Diagnostic value of alpha-fetoprotein combined with neutrophil-to-lymphocyte ratio for hepatocellular carcinoma

Background

To investigate the diagnostic performance of alpha-fetoprotein (AFP) and neutrophil-to-lymphocyte ratio (NLR) as well as their combinations with other markers.

Methods

Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), AFP and levels as well as the numbers of neutrophils and lymphocytes of all enrolled patients were collected. The NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. Receiver operating characteristic (ROC) curve analysis was conducted to determine the ability of each marker and combination of markers to distinguish HCC and liver disease patients.

Results

In total, 545 patients were included in this study. The area under the ROC curve (AUC) values for AFP, ALT, AST, and NLR were 0.775 (0.738–0.810), 0.504 (0.461–0.547), 0.660 (0.618–0.699), and 0.738 (0.699–0.774) with optimal cut-off values of 24.6?ng/mL, 111?IU/mL, 27?IU/mL, and 2.979, respectively. Of the four biomarkers, AFP and NLR showed comparable specificity (0.881 and 0.858) and sensitivity (0.561 and 0.539). The combination of AFP and NLR showed the highest AUC (0.769) with a significantly higher sensitivity (0.767) and a lower specificity (0.773) compared to AFP or NLR alone, and it had the highest sum of sensitivity and specificity (1.54) among all combinations. In patients with AFP <?20?ng/mL, the NLR showed the highest AUC and combination with other markers did not improve the diagnostic accuracy.

Conclusions

Our data indicate that the combination of AFP and NLR offers better diagnostic performance than either marker alone for differentiating HCC from liver disease, which may benefit clinical screening.

     

比阿培南治疗肝衰竭并发细菌感染疗效观察

目的观察比阿培南治疗肝衰竭并发细菌感染的临床疗效。方法30例肝衰竭并发细菌感染患者随机分成两组,分别给予比阿培南（观察组）、头孢哌酮／他唑巴坦钠（对照组）治疗,治疗1周后比较两组疗效。结果观察组有效率86．67％、治愈率73．33％,优于对照组（53．33％、33．33％,均P〈0．05）。结论比阿培南治疗肝衰竭并发细菌感染疗效确切,不良反应轻微。     

Tryptophan hydroxylase 2 gene is associated with major depressive disorder in a female Chinese population

Background

Previous candidate gene studies of major depressive disorder (MDD) have provided inconclusive evidence of association for genes with strong biological rationale for MDD. In this study, we aimed to investigate the association of tryptophan hydroxylase 2 gene with MDD and its treatment response in the Chinese Han population.

Methods

Three hundred and sixty eight depressed patients who met DSM-IV criteria for major depressive disorder were recruited for the study. 371 normal controls were recruited from local community. Patients and normal controls were genotyped for TPH2 (rs4290270 and rs7305115) variants by polymerase chain reaction. Male and female subjects were analyzed separately.

Results

No differences were found in the frequencies of the single alleles and genotypes of the tested polymorphisms between MDD patients and normal group. The frequency of the A-A haplotype was significantly higher in female MDD compared to healthy female controls (P < 0.05). No significant association with treatment response was discovered in haplotype and single-marker analysis.

Limitations

This study lacks a placebo control and we cannot definitively exclude the possibility that some patients in the responder group responded to the placebo effect alone.

Conclusion

The result suggests that TPH2 gene may have a gender dependent effect on susceptibility to MDD but not with its treatment response in Chinese Han population. Further studies are needed to replicate the association that we observed.     

循证护理对乳腺癌化疗患者自尊水平和应对方式的影响

目的：探讨循证护理对乳腺癌化疗患者自尊水平和应对方式的影响。方法：将乳腺癌术后化疗患者58例随机均分为观察组和对照组,对照组采用常规护理,观察组给予循证护理。观察护理前后2组患者的自尊水平（自卑感量表,FIS）评分和应对方式（医学应对问卷量表,MCMQ）评分变化情况。结果：护理前2组患者FIS和MCMQ各项评分均无明显差异（P〉0.05）;护理后2组患者FIS各项评分均明显增加,观察组评分较对照组增加显著（P〈0.05）;观察组MCMQ评分明显高于对照组（P〈0.05）,而回避、屈服评分显著低于对照组（P〈0.05）。结论：循证护理能显著提高乳腺癌化疗患者的自尊水平,改善应对方式。     

酒精性肝硬化伴戒断综合征的护理干预研究

目的探讨酒精性肝硬化伴饮酒戒断综合征的有效护理干预方法。方法选择80例酒精性肝硬化伴饮酒戒断综合征患者,按随机数字表法随机分为对照组和干预组各40例,对照组在药物治疗的同时由护士对患者进行一般性指导,干预组则采取综合护理干预方法,通过量表调查对患者自我情绪改变、健康行为和生活质量角度进行测试和评定。结果干预组和对照组患者在自我情绪、健康行为和生活质量的改变方面具有统计学差异(P<0.01)。结论通过在护理上积极多方位整体干预,可使酒精性肝硬化伴饮酒戒断综合征患者以积极的心态应对并克服酒精戒断症状带来的负性心理情绪反应,从而提高治疗的依从性,明显改善肝功能。     

Severe chronic active Epstein–Barr virus infection associated with multiple necrotic lesions in the liver

We report an atypical presentation of a chronic active Epstein–Barr virus (EBV) infection with multiple nodular coagulation necrosis in the liver, that appeared as hypodense areas on a CT scan. The patient, a 26-year-old man, was hospitalized following over 2 years of intermittent fever, weight loss and liver abnormalities after contracting infectious mononucleosis. We diagnosed his illness as a chronic active EBV infection (CAEBV) because of the high antibody titers against EBV and the histological evidence of organ disease with demonstration of EBV mRNA. A liver biopsy revealed EBV-infected T-cell infiltration with hemophagocytosis and marked hepatocytolytic necrosis. The patient developed multiple coagulation necrosis with well-defined borders surrounding T-cell aggregation in the liver 8 months later. He died of respiratory failure due to interstitial pneumonitis. The analysis of EBV-genome termini demonstrated a clonal proliferation of T-cells harboring EBV, but no T-cell antigen receptor (TCR) gene rearrangement was observed. We speculate that the pathogenesis of this disease was an atypical expression of organ damage as a result of an aberrant T-cell response to EBV infection.     

内毒素休克大鼠血清中TNF-α、皮质醇、LPS的测定及肾上腺的病理改变

目的:建立内毒素休克大鼠模型,探讨内毒素休克形成机制.方法:将40只Wistar大鼠随机分为正常对照组(n=10)和内毒素休克组(n=30).内毒素休克组采用腹腔注射适量D-氨基半乳糖(D-GalN)致敏后,经尾静脉注射休克剂量内毒素脂多糖(LPS),观察大鼠平均动脉压(MAP)变化,以评定模型是否成功.ELISA法测...     

乏氧诱导的A549细胞外泌体特征及其对放射抗拒性的影响

目的 收集乏氧和常氧条件下人肺腺癌A549细胞产生的外泌体,观察常氧下A549细胞与外泌体共培养后对X射线敏感性及侵袭性的变化。方法 分别在乏氧（1% O₂）和常氧条件下（21% O₂）培养A549细胞,超高速离心法收集在细胞分泌的常氧外泌体（N-EXO）和乏氧外泌体（H-EXO）。NanoSight检测外泌体数量,扫描电镜观察外泌体的外观和大小。蛋白印迹检测外泌体蛋白CD63。CCK8检测细胞对X射线的耐受性。荧光显微镜观察A549细胞对PKH67标记的外泌体的摄取。细胞划痕实验和Transwell实验观察加入不同的外泌体后细胞侵袭和侵袭性变化,ELISA方法检测细胞上清液中基质金属蛋白酶2（MMP2）和基质金属蛋白酶9（MMP9）的表达变化。细胞克隆形成实验观察二种外泌体对细胞放射抵抗性的改变。结果 每ml细胞培养液中H-EXO的数量增多。H-EXO和N-EXO均呈现出典型的环饼状,H-EXO直径变小,粒径分布在30~200 nm,小于N-EXO的粒径（50~220 nm）。H-EXO和N-EXO的CD63表达无明显差别。乏氧条件培养的A549细胞接受2 Gy X射线后,细胞的增殖水平在4和6 d时远高于常氧条件下的细胞。PKH67绿色荧光标记的外泌体分布在细胞内部。12、24、48 h后,H-EXO组细胞划痕宽度远小于N-EXO组（t=2.96、6.76、3.35,P<0.05）。H-EXO组细胞穿膜细数量大于N-EXO组和对照组（t=4.84、7.88,P<0.01）。H-EXO组上清液中MMP2（t=4.70、3.21,P<0.05）和MMP9（t=5.61、3.76,P<0.05）表达水平较对照组和N-EXO组均明显增高。对照组、N-EXO和H-EXO的D₀值分别为2.614、2.552、4.850。H-EXO较N-EXO可以明显增强A549细胞的放射抵抗性。结论 乏氧条件下,A549细胞释放的外泌体数量增多、粒径变小,乏氧外泌体可以促进常氧细胞的侵袭性,并且能够增强细胞对X射线的耐受性。     

Clinical application of protein induced by vitamin K antagonist-II as a biomarker in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths worldwide. Early diagnosis improves the prognosis. Protein induced by vitamin K antagonist-II (PIVKA-II) is an effective serum biomarker for HCC diagnosis and prognosis. Combined with another serum biomarker α-fetoprotein (AFP), the sensitivity and specificity of HCC diagnosis can be improved to a maximum of 94 and 98.5 %, respectively. PIVKA-II alone or in combination with AFP and/or AFP-L3 was effective in predicting the treatment response and clinical outcome of curative hepatic resection, chemotherapy, targeted therapy, radiotherapy, and liver transplantation. Japanese clinical guidelines recommend the combined use of PIVKA-II and AFP for the diagnosis of HCC, management of high-risk population, and prognosis of anticancer treatment. Further, PIVKA-II as a functional target promoted HCC cell proliferation, invasion, and metastasis by activating c-Met and other signal transduction pathways. Inhibition of PIVKA-II may provide a selective and effective therapy for HCC.