein-negative hepatocellular carcinoma].

Objective: To establish a diagnostic model for alpha-fetoprotein-negative hepatocellular carcinoma (AFP-NHCC) by combining multiple laboratory hematological indicators and explore its clinical diagnostic efficiency. Methods: A total of 124 inpatients, including 110 males and 14 females, aged 57 (51, 66) years, who were first diagnosed with AFP-NHCC in the PLA General Hospital were included from December 2011 to June 2017. Meanwhile, 331 cases of non-HCC were enrolled as the control group, including 279 males and 52 females, aged 58 (51, 63) years old, with 47 cases of hepatitis B virus (HBV) infection, 40 cases of liver cirrhosis, 64 cases of hepatic hemangioma or cysts, 7 cases of liver nodules, 8 cases of fatty liver, 146 cases of non-liver disease and 19 health controls. Subjects in the AFP-NHCC group and the control group were divided into a training group and a validation group. A total of 196 subjects were involved in the training group, including 103 AFP-NHCC patients and 93 non-HCC patients (19 healthy controls, 25 patients with HBV infection, 22 patients with liver cirrhosis, 23 patients with hepatic hemangioma or cyst, and 4 patients with liver nodules). The differences in laboratory parameters were analyzed, and a diagnostic model of AFP-NHCC under different AFP levels was established. Likewise, 259 subjects, including 113 patients with liver disease, were involved in the validation group to verify the diagnostic efficiency of the model for AFP-NHCC. The receiver operating characteristic (ROC) curve was used to analyze the sensitivity and specificity of different models, and the area under the curve (AUC) was calculated to evaluate the diagnostic performance of different models. Results: In the training group, the indicators of AFP-NHCC diagnostic model included platelet (PLT), prothrombin activity (PTA), serum albumin (ALB), prothrombin time (PT) and carbohydrate antigen 19-9 (CA19-9), and the AUC of the model was 0.848 (95%CI: 0.786-0.911) when AFP≤5 µg/L. Similarly, the indicators of AFP-NHCC diagnostic model included PLT, PTA, ALB, PT and hematocrit (HCT), and the AUC of the model was 0.839 (95%CI: 0.780-0.897) when AFP≤10 µg/L. When AFP≤20 µg/L, the indicators of AFP-NHCC diagnostic model contained PLT, PTA, ALB, PT, HCT and AFP, and the AUC of the model was 0.866 (95%CI: 0.815-0.917). The AUC values of these three models were higher than those of AFP and CA19-9 alone for the diagnosis of AFP-NHCC [0.634 (95%CI: 0.560-0.709), 0.691 (95%CI:0.620-0.761), all P<0.05]. The indicators screened by these three models were combined to establish the final diagnostic model, and the AUC of the model was 0.873 (95%CI: 0.824-0.923), with the sensitivity of 78.6% (81/103) and the specificity of 81.7% (76/93). In the validation group, the predictive AUC of the final model in liver disease patients was 0.892 (95%CI: 0.832-0.951), with the sensitivity of 100% (21/21) and the specificity of 71.7% (66/92), while in the total validation population, the predictive AUC was 0.931 (95%CI: 0.890-0.972), with the sensitivity of 100.0% (21/21) and the specificity of 75.6% (180/238). Conclusion: The final diagnostic model includes PLT, PTA, ALB, PT, HCT, CA19-9 and AFP, which has higher sensitivity and specificity, and has good diagnostic efficiency for the clinical diagnosis of AFP-NHCC.

[Expression of renal PLA2R in patients with idiopathic membranous nephropathy and its relationship with the curative effect of immunotherapy].

OBJECTIVE: To detect the expression of renal M-type phospholipase A2 receptor (PLA2R) in patients with idiopathic membranous nephropathy (IMN), and to explore the relationship between renal PLA2R and the curative effect of immunotherapy. METHODS: A total of 56 patients who were diagnosed as IMN from January 2012 to June 2014 in the department of nephrology in First People's Hospital, Shanghai Jiaotong University, were included in this study. The expression of renal PLA2R was detected by immumofluorescence assay. The IMN patients were treated with corticosteroids and cyclophosphamide, and the relationship between renal PLA2R and the curative effect of immunotherapy was observed. RESULTS: The ratio of PLA2R related IMN (renal PLA2R-positive) patients was 71.4%(40/56). The recovery conditions in proteinuria and serum albumin were better in the non-PLA2R related IMN group since 6 months after the treatment (P<0.05). The overall response rate in PLA2R related IMN group was 58.3%, 62.5% and 62.5% after 6, 9, 12 months, respectively. However, the overall response rate in non-PLA2R related IMN group almost reached 100% after treatment for 6 months. Compared with PLA2R related IMN group, the time which patients reached complete remission was significantly shorter in the non-PLA2R related IMN group [(5.4±3.5) vs (10.5±1.6) months, P<0.05]. CONCLUSIONS: Detection of renal PLA2R can be helpful to diagnose IMN. Non-PLA2R related IMN patients usually have a better curative effect of immunotherapy and a shorter time to onset of efficacy.

Low adenosine triphosphate activity in CD4+ cells predicts infection in patients with lupus nephritis.

OBJECTIVES: The ImmuKnow (Cylex) assay has been reported to predict the risk of infection in some diseases; however, it is uncertain whether ImmuKnow can predict the risk of infection in lupus nephritis (LN) patients receiving immunosuppressive therapy. METHODS: The ImmuKnow Immune Cell Function Assay (Cylex, Inc., Columbia, MD, USA) was applied to measure the activity of CD4+ T cells, as a marker of global immune-competence. The correlation between changes in T cell activation and the relative risk of over-immunosuppression as well as infection was studied. The amount of adenosine triphosphate (ATP) produced by CD4+ T cells in response to phytohemagglutinin (PHA) was measured for 74 LN patients without infection, 22 LN patients with severe infection (i.e. required hospitalisation), and 28 healthy controls. RESULTS: No correlation was found between the ATP level and systemic lupus erythematosus (SLE) activity. The mean ATP level was significantly lower in LN patients with infection than that in healthy controls (p<0.01) and non-infected LN patients (p<0.01). The mean ATP level in non-infected LN patients was not significantly different compared to healthy controls. A cut-off ATP value of 300 ng/mL predicted infection in LN patients with a specificity of 77% and a sensitivity of 77%. Multi-variable partial correlation coefficient between the ATP assay and severe infection was r =-0.040, p<0.001; CRP was r=0.962, p<0.001. CONCLUSIONS: The ImmuKnow assay may be effective in identifying an increased risk of infection in LN patients but is not correlated with SLE activity. Combined CRP value will increase the diagnostic rate of severe infection in SLE. Larger studies are required to establish clinical advantages of this assay in SLE treatment.

The abnormal expression level of microRNA in epithelial-mesenchymal transition of peritoneal mesothelial cells induced by high glucose.

OBJECTIVE: To determine the expression level of the microRNA in the process of epithelial-mesenchymal transition (EMT) of the peritoneal mesothelial cells (PMCs) induced by high glucose. MATERIALS AND METHODS: The PMCs were cultured using M199 medium with 10% fetal bovine serum, and the EMT was induced by D-glucose stimulation. Epithelial-mesenchymal transition was determined by changes in cell morphology and the expression levels of the EMT marker genes. Changes in cell morphology were observed by inverted microscope, and the expression levels of the EMT marker genes were determined by real-time PCR. The expression levels of the microRNA were detected by real-time PCR with microRNA-specific stem-loop structure primer. RESULTS: The PMCs changed to fusiformis following a high-glucose medium stimulated for 48 hours, and the EMT marker genes changed significantly, such as the decrease of E-cadherin and an increase of Vimentin (p < 0.01). These results proved the EMT had been induced by high-glucose. Applying real-time PCR with microRNA-specific stem-loop structure primer, miR-193a increased notably (p < 0.01), and miR-15a and let-7e decreased (p < 0.01), while miR-16 and miR-21 had no significant changes (p > 0.05). Most importantly, the increase of miR-193a was correlated with stimulus duration. CONCLUSIONS: MicroRNA with abnormal expression levels have a primary role in regulating the EMT of PMCs induced by high glucose.

Effect of sodium glycyrrhetinate on chemical peritonitis in rats.

AIM: To study the anti-inflammatory mechanisms of sodium glycyrrhetinate (SG). METHODS: Rat chemical peritonitis was used. The protein content and prostaglandin E2 (PGE2) content in exudate were measured by Folin-phenol assay and RIA, respectively. SOD activity in neutrophils (Neu) was determined by pyrogallol-NBT colorimetry. cAMP content in Neu was detected by competitive protein binding assay. RESULTS: In peritonitis caused by histamine, SG 10-20 mg.kg-1 i.m. reduced exudate volume and Neu counts, and 5-20 mg.kg-1 i.m. lowered the protein content in exudate. In peritonitis induced by carrageenan, SG 20 mg.kg-1 i.m. reduced exudate volume, Neu counts, protein content and PGE2 content in exudate, increased SOD activity in Neu, but did not affect beta-glucuronidase release from Neu. In peritonitis induced by arachidonic acid, SG 20 mg.kg-1 i.m. reduced Neu counts, protein content, and PGE2 content in exudate, and attenuated the reduction of cAMP level in Neu. CONCLUSION: SG exerts its anti-inflammatory action by lowering permeability of capillaries in inflammatory site, inhibiting Neu emigration and PGE2 biosynthesis, and scavenging oxygen free radicals.