Prevalence and Clinical Significance of Portal Vein Thrombosis in Patients With Cirrhosis and Acute Decompensation.

BACKGROUND & AIMS: Portal vein thrombosis (PVT) is a common and serious complication in patients with cirrhosis. However, little is known about PVT in patients with cirrhosis and acute decompensation (AD). We investigated the prevalence and clinical significance of PVT in nonmalignant patients with cirrhosis and AD. METHODS: We performed a retrospective study of 2 cohorts of patients with acute exacerbation of chronic liver disease who participated in the Chinese AcuTe on CHronic LIver FailurE study, established by the Chinese Chronic Liver Failure Consortium, from January 2015 through December 2016 (n = 2600 patients) and July 2018 through January 2019 (n = 1370 patients). We analyzed data on the prevalence, clinical manifestations, and risk factors of PVT from 2826 patients with cirrhosis, with and without AD. RESULTS: The prevalence of PVT in patients with cirrhosis and AD was 9.36%, which was significantly higher than in patients with cirrhosis without AD (5.24%) (P = .04). Among patients with cirrhosis and AD, 63.37% developed PVT recently (the first detected PVT with no indication of chronic PVT). Compared with patients without PVT, a significantly higher proportion of patients with PVT had variceal bleeding (47.33% vs 19.63%; P < .001) and patients with PVT had a significantly higher median serum level of D-dimer (2.07 vs 1.25; P < .001). Splenectomy and endoscopic sclerotherapy were independent risk factors for PVT in patients with cirrhosis and AD. The 1-year mortality rate did not differ significantly between patients with vs without PVT. CONCLUSIONS: In an analysis of data from 2826 patients with cirrhosis, a significantly higher proportion of those with AD had PVT than those without AD. PVT was associated with increased variceal bleeding, which would increase the risk for AD. Strategies are needed to prevent PVT in patients with cirrhosis, through regular screening, to reduce portal hypertension. ClinicalTrials.gov no: NCT02457637 and NCT03641872.

Hepatic and extrahepatic metabolic modulation in hbv-related decompensated cirrhosis and acute-on-chronic liver failure.

Acute-on-chronic liver failure (ACLF) and decompensated cirrhosis (DC) are life-threatening syndromes that can develop at the end-stage of chronic hepatitis B virus (HBV) infection. Both ACLF and DC are complicated by hepatic and extrahepatic pathogeneses. To better understand the compartment-specific metabolic modulations related to their pathogenesis, HBV-DC, HBV-ACLF patients, and controls (30 each) were analyzed by metabolomics using portal (Port), hepatic vein (Hep), and peripheral (Peri) serum. Compartment ratios of metabolites (RatioHep/Port, RatioPeri/Hep, and RatioPort/Peri) were calculated. The liver tissues (10 per group) were analyzed using transcriptomics and metabolomics. An additional 75 patients with ACLF, 20 with DC, and 20 with liver cirrhosis (LC) were used to confirm oxlipid dysregulation. Both multi-omics datasets suggest suppressed energy, amino acid, and pyrimidine metabolism in the ACLF/DC liver. The serum metabolomic variations were contributed primarily by disease rather than sampling compartments, as both HBV-ACLF and HBV-DC patients demonstrated abnormal profiles of amino acids and peptides, indoles, purines, steroids, and benzimidazoles. In ACLF/DC patients, impaired hepatic metabolism resulted in a highly correlated hepatic and portal vein serum metabolome and release of inflammatory lipids and heme metabolites from the liver. HBV-ACLF showed higher RatioPeri/Hep of extrahepatic inflammatory oxlipids, while HBV-DC patients showed higher RatioPort/Peri of gut microbial metabolites. An inflammatory oxlipid outburst was confirmed in the early stages of HBV-ACLF. The inflammatory effects of the selected oxlipids were confirmed in monocytes. These findings support a synergy between liver-specific mechanisms and systemic inflammation in ACLF/DC development, and that pro-inflammatory oxlipids are metabolic signatures of early HBV-ACLF.

[Progresses on thyroid hormone responsive spot 14 (THRSP) gene in chickens and ducks].

Thyroid hormone responsive spot 14 (THRSP), expressed in lipogenic tissues, is suggested as a transcription factor to regulate gene expression of rate-limiting enzymes in lipogenesis. Two THRSP isoforms, THRSPa and THRSPb, were detected at cDNA levels in chickens and ducks. Chicken THRSPa was speculated to be associated with growth development and lipid metabolism because of significant correlation between the indels in the coding region of THRSPalpha and growth, as well as abdominal fat traits of chickens. The differences of THRSP structure and expression between chickens and ducks were reviewed. Furthermore, polymorphism and genetic effects of THRSP gene in chickens and ducks were analyzed.

[The summary of the clinic study of Zhi-Xin-Fang treating the heart failure resulting from cardiomyopathy].

OBJECTIVE: To observe the therapeutic and prognostic effects and to evaluate the safety of Zhi-Xin-Fang on heart failure resulting from cardiomyopathy. METHODS: 62 patients with cardiomyopathy combined with heart failure were treated with standard western medical therapy as treatment group. The other 60 patients with the same diseases were administered with both Zhi-Xin-Fang and standard western medicines as control. Several parameters were observed to evaluate the effect of Zhi-Xin-Fang on the heart failure, containing the therapeutic effect of clinical symptom and physical signs, the improvement of heart function and the ultrasonic caridogram. We also observed the effect of Zhi-Xin-Fang to relieve the clinical symptom and improve the heart function and quality of life and prognosis. RESULTS: As the NYHA classify for heart failure, the effective rate for the treatment group was 95% , more effective than the control group (effective rate: 80.65%) (P<0.05). There was significant improvement for LVEF and LVDS for both groups. However, the treatment group was better than the control group (P<0.05). The clinical symptom was significantly improved compared to the untreatment in both groups. The treatment group was better than the control group for effective rate (P<0.05) but not for the total effective rate. There was no significant difference for the function of liver and kidney, blood routine method, electrolyte compared to before for the two groups. CONCLUSION: The standard western medicines combined with Zhi-Xin-Fang is a good therapy for treating heart failure resulting from cardiomyopathy. The combined therapy can relieve the cinical symptom of heart failure, improve the heart function and quality of life. It is also safer for the patients. However, its long-term prognosis should be further studied in the future.

Acute-on-chronic liver failure in chronic hepatitis B: an update.

INTRODUCTION: Acute-on-chronic liver failure is a common pattern of end-stage liver disease in clinical practice and occurs frequently in patients with chronic hepatitis B or HBV-related cirrhosis. New progress in recent years leads to a better understanding of this disease. Areas covered: This review updates the current comprehensive knowledge about HBV-ACLF from epidemiological studies, experimental studies, and clinical studies and provide new insights into the definition, diagnostic criteria, epidemiology, nature history, pathogenesis, treatment and prognostication of HBV-ACLF. Expert commentary: Patients with chronic hepatitis B or HBV-related cirrhosis are at risk of developing acute-on-chronic liver failure, with multi-organ failure and high short-term mortality. The precipitating events can be intra-hepatic or extra-hepatic and the underlying chronic liver injury can be cirrhotic or non-cirrhotic. Host and viral factors contribute to the susceptibility of developing HBV-ACLF. Systemic inflammation is the driver of HBV-ACLF, which can be attributed to non-sterile and sterile factors. Liver transplantation is the definitive treatment for HBV-ACLF. Cell therapy is a promising alternative to LT, but requires validation and still has concern of long-term safety. Other medical therapies, such as nucleoside analogue, artificial liver supporting and glucocorticoid may improve survival in a specific subgroup. New scoring systems improve the accuracy of prognostication in HBV-ACLF, which is critical for early identification of candidates for LT.

[Establishment of a fluorescent quantitative PCR detection method for rabies virus and preparation of RNA positive controls].

OBJECTIVE: Establish the fluorescent quantitative RT-PCR detection method for rabies virus (RV) and construct RNase-resistant virus-like particles as positive controls. METHODS: Analyze the database in GenBank, the probe and the primers were designed in the conservative region of N gene of rabies virus and the method of real-time fluorescent quantitative PCR was obtained; On the basis of MS2 phage, with the technology of gene recombination, prepare the RNase-resistant virus-like particles for RV positive controls; RESULTS: RNase-resistant virus-like particles were obtained after prokaryotic expression in E. coli. The designed primers and probe were confirmed to be very specific and conservative, and be sensitive to-concentration of 15 copies/microl. CONCLUSION: Established the method of detecting rabies virus by reverse transcription real-time quantitative PCR,obtained the RNase-resistant and no infectivity virus-like particles as positive controls of rabies virus.