Anemia Predicts Poor Outcomes in Patients with HBV-Related Decompensated Cirrhosis.

BACKGROUND: Anemia is common in patients with severe chronic liver disease, but its role in HBV-related decompensated cirrhosis (DeCi) is still unclear. We therefore aimed to assess the impact of anemia on prognosis in HBV-DeCi patients. METHODS: One hundred thirty-three patients diagnosed with HBV-DeCi were retrospectively collected. RESULTS: A total of 113 (85.0%) patients suffered from anemia in our cohort. The low hemoglobin (Hb) level group exhibited a significantly increased 28-day mortality rate compared with the high Hb group. Hb level was a predictor of 28-day mortality in HBV-DeCi patients. CONCLUSIONS: Reduced Hb levels were associated with unfavorable prognosis in HBV-DeCi patients, and more attention should be paid to anemia in routine clinical assessments of liver cirrhosis.

Sigma Metrics used to Evaluate the Performance of Internal Quality Control in a Clinical Biochemistry Laboratory.

BACKGROUND: The performance of 17 routine chemical detection methods was evaluated by the Sigma (σ) index, and separate quality control standards were established according to the sigma values of different detection methods. METHODS: The internal quality control (IQC) and external quality assessment (EQA) data of 17 assays in the biochemical laboratory of our hospital were collected from January to June 2019. Referring to the total allowed error (TEa) standards established in the Health Industry Standards of the People's Republic of China (WS/T 403-2012), the sigma metric of each assay was calculated, the performance level for inspection was evaluated, the quality goal index (QGI) was calculated for items with analysis performance < 5 sigma, and the main causes of poor performance were determined to guide quality improvement. RESULTS: For level 1 internal quality control (IQC), five assays (AMY, Crea, UA, TP, and Na) showed a performance of ≥ 6 sigma levels. Five assays (GGT, LDH, ALP, K, and Ca) had a performance lower than 3 sigma. For level 2 IQC, nine assays (ALT, AST, CK, AMY, Crea, UA, TP, Na, and Mg) achieved 6 sigma, and four assays (GGT, LDH, ALP, and K) achieved less than 3 sigma. Among the 12 assays with a sigma value < 5, the precision of 1 assay should be improved first, the accuracy of 6 assays should be improved next, and both the precision and the accuracy of 5 assays should be improved. CONCLUSIONS: The sigma metric is the best tool for evaluating the performance of different test methods. Assays with high sigma values can be evaluated with single-rule quality control, while assays with low values should be evaluated with strict quality control rules.

The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Patients with HBV-Related Decompensated Cirrhosis.

BACKGROUND: The C-reactive protein to albumin ratio (CAR) is a novel inflammation index that has recently been used as a marker for poor prognosis or mortality in various patient groups. This study aimed to evaluate the association between the CAR and 30-day mortality in patients with hepatitis B virus-related decompensated cirrhosis (HBV-DeCi). METHODS: This was a retrospective cohort study of 113 patients who had been diagnosed with HBV-DeCi. Univariate and multivariate regression models were used to determine risk factors for mortality. RESULTS: The CAR was observed to be significantly higher in the non-surviving patients compared to the surviving patients. Moreover, the CAR was positively correlated with the model for end-stage liver disease (MELD) score and Child-Pugh score. In multivariate analysis, the CAR and the MELD score were independent prognostic factors for HBV-DeCi patients. CONCLUSIONS: A high CAR value at admission can serve as an independent predictor of 1-month mortality in patients with HBV-DeCi.

Monocyte chemotactic protein-1 as possible prognostic markers of the efficacy of antiviral treatment in chronic hepatitis C.

BACKGROUND/AIMS: Antiviral therapy with interferon and ribavirin had been proved to be effective in Hepatitis C treatment. However, the valuable markers for monitoring the efficacy of antiviral therapy are required clinically. The present study aimed to evaluate the association between pretreatment levels of Monocyte chemoattractant protein-1 levels (MCP-1) and the virological response in treated patients with chronic hepatitis C infection. METHODOLOGY: Concentrations of MCP-1 in serum were determined in 165 patients with chronic hepatitis C (CHC) treated with interferon and ribavirin by enzyme linked immunosorbent assay before and 48 weeks after cessation of therapy. RESULTS: Pretreatment MCP-1 levels in patients with sustained virological response (SVR) were significantly lower than in non-responders (Non-SVR) (220.2 +/- 31.7 vs. 305.6 +/- 50.7 pg/mL, p = 0.009) and MCP-1 significantly decreased in patients with SVR (form 220.2 +/- 31.7 pg/mL to 140.2 +/- 26.7 pg/mL; p <0.01) but not in Non-SVR (form 305.6 +/- 50.7 pg/mL to 286.6 +/- 41.9 pg/mL; p = 0.17) after 48 weeks of treatment. By multivariate analysis, non-1 genotype was independent predictors of SVR in all patients. When multivariate analysis was restricted to patients with non-1 genotype, only pretreatment MCP-1 levels were identified as predictive factors of SVR. CONCLUSIONS: MCP-1 may be a prognostic marker of the efficacy of antiviral therapy in CHC patients.

Changes of ammonia levels in patients with acute on chronic liver failure treated by plasma exchange.

BACKGROUND/AIMS: Acute on chronic liver failure (AoCLF) is associated with a high mortality rate. Plasma exchange (PE) is useful to bridge AoCLF patients to liver transplantation. The aim of this study was to assess the effects of PE on plasma ammonia levels (PAL) in AoCLF patients. METHODOLOGY: Seventy patients with AoCLF in 2 groups (PE plus standard medical treatment group, n = 32; and standard medical treatment group, n = 38) were enrolled in study. PAL was detected on admission and on days 7, 14, 21, and 30 during hospitalization. RESULTS: All AoCLF patients showed PAL more than the upper limit of the normal range. More dramatic decreased in the PE survivors (form 116.8 +/- 36.3 to 44.8 +/- 16.3, p < 0.01) than the medical survivors (form 105.7 +/- 30.2 to 57.1 +/- 20.3, p < 0.05) after 30 days of treatment. Furthermore, PAL after medical treatment were still higher than those of PE treatment in the survivors (57.1 +/- 20.3 vs. 44.8 +/- 16.3, p < 0.05). Among the non-survivors in the medical group, PAL remained at high levels throughout the examination period. Importantly, an increased PAL associated with high mortality and reduced survival time of AoCLF patients. CONCLUSIONS: Ammonia may be important in the pathogenesis of the AoCLF and PE may represent a reliable hepatic support device for AoCLF.

A contribution to Porogramme (Polyporaceae, Agaricomycetes) and related genera.

The polypores with shallow pores from tropical Asia and America are studied. Our molecular phylogeny based on the internal transcribed spacer (ITS), the large subunit nuclear ribosomal RNA gene (nLSU), the translation elongation factor 1-α gene (TEF1), and the largest subunit of RNA polymerase II (RPB1) demonstrates six clades are formed among Porogramme and related genera. Two new genera, Cyanoporus and Pseudogrammothele, are established, and the six clades represent Porogramme, Cyanoporus, Grammothele, Epithele, Theleporus, and Pseudogrammothele, respectively. The molecular clock analyses estimate the divergence times of the six clades based on a dataset (ITS + LSU + TEF1 + RPB1 + RPB2), and we recognize the mean stem ages of the six genera are earlier than 50 Mya. Three new species in Porogramme were morphologically and phylogenetically confirmed, and they are described as P. austroasiana, P. cylindrica, and P. yunnanensis. Phylogenetic analysis shows that type species of Tinctoporellus and Porogramme are nested in the same clade, and Tinctoporellus is treated as a synonym of Porogramme. Based on our phylogeny, twelve new combinations are proposed, and the differences between the new species and similar or related species are discussed.

Changes in peripheral T-lymphocyte subsets in acute-on-chronic liver failure patients with artificial liver support system.

BACKGROUND/AIMS: HBV-related acute-on-chronic liver failure (AoCLF) is associated with a high mortality rate. An artificial liver support system (ALSS) is a newly emerging therapeutic option, which can be implemented in routine patient care. In order to determine if any pretreatment immunological parameter could be an indicator to evaluate immune states for the outcome of the AoCLF patients, we analyzed the relationship between the level of T-lymphocyte subsets (CD4+, CD8+, CD4/CD8 ratio) and its therapeutic effect and prognosis. METHODOLOGY: Sixty-three patients with AoCLF were enrolled in 2 groups (ALSS plus routine-care, n=29 and routine-care only, n=34). In the ALSS group, there were 17 survivors (17/29), while in the routine-care group there were 11 survivors (11/34), both after 30 days of treatment. Twenty-three healthy donors were used as the control group. The number of CD4 and CD8 T cells was detected by flow cytometry and the ratio of CD4/ CD8 was calculated on admission and on days 7, 14, 21 and 30, during hospitalization. RESULTS: More dramatic increased CD4/CD8 ratio in the ALSS survivors (form 0.92±0.18 to 1.26±0.24, p<0.01) than the medical survivors (form 0.86±0.16 to 1.09±0.16, p<0.05) after 30 days of treatment. A declined tendency was observed in nonsurvivors. CONCLUSIONS: T-lymphocyte subsets may be important in the pathogenesis of the AoCLF and ALSS may represent a reliable hepatic support device for Ao- CLF.

Outline, Divergence Times, and Phylogenetic Analyses of Trechisporales (Agaricomycetes, Basidiomycota).

Phylogenetic analyses inferred from the nuc rDNA ITS1-5.8S-ITS2 (ITS) data set and the combined 2-locus data set [5.8S + nuc 28S rDNA (nLSU)] of taxa of Trechisporales around the world show that Sistotremastrum family forms a monophyletic lineage within Trechisporales. Bayesian evolutionary and divergence time analyses on two data sets of 5.8S and nLSU sequences indicate an ancient divergence of Sistotremastrum family from Hydnodontaceae during the Triassic period (224.25 Mya). Sistotremastrum family is characterized by resupinate and thin basidiomata, smooth, verruculose, or odontoid-semiporoid hymenophore, a monomitic hyphal structure, and generative hyphae bearing clamp connections, the presence of cystidia and hyphidia in some species, thin-walled, smooth, inamyloid, and acyanophilous basidiospores. In addition, four new species, namely, Trechispora dentata, Trechispora dimitiella, Trechispora fragilis, and Trechispora laevispora, are described and illustrated. In addition, three new combinations, namely, Brevicellicium daweishanense, Brevicellicium xanthum, and Sertulicium limonadense, are also proposed.

Changes of serum cytokine levels in patients with acute on chronic liver failure treated by plasma exchange.

BACKGROUND AND AIM: Acute on chronic liver failure (AoCLF) is associated with a high mortality rate. Plasma exchange (PE) may be useful to bridge patients with AoCLF to liver transplantation or to regenerate their own livers. The aim of this study was to assess the effects of PE on the circulating concentrations of cytokines in patients with AoCLF. METHODS: One hundred forty-nine patients with AoCLF in 2 groups (PE plus routine-care, n=62; and routine-care, n=87) were enrolled in our study. Fifteen healthy donors were used as the control group. Cytokine levels such as interferon-γ (IFN-γ), interleukin-10 (IL-10), interleukin-4 (IL-4), interleukin-2 (IL-2), and tumor necrosis factor- α (TNF-α) were detected on admission and on days 7, 14, 21, and 30 during hospitalization. RESULTS: All the detected cytokine values (IFN-γ, IL-10, IL-4, IL-2, and TNF-α) in the patient groups were higher compared with those in the healthy controls (P<0.001). PE was effective to decrease the serum concentration of cytokines: TNF-α dropped from (3.46±1.23) pg/mL to (1.64±0.66) pg/mL (P<0.01), IL-10 from (6.2±2.1) pg/mL to (3.5±1.1) pg/mL (P<0.01), IL-2 from (7.5±4.7) pg/mL to (4.0±2.1) pg/mL (P<0.01), IFN-γ from (27.5±15.8) pg/mL to (15.5±11.8) pg/mL (P<0.01), and IL-4 from (86.7±31.3) pg/mL to (44.7±26.3) pg/mL (P<0.01). CONCLUSIONS: Cytokines may be important in the pathogenesis of the AoCLF, and PE may represent a reliable hepatic support device for AoCLF.

[The change of intestinal microecology in rats after orthotopic liver transplantation].

OBJECTIVE: To investigate the intestinal microflora status and bacterial translocation in rats after liver transplantation. METHODS: Male Brown-Norway (BN) rats were randomly divided into 4 groups: group I (n = 8) for liver transplantation; group II (n = 8) for simulated liver transplantation; group III (n = 8) for sham operation and group IV (n = 8) for normal group. Caecal bacterial counts, plasma endotoxin, intestinal mucosal ultrastructure and bacterial translocation to liver, spleen, kidney, and mesenteric lymph node were studied 24 h after surgery. RESULTS: The numbers of Bifidobacterium and Lactobacillus per gram of wet feces were significantly decreased in group I compare with those in the group III and group IV, while Enterobacteriaceae and Enterococcus counts were increased markedly compare with those in the group III and group IV, but no different was found between group I and group II. Impaired intestinal mucosa integrity were found in the group I and group II. In group I, the levels of plasma endotoxin increased after the transplantation when compare with group III and group IV. Increased incidence of bacterial translocation to liver, spleen and mesenteric lymph node were also observed after the transplantation (compare with those in the group IV, P < 0.01; compare with those in the group III, P < 0.01, P < 0.01, P < 0.05, separately). The increased rate of the bacterial translocation in liver was also found in transplantation group as compare with group II (P < 0.05). CONCLUSIONS: Liver transplantation may lead to disturbance of intestinal microflora and impairment of intestinal mucosal barrier function, and this dysfunction might be caused by the process of intestinal ischemia-reperfusion injury in transplantation.

Changes in peripheral CD4+CD25(high) regulatory T cells in the acute-on-chronic liver failure patients with plasma exchange treatment.

The prevalence of CD4+CD25(high) regulatory T cells (Tregs) in patients with acute-on-chronic liver failure (AoCLF) who received plasma exchange (PE) and/or medical treatment was investigated. One hundred five patients with AoCLF in two groups (PE plus routine-care, n = 48 and routine-care, n = 57) were enrolled in our study. In the PE group, there were 27 survivors (27/48) while, in the routine-care group, there were 18 survivors (18/57), both after 30 days treatment. Twenty-three healthy donors were used as the control group. Tregs were determined by flow cytometry serially. In the survivors, Tregs frequency were lower compared with the normal controls on admission and showed an up and down tendency; moreover, this frequency turned to the level as that in healthy subjects and was faster in the PE compared with the medical group while, among the nonsurvivors, Tregs stayed at a high level throughout the examination period. Importantly, an increased quantity of Tregs was associated with high mortality and reduced survival time of AoCLF patients. These data suggest that Tregs play a role in determining the patient's fate toward either a favorable or unfavorable clinical course of disease, and PE may represent a reliable hepatic support device for AoCLF.