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May 2013, Volume 16, No.14 Abstracts

 Epidemiological Analysis of Spontaneous Regression of Hepatocellular Carcinoma

HUANG Tian-ming, MO Fa-rong,LUO Guo-rong.Department of Histology and Embryology of Guangxi Medical University,Nanning 530021, China

Abstract Objective To investigate the regularity of spontaneous regression of hepatocellular carcinoma(HCC).

Methods A total of 85 cases of HCC spontaneous regression of HCC were obtained through searching in MEDLINE. All clinical data were analyzed and compared with HCC epidemiological characteristics.

Results The probability of HCC spontaneous regression incidence was higher than previously estimated. It mostly occurred in alcohol-caused HCC patients, not obviously correlated with patients kind, age, gender, tumor differentiation and its progression. The most probable cause leading HCC spontaneous regression were immune factors.

Conclusion Spontaneous regression of HCC maybe be a result of changes of external micro-environment or conditions, not correlated with the biological properties of tumor cells.Deep exploration for its mechanism may open up an entirely new approach to HCC direction.

Key words Carcinoma, hepatocellular; Neoplasm regression, spontaneous; Epidemiology; Immunity

The Value of Plasma Thioredoxin in the Diagnosis of Hepatocellular Carcinoma

LIU Bao-kui,YANG Yu-xiu,HAN Shuang-yin,et al.Department of Gastroenterology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China

Abstract Objective To investigate the diagnostic value of plasma thioredoxin (TRX) in the diagnosis of hepatocellular carcinoma(HCC).Methods From May-September 2012, enzyme linked immunosorbent assay (ELISA) was used to determine the plasma levels of TRX and AFP in 90 patients with HCC,40 patients with cirrhosis,and 35 healthy controls.The sensitivity and specificity of TRX in diagnosing HCC were determined through ROC curve and the relationship between the expression of TRX and clinical parameters in HCC patients was analyzed.Results The plasma TRX level in HCC patients was higher than that in cirrhosis patients and healthy controls (P0.05).There was no correlation between plasma levels of AFP and TRX in 90 patients with HCC(r=-0.06,P=0.560).The plasma TRX level was not associated with age,gender,hepatitis infection status,tumor size and histological differentiation and TNM stage of HCC patients(P0.05).The best cut-off value of TRX was 33.0 μg/L,which yielded a sensitivity and specificity of 74.4% and 77.3%,respectively for diagnosis of HCC.TRX positive rate was 55.6% (50/90),AFP positive rate was 33.3%(30/90),and the combined TRX and AFP positive rate was 72.3% (65/90).Conclusion Plasma TRX might serve as a new complementary tumor marker for HCC.Combined detection with TRX and AFP could improve HCC early diagnosis.

Key words Carcinoma, hepatocellular; Thioredoin; Enzyme-linked immunosorbent assay; alpha-Fetoproteins

The Clinical Value of Single and Combined Detection by Golgi Protein 73, α-L-Fucosidase, and α-Fetoprotein in the Diagnosis of Primary Hepatic Carcinoma

XIAO Lei, MAO Rui, YANG Ying, et al.Cancer Center of the First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China

Abstract Objective To explore the value of single and combined detection by Golgi Protein 73GP73, α-L-fucosidaseAFUand α-fetoproteinAFPin the diagnosis of primary hepatic carcinomaPHC.

Methods We included 80 patients with PHC who first visited our hospital between May and September 2011 into the PHC group, 65 patients with hepatocirrhosis into the cirrhosis group, 54 patients with chronic viral hepatitis into the hepatitis group, and 50 healthy people into the control group.Enzyme-linked immunosorbent assayELISAwas used to determine the serum GP73 level of the subjects, immunoturbidimetry to determine AFU level, and electrochemiluminescence assay to determine serum AFP level.ROC curves of single and combined detection of PHC by GP73, AFU, and AFP were plotted to calculate the area under ROC curveAUC, sensitivity, and specificity.

Results Significant differences were observed among the four groups in serum GP73, AFU, and AFP levelsP0.001.The AUCs of single detection by GP73, AFUC, and AFP were 0.80495%CI0.746, 0.862)〕, 0.79895%CI0.739, 0.858)〕, and 0.79795%CI0.731, 0.862)〕, respectively, no significant difference found P0.05.The single detection by GP73 had higher sensitivity82.5%and lower specificity63.3%than AFP66.3%, χ2=4.65; 88.7%, χ2=28.91; P0.05.The sensitivity of single detection by AFU73.8% was not significantly different from that of AFP66.3%, χ2=0.89, P0.05, while the specificity of AFU77.5%was lower than that of AFP88.7%, χ2=8.40, P0.05.The sensitivity of combined detection by GP73+AFU and GP73+AFU+AFP was 92.5% and 96.3%, respectively.

Conclusion GP73 has high sensitivity and AFP has high specificity in single detection of PHC.Combined detection by GP73, AFU, and AFP can greatly improve the detection rate of PHC.

Key words Liver neoplasms; Golgi apparatus; alpha-L-Fucosidase; alpha-Fetoproteins; Diagnosis

The Value of Glycated Hemoglobin in Screening and Diagnosis of Diabetes Mellitus

ZHANG Zhen, LI Jun, LI Si-yuan, et al.Medical College of Shihezi University, Shihezi 832000,China

Abstract Objective To evaluate the value of glycosylated hemoglobin (HbA1c) in the screening and diagnosis of diabetes mellitus(DM).Methods A total of 251 patients requiring detection of DM in our department between June 2011 and June 2012 underwent oral glucose tolerance test(OGTT), and determination of fasting plasma glucose(FPG), 2 hours plasma glucose(2 hPG), and HbA1c.SPSS 17.0 was used to conduct univariate analysis and SNK- q test.MedCalc 9.0 was used to plot receiver operating characteristic(ROC) curve to obtain the best critical point of HbA1c and FPG in diagnosing DM, and the area under the curve(AUC).Results OGTT results showed 168 cases(66.9%) of DM, 70 cases(27.9%) of impaired glucose regulation(IGR), and 13 cases(5.2%) of normal glucose tolerance(NGT).Significant difference was observed among the three groups in levels of FPG, 2 hPG, and HbA1c (P0.01).To be specific, level of 2 hPG of the IGR group was significantly higher than that of the NGT group, levels of FPG, 2 hPG, and HbA1c of the DM group were significantly higher than those of the NGT and IGR group(P0.05).The optimal cut-point of HbA1c in ROC curve was 7.0%, with sensitivity of 91.07%95%CI0.857, 0.949), specificity of 92.77%95%CI0.849, 0.973), AUC of 0.97195%CI0.942, 0.988), Youden index of 0.84, positive predictive value(+PV) of 96.2%,negative predicative value(-PV) of 83.7%, positive likelihood ratio(+LR) of 12.60, and negative likelihood ratio(-LR) of 0.10.The optimal cut-point of FPG in ROC curve was 6.9 mmol/L, with sensitivity of 80.95%, specificity of 100.00%, AUC of 0.94495%CI0.908, 0.969), Youden index of 0.81, +PV of 100.0%, and -PV of 72.2%.Conclusion HbA1c can be used as a screening and diagnostic criterion for DM and the optimal cut-point is 7.0%.HbA1c has higher sensitivity but lower sensitivity than FPG.

Key words Glycated hemoglobin; Diabetes mellitus; Fasting plasma glucose; Oral glucose tolerance test; Receiver operating characteristic curve

Correlation of Plasma Homocysteine with Depression in Essential Hypertension Patients

LI Ying-ying,PALIDAAbulaiti,GULIZHAERMaimaitiming.The Second Department of Cadre Medical Wards,the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China

Abstract Objective To explore the correlation of depression with plasma homocysteine (Hcy) in essential hypertension (EH) patients.Methods Depression were screened by Zung self-rating depression scale (SDS) and sublist of hospital anxiety and depression scale (HAD) in 163 EH patients ( 114 males and 52 females) admitted to this hospital from August 2011 to June 2012.Hcy level was determined by enzymatic cycling assay.Results There were totally 69 EH patients combined with depression42.3%, 31 had hyperhomocysteine (HHcy) in this study.When the patients were divided,according to whether combined with depression,into depressive and non-depressive groups,no significant difference was noted in age,body mass index (BMI),hypertensive duration,grade of hypertension or combination rate of coronary heart disease (CHD) between 2 groups (P0.05),there was difference in gender,Hcy level and HHcy incidence (P0.05).When the patients were divided,based on blood pressure (BP) level,into 3 groups,there was no difference in plasma Hcy level between patients with different BP degrades (P0.05),there was in SDS score (P0.05).Conclusion EH patients have a high incidence of depression and there is gender difference (higher in females than in males).HHcy incidence and plasma Hcy level increase in EH patients combined with depression.

Key words Essential hypertension; Depression; Hyperhomocysteinemia

Smoking Cessation Time Influencing Expression of Inflammatory Cytokines in AMI Patient before and after Thrombolytic Recanalization

CHEN Zhi-guo,TAN Li-duan,YU Hai-xia,et al.Department of Emergency,Chengde Central Hospital,Chengde 067000, China

Abstract Objective To explore the effects of smoking cessation time on expressions of serum IL-1,TNF-α and IL-10 in patients with acute myocardial infarction (AMI) before and after thrombolytic recanalization.

Methods Sixty AMI patients admitted to Chengde Central Hospital from July 2010 to December 2011 were divided,based on their smoking information,into Groups A(nonsmoking),B(cessation time 5 years),C(cessation time 5 years).Recombinant streptokinase was used to perform intravenous thrombolysis.Venous blood was collected before thrombolysis,at hours 12,24 after,to detect IL-1,IL-10 by double-antibody sandwich ABC-ELISA method,TNF-α by radioimmunoassay.

Results There was significant difference in TNF-α,IL-1,IL-10 between 3 groups before thrombolysis and at hours 12,24 after (P0.05);Group B had higher levels than groups A,C (P0.001);No difference was noted between groups A and C (P0.05).The levels of TNF-α,IL-1,IL-10 were significantly higher at hours 12,24 after thrombolysis than before in 3 groups (P0.001),higher at hour 24 than at hour 12 after thrombolysis in group B (P0.001),but there was no difference between groups A and C (P0.05).

Conclusion The time of smoking cessation affects the inflammatory cytokines expression in AMI patients before and after thrombolytic therapy.Patients having stopped smoking 5 years or more have lower inflammatory cytokines expression,their myocardial ischemia-reperfusion injuries are basically the same as those of non-smokers.

Key words Smoking cessation; Acute myocardial infarction; Thromblytic recanalization; Tumor necrosis factor-alpha; Interleukin-1; Interleukin-10

The Association between Tricuspid Annular Plane Systolic Excursion and Renal Function in Patients with Chronic Systolic Heart Failure

JIN Ya-ge,ZHANG Fei-fei.Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China

Abstract Objective To explore the association between tricuspid annular plane systolic excursion (TAPSE) and renal function in patients with chronic systolic heart failure (CHF).

Methods Ninety-eight inpatients with CHF who had left ventricular ejection fraction (LVEF) 45% on echocardiogram were enrolled.M-mode Doppler echocardiography was performed in all patients.The patients were divided into two groups according to the level of TAPSE: group with dysfunction of right ventricle (DFRV) (TAPSE16 mm) and group with normal function of right ventricle (NFRV) (TAPSE16 mm).We conducted blood test to determine routine renal function indices and NT-proBNP; Used simplified Modification of Diet in Renal Disease (MDRD) formula to calculate glomerular filtration rate (eGFR;And applied echocardiography to determine left ventricular end diastolic diameter LVDd,right ventricular end diastolic diameter RVDd,pulmonary arterial systolic pressure PASP,and LVEF; Mean arterial pressure was also measured. The above indices and the equivalent daily dosage of intravenous loop diuretics were compared between the two groups.

Results No significant differences were observed between the two groups in age,sex,renal function grading, cause of heart failure, and incidence of atrial fibrillation P0.05.Significant differences were not observed between the two groups in LVDd,PASP,LVEF,or MAP P0.05,but in RVDdP0.05.The differences of NT-proBNP level between the two groups was not statistically significant P0.05.The incidence of renal dysfunction in the DFRV group (73%) was significantly higher than that in the NFRV group (30%) P0.05.The eGFR of DFRV group 〔(70±21mlmin-1•(1.73 m2-1〕 was significantly lower than that of NFRV group 106±29mlmin-1•(1.73 m2-1〕(P0.05.Binary Logistic regression analysis was conducted with renal function as the dependent variable, LVDd, RVDd, PASP, LVEF, MAP, TAPSE, and NT-proBNP as the independent variables. Analysis results showed that TAPSE decrease was the only risk factor for renal dysfunction in CHF patients. For 1 mm decrease of TAPSE, the risk of renal dysfunction in CHF patients increased 1.78 times. The use rate of intravenous loop diuretics in the DFRV group 85% during correction of cardiac failure was significantly higher than that in the NFRV group 39% P0.05.

Conclusion CHF patients with DFRV have higher incidence of renal dysfunction. TAPSE decrease is a risk factor and might be a predictor of renal dysfunction.CHF patients with DFRV usually need more intravenous loop diuretics.

Key words Heart failure, systolic; Glomerular filtration rate; Tricuspid annular plane systolic excursion; Rennal insufficiency

Relationship of Liver Pathology and Clinical Data of HBV-infected Patients with Normal or Mildly Abnormal Alanine Aminotransferase Level

MA Jun-ji,FENG Li-ying,FENG Zhi-jie,et al.Department of Gastroenterology,the Second Hospital of Hebei Medical University,Hebei Key Laboratory of Gastroenterology,Hebei Institute of Gastroenterology,Shijiazhuang 050000,China Abstract Background The serum alanine aminotransferase (ALT) level in chronic hepatitis B virus (HBV)-infected patients may stay within the reference range or less than 2 times of the maximum reference value,yet serious damage even cirrhosis and cancer may happen to the liver.Objective To evaluate liver histopathology differences between HBV-infected patients with normal and mildly abnormal ALT level,and analyze its relationship with basic clinical data.Methods HBV-infected patients who were admitted to our department and underwent a liver biopsy between January 2005 and December 2012 were enrolled.The diagnostic criteria for HBV infection included history of HBV infection or HBsAg positive for over 6 months,and current positive HBsAg and/or HBV DNA.Chronic HBV-infected patients were divided into normal-ALT and mildly-abnormal-ALT groups according to the serum ALT level.The pathological features,sex,age,HBeAg,and HBV DNA viral load were compared between the two groups.Results A total of 165 HBV-infected patients were divided into a normal-ALT group (n=113) and a mildly-abnormal-ALT group (n=52) based on the serum ALT level.The age and sex ratio were significantly different between the two groups (t=2.12,χ2=15.92,P0.01).The constitute ratio of liver inflammation grading and fibrosis staging were also significantly different between the two groups (χ2=16.03,12.72,P0.05).In normal-ALT group,age was positively correlated with fibrosis staging score (r=0.29, P0.01).In mildly-abnormal-ALT group,age was positively correlated with inflammation grading score (r=0.38,P0.01) and fibrosis staging score (r=0.51,P0.01).No significant differences were observed in the constitute ratio of the HBV DNA viral load between the two groups (χ2=1.74,P0.05).In mildly-abnormal-ALT group,HBV DNA viral load was negatively correlated with inflammation grading score (r=-0.28,P0.05).Conclusion Risk factors for liver inflammatory injury in HBV-infected patients with mildly abnormal ALT include older age and HBeAg negative.High HBV DNA viral load with less serious inflammatory injury in liver tissue may be related to immune tolerance.Liver fibrosis in HBV-infected patients with normal or mildly abnormal ALT is closely related to age.Timely liver biopsy is essential to identify liver damage in chronic HBV-infected patients with normal or mildly abnormal ALT.

Key words Alanine aminotransferase;Hepatitis B surface antigens;Hepatitis B virus;Liver histopathology

Effects of Alanyl-Glutamine on Intestinal Barrier and Immunity Function in Critically Ill Patients

HAN Hai-yan.Cadre Ward, the First Hospital of Fuzhou, Fuzhou 350009, China

Abstract Objective To study the effects of Alanyl-GlutamineAln-Glnon intestinal barrier and immunity function in critically ill patients.Methods Thirty critically ill patients admitted into our ward between September 2008 and July 2012 were included in the study.They were divided into three groupsn=10 for group A, B, and Cbased on chronological order of their admission.All groups were given basic treatment to their primary diseases.Patients in group A were given intravenous administration of Aln-Gln dipeptide, 0.5 gkg-1d-1, for 7 days; Patients in group B were given nasal feeding of Aln-Gln dipeptide, 0.5 gkg-1d-1, for 7 days; While group C did not receive other therapy than basic treatment.Urine lactulosemannitoL/M ratio, levels of plasma glutamineGln, diamine oxidase

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