Sleeve gastrectomy prior to liver transplantation is superior to medical weight loss in reducing posttransplant metabolic complications

Strategies to optimize the management of obesity-related metabolic complications after liver transplantation (LT) are needed. We examined the effect of pre-LT sleeve gastrectomy (SG), as compared to medical weight loss (MWL), on post-LT outcomes. This is a cohort study of adults (≥18 years) with medically complicated obesity who were eligible for pre-LT SG and underwent LT from January 1, 2006 to June 1, 2016. Logistic regression models evaluated the association of SG on post-LT diabetes and hypertension, defined as new-onset or progressive disease post-LT. Cox regression models evaluated the association of SG on recurrent and de novo nonalcoholic fatty liver disease (NAFLD). Among 70 LT recipients who were eligible for pre-LT SG, 14 (20%) underwent SG and 56 (80%) underwent MWL only. Mean follow-up was 5.2 years post-LT. The SG cohort sustained higher % total body weight loss at 3 years post-LT (28.9% vs. 5.4%, p < .001). In multivariable analyses, SG was associated with significantly lower risk of post-LT diabetes (OR 0.04, 95% CI 0.00–0.41, p = .01), hypertension (OR 0.15, 95% CI 0.04–0.67, p = .01), and recurrent and de novo NAFLD (HR 0.19, 95% CI 0.04–0.91, p = .04). When compared to MWL, SG resulted in sustained weight loss and significantly lower risk of diabetes, hypertension, and recurrent and de novo NAFLD post-LT.     

Changes in humoral immune response after SARS-CoV-2 infection in liver transplant recipients compared to immunocompetent patients

The protective capacity and duration of humoral immunity after SARS-CoV-2 infection are not yet understood in solid organ transplant recipients. A prospective multicenter study was performed to evaluate the persistence of anti-nucleocapsid IgG antibodies in liver transplant recipients 6 months after coronavirus disease 2019 (COVID-19) resolution. A total of 71 liver transplant recipients were matched with 71 immunocompetent controls by a propensity score including variables with a well-known prognostic impact in COVID-19. Paired case–control serological data were also available in 62 liver transplant patients and 62 controls at month 3 after COVID-19. Liver transplant recipients showed a lower incidence of anti-nucleocapsid IgG antibodies at 3 months (77.4% vs. 100%, p < .001) and at 6 months (63.4% vs. 90.1%, p < .001). Lower levels of antibodies were also observed in liver transplant patients at 3 (p = .001) and 6 months (p < .001) after COVID-19. In transplant patients, female gender (OR = 13.49, 95% CI: 2.17–83.8), a longer interval since transplantation (OR = 1.19, 95% CI: 1.03–1.36), and therapy with renin–angiotensin–aldosterone system inhibitors (OR = 7.11, 95% CI: 1.47–34.50) were independently associated with persistence of antibodies beyond 6 months after COVID-19. Therefore, as compared with immunocompetent patients, liver transplant recipients show a lower prevalence of anti-SARS-CoV-2 antibodies and more pronounced antibody levels decline.     

Binge-eating disorder is associated with an unfavorable body mass composition in patients with non-alcoholic fatty liver disease

The interaction between eating disorders and non-alcoholic fatty liver disease (NAFLD) remains unexplored, especially with regards to binge-eating disorder (BED). Our team conducted a service evaluation project in order to assess risk factors for the presence of BED among patients with NAFLD and the impact of BED on body mass composition. The overall prevalence of patients screening positive to BED Screener-7 (BEDS-7) was 28.4%, while a previous diagnosis of depression and marital status (as single or separated) were independently associated with positive BED. Furthermore, patients with positive BEDS-7 had higher BMI, with greater visceral component and overall lower muscle mass. There was no difference in terms of liver disease severity as assessed by noninvasive markers of fibrosis. However, as body mass composition and sarcopenia have been shown to be associated to disease progression in patients with NAFLD, further studies are required to ascertain the long-term impact of BED in these patients. Moreover, further work is warranted to identify to implement multidisciplinary approach within clinical psychology for the management of patients with BED, who may be particularly challenging in terms of achieving lifestyle modifications. As a hepatology community, we should address NAFLD with a more holistic approach.     

慢性肝炎、肝硬化与消化性溃疡的研究

为研究肝源性溃疡（ＨＰＵ） 的临床特征及其可能的发病机制,分析了１６４ 例慢性肝病患者及３６ 例急性肝炎患者的ＨＰＵ 发生情况,并观察了ＨＰＵ 患者血清微量元素变化。结果：①慢性肝病患者ＨＰＵ 发生率为４０ ％ ,其中十二指肠球溃疡占８８ ．８ ％ ;②平均发病年龄４６ ．８ 岁;临床症状不典型;③ＨＰＵ 发生率与肝脏病变程度有关;④ＨＰＵ 患者血清Ｚｎ 明显降低（ Ｐ＜ ０ ．０５） ,Ｆｅ 明显增加（ Ｐ＜ ０ ．０５） 。结果提示,ＨＰＵ 不同于普通消化性溃疡;其病因和发病机制不完全清楚,可能是与肝病有关的胃粘膜攻击因子增强及防御因子减弱等多因素共同作用的结果。     

慢性乙型肝炎患者外周血单个核细胞表达IL-18的实验研究

目的探讨外周血单个核细胞（PBMC）IL-18分泌水平在乙型肝炎病毒（HBV）慢性感染中的意义。方法采用ELISA法测定20例正常人和44例HBV感染者PBM℃经植物血凝素（PHA）刺激后IL-18在上清液中的表达水平。结果正常及患者组PBMC上清液中IL-18有低水平表达，经PHA刺激后其活性明显升高（与未刺激组比较，P〈0．01）；正常及患者组PBMC经PHA刺激后，患者组IL-18水平显著低于正常对照组，其中轻度及中度组与对照组比较差异有非常显著意岁（P〈0．01）、重度组与对照组比较差异有显著意义（P〈0．05）；血HBV—DNA复制指标水平越高，IL-18活性越低；患者组血清ALT水平与PBMC经PHA刺激后的IL-18活性水平呈明显正相关（r=0．45，P〈0．01）。结论PBMC能表达IL-18；乙型肝炎慢性化以及高复制状态可能与PBMC分泌IL-18活性降低有关；IL-18水平在HBV感染者不同阶段的变化有助于了解和观察病情及预后。     

扶正化瘀胶囊抗肝纤维化的临床疗效和作用机制

正虚血瘀是肝纤维化的基本病机,扶正化瘀胶囊是针对此基本病机制成的抗肝纤维化药物。十多年来的临床和实验研究发现,该药可通过保护肝细胞、减轻肝损伤、抑制肝纤维化的形成等多种作用机制,来发挥其在抗肝纤维化、逆转肝纤维化、改善肝功能等方面的临床疗效。扶正化瘀胶囊是一个作用机制明确,值得临床大力推广的安全有效的抗肝纤维化药物。     

Genotyping of Entamoeba nuttalli strains from the wild rhesus macaques of Myanmar and comparison with those from the wild rhesus macaques of Nepal and China

Entamoeba nuttalli found in macaques is phylogenetically the closest species to Entamoeba histolytica and is potentially pathogenic. In this study, the prevalence of Entamoeba infections was examined in wild rhesus macaques by examining 73 and 90 fecal samples collected from two sites, Popa Taung Kalat (PTK) and Pho Win Taung (PWT), in Myanmar. The positive rates of E. nuttalli detected using PCR were 49% and 31% in PTK and PWT, respectively, but no infections of E. histolytica and E. moshkovskii were found. Entamoeba dispar was detected in 6% of samples only from PWT. Positive rates of E. chattoni and E. coli were both 70% in PWT and 67% and 79% in PTK, respectively. Six E. nuttalli strains from PTK and eight from PWT were obtained in the culture with xenic medium and then, one and two strains, respectively, were axenized and finally cloned. The genotypic analysis of serine-rich protein genes revealed two genotypes each in both sites. The genotypes found in five of six strains from PTK were similar to those from the strains found in Nepal, whereas the remaining one from PTK and two from PWT were similar to those obtained from macaques in China. The sequence of the 18S rDNA of strains with these four genotypes was identical to that of the strains from China. Six loci of tRNA-linked short tandem repeats were analyzed for further genotyping of the strains. Although there were two types in locus A-L in PTK isolates, one of each type for PTK and PWT was found in the other loci, including locus A-L in PWT strains. These results demonstrated that the E. nuttalli strains from Myanmar are closer to the strains from macaques in China rather than those from macaques in Nepal.