Immune derangement occurs in patients with H7N9 avian influenza

Introduction

Currently, little is known about the immunological characteristics of patients with avian influenza A (H7N9) virus infection.

Methods

The numbers and percentages of peripheral blood immune cells were measured in 27 patients with laboratory-confirmed H7N9 virus infection and 30 healthy controls (HCs). The functional phenotypes of T cells and monocytes, as well as serum cytokine levels, were analyzed by flow cytometry.

Results

There were 19 patients (70.4%) with acute respiratory distress syndrome, 13 (48.1%) with secondary respiratory infection, 20 (74%) with systemic inflammatory response syndrome (SIRS; defined as having at least two concurrent SIRS components), 18 (66.7%) with lymphocytopenia and 11 (40.7%) with reduced numbers of monocytes. In comparison with levels in the HCs, the levels of serum interleukin 6 (IL-6), IL-8 and IL-10 and the percentages of CD38+ or Tim-3+ T cells were significantly increased. However, the percentages of human leukocyte antigen-DR + and Tim-3+ monocytes were significantly decreased in patients compared with HCs.

Conclusions

Patients with avian H7N9 virus infection display profound SIRS concomitantly with an anti-inflammatory response, which may be associated with the rapid progression of and high mortality associated with this novel viral disease.     

17-beta-hydroxysteroid dehydrogenase 13 inhibits the progression and recurrence of hepatocellular carcinoma

Background: Our previous study showed that 17-beta-hydroxysteroid dehydrogenase 13(HSD17 B13) is down-regulated in hepatocellular carcinoma(HCC). But its function in HCC remains unknown. This study aimed to reveal the function of HSD17 B13 and its clinical significance in HCC.Methods: m RNA levels of HSD17 B13 were analyzed in cohort 1(30 normal, 30 HBV cirrhosis, 60 HBVrelated HCC and 60 peritumoral tissue) by real-time PCR. HSD17 B13 protein was evaluated in cohort 2(15 normal, 33 HBV-cirrhosis, 12 dysplastic nodules, 34 HBV-related HCC, and 9 metastatic HCC) using immunohistochemistry. The association between HSD17 B13 and the survival of HCC patients was analyzed in cohort 3(n = 88). The inhibitory mechanism of HSD17 B13 on HCC was explored.Results: The m RNA of HSD17 B13 and its protein expression were significantly down-regulated in HCC compared to non-tumor specimens(P 0.001). The sensitivity, specificity and area under curve(AUC)values of HSD17 B13 expression levels for HCC detection were 81.7%, 83.7% and 0.856, respectively(P 0.001). Lower HSD17 B13 in peritumoral tissue was an independent risk factor of worse recurrence free survival of HCC patients(HR: 0.41; 95% CI: 0.20–0.83; P = 0.014). The study in Huh 7 and SK-HEP-1 cells showed that HSD17 B13 induced an accumulation of cells in G1 phase and reduction of cells in S and G2 phases via up-regulating the expression of P21, P27 and MMP2.Conclusions: Lower HSD17 B13 in peritumoral tissues was associated with worse recurrence free survival and overall survival of HCC patients. HSD17 B13 delayed G1/S progression of HCC cells. HSD17 B13 may be a therapeutic target for the treatment of HCC.     

一种改良的布鲁氏菌病抗体微量凝集检测方法的建立与评价

目的 建立一种微量的布鲁氏菌病抗体凝集检测方法,用于布鲁氏菌病高通量检测。方法 依据我国《布鲁氏菌病诊断标准》(WS269-2007)规定的病人诊断标准,用试管凝集试验做诊断标准。通过优化微量凝集试验抗原浓度,对142份疑似病人血清同时做试管凝集和微量凝集试验,进行效果评价。结果 最优的微量凝集抗原浓度为1:10,建立微量凝集法具有较高的敏感度和特异度,分别为98.9%和92.3%;和常规试管凝集法相比,两种方法符合率为96.5%。常规试管凝集检测得到21份阴性样本,22份可疑样本(1:50),99份阳性样本(>1:100)。微量凝集检测得到30份阴性样本、17份可疑样本(1:50)、95份阳性样本(>1:100)。两种试验方法,结果相同的占70.4%(100/142),经统计学检验差异无统计学意义(χ²=0.8,P>0.05)。结论 建立一种可显色的布鲁氏菌病抗体微量凝集检测方法,可以在96孔V型板上同时检测24份标本,且结果易判读,更适宜基层防疫人员现场检测,最终为疫情处置提供强有力的技术支持。     

Hepatocellular Carcinoma Multidisciplinary Clinic-Cairo University (HMC-CU) score: A new simple score for diagnosis of HCC

Background and Study AimsThe risk of hepatocarcinogenesis depends on background liver factors, of which fibrosis is a major determinant. Serum markers and scores are of increasing importance in non-invasive diagnosis of hepatic fibrosis. Our aim was to predict the occurrence of hepatocellular carcinoma (HCC) using a non-invasive fibrosis score calculated using routine patient data.Patients and mthodsOur retrospective study included 1,291 hepatitis C related-HCC Egyptian patients (Group 1) recruited from the multidisciplinary HCC clinic, Faculty of Medicine, Cairo University in the period between February 2009 and June 2016 and 1072 chronic hepatitis C-naïve patients (Group 2) with advanced fibrosis (≥F3) and cirrhosis (F4). King score, Fibro Q score, Aspartate aminotransferase-to-platelet ratio index (APRI), AST to ALT ratio (AAR), LOK score, Göteborg University Cirrhosis Index (GUCI), Fibro-α and Biotechnology Research Center (BRC) scores were calculated for all patients. Regression analysis and receiver operating characteristics (ROC) were used to calculate the sensitivity, specificity and predictive values for significant scores with the best cut-off for predicting HCC. A regression equation was used to calculate predicted probabilities of HCC using the following variables; age, gender, haemoglobin, international normalised ratio (INR), albumin and alpha fetoprotein. The appropriate score cut-off points yielding optimal sensitivity and specificity were determined by ROC curve analysis.ResultsThere was a highly significant difference between the two groups for all calculated scores (P = 0.0001). Our new score, the Hepatocellular Carcinoma Multidisciplinary Clinic-Cairo University (HMC-CU) score (Logit probability of HCC =  − 2.524 + 0.152*age – 0.121*Hb − 0.696*INR – 1.059*Alb + 0.022*AFP + 0.976*Sex. Male = 1, Female = 0), with a cut-off of 0.559 was superior to other scores for predicting HCC, having a sensitivity of 90% and specificity of 80.6%.ConclusionThe HMC-CU score is a promising, easily calculated, accurate, cost-effective score for HCC prediction in chronic HCV patients with advanced liver fibrosis.     

Outcomes of central hepatectomy versus extended hepatectomy

BackgroundCentral hepatectomy (CH) is more difficult than extended hepatectomy (EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent post-hepatectomy liver failure (PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors.MethodsA total of 178 major liver resections performed by specialist surgeons from two Australian tertiary institutions between June 2009 and March 2017 were reviewed. Eleven patients had CH and 24 had EH over this study period. Indications and perioperative outcomes were compared between the groups.ResultsThe main indication for performing CH was colorectal liver metastases. There was no perioperative mortality in the CH group and four (16.7%) in the EH group (P = 0.285). No group differences were found in median operative time [CH vs. EH: 450 min (290–840) vs. 523 min (310–860), P = 0.328], intraoperative blood loss [850 mL (400–1500) vs. 650 mL (100–2000), P = 0.746] or patients requiring intraoperative blood transfusion [1 (9.1%) vs. 7 (30.4%), P = 0.227]. There was a trend towards fewer hepatectomy-specific complications in the CH group [3 (27.3%) vs. 13 (54.2%), P = 0.167], including PHLF (CH vs. EH: 0 vs. 29.2%, P = 0.072). Median length of stay was similar between groups [CH vs. EH: 9 days (5–23) vs. 12 days (4–85), P = 0.244].ConclusionsCH has equivalent postoperative outcomes to EH. There is a trend towards fewer hepatectomy-specific complications, including PHLF. In appropriate patients, CH may be considered as a safe parenchyma-sparing alternative to EH.