Ursodeoxycholic acid in the treatment of primary biliary cirrhosis: A short-term, randomized, double-blind controlled, cross-over study with long-term follow up

Abstract In order to evaluate the efficacy of ursodeoxycholic acid (UDCA) in the treatment of Chinese patients with primary biliary cirrhosis, a short-term, randomized, double-blind controlled, cross-over study was done with long-term follow up. In the first part of the study, 12 patients were randomly chosen to receive either UDCA 600 mg/day for 3 months followed by a placebo for 3 months or a placebo for 3 months followed by UDCA for 3 months. The clinical symptoms of pruritus improved when the patients were receiving UDCA but became worse when receiving a placebo. Mean serum levels of alkaline phosphatase (ALPase), γ-glutamyl transferase (γ-GT), total bilirubin, cholesterol, alanine aminotransferase (ALT) and aspartate aminotransferase all decreased below the baseline values when receiving UDCA treatment and all increased above the baseline values when receiving the placebo. The difference was statistically significant. In the second part of the study, 19 patients received long-term UDCA treatment (mean 20 months). The clinical symptoms of pruritus improved in 90% of the pruritic patients. Serum levels of ALPase, γ-GT and ALT fell significantly from the pretreatment values 6, 12 and from the mean 20 months after UDCA treatment. Serum levels of total bilirubin fell significantly 6 and 12 months after UDCA treatment but did not reach statistical significance at the last follow up. No patient lost antimitochondrial antibody and elevated immunoglobulin levels did not improve significantly, but the Mayo clinical risk score improved significantly after long-term UDCA treatment. Treatment failure was noted in three patients: two patients in the histologic stage IV with clinical overt jaundice died of complications 4 and 5 months after UDCA treatment, respectively; another patient underwent a liver transplantation 1 year after the UDCA treatment due to progressive jaundice. No severe adverse reaction was noted during UDCA treatment, only one patient suffered from a mild allergic reaction. In conclusion, UDCA is safe and effective in the treatment of Chinese PBC patients in stages I—III.     

急性淋巴细胞白血病维持化疗阶段患儿的症状群及其前哨症状的调查

目的 探讨急性淋巴细胞白血病患儿维持化疗阶段症状群及各症状群的前哨症状。方法 采用便利抽样法,选取2020年6月—2021年8月在苏州大学附属儿童医院血液科病房收治的处于维持化疗阶段的急性淋巴细胞白血病患儿作为研究对象,采用记忆症状评估量表儿童版对其进行调查。采用探索性因子分析并结合Spearman秩相关分析确定症状群;基于Apriori算法关联分析确定各症状群的前哨症状。结果 急性淋巴细胞白血病患儿在维持化疗阶段存在5类症状群,即情绪心理症状群、胃肠道症状群、躯体症状群、神经系统症状群、自我形象受损症状群,其Cronbach α系数分别为0.943、0.906、0.874、0.891、0.900;睡眠困难、呕吐、咳嗽、头痛、脱发依次为上述症状群的前哨症状。结论 急性淋巴细胞白血病患儿在维持化疗阶段经历多种症状群困扰。症状群及其前哨症状的确定有利于简化症状的评估和管理,提高症状管理效率,减轻患儿及家庭的疾病负担。     

PATTERN OF T-CELL RECEPTOR DELTA GENE REARRANGEMENT BY SOUTHERN BLOTTING AND POLYMERASE CHAIN REACTION TECHNIQUE IN HONG KONG CHINESE PATIENTS WITH NON-T-CELL HEMATOLOGICAL MALIGNANCIES

It has been recognized that clonal T-cell receptor delta (TCRδ) gene rearrangement is present in both T- and B-cell malignancies. The highly sensitive polymerase chain reaction (PCR) technique may be applicable to cases of leukemia and lymphoma of non-T-cell origin for detection of minimal residual disease (MRD). A PCR technique was used in this study to investigate the pattern of clonal TCRδ gene rearrangement in Hong Kong Chinese patients with non-T-cell hematological malignancies. Seventy-three patients with the diagnosis of acute leukemia and non-Hodgkin's lymphoma of non-T-cell origin were included in this study. There were 20 patients with common ALL (cALL), seven precursal B-cell ALL (PreB-ALL), 23 acute myeloid leukemia (AML), and 23 non-Hodgkin's lymphoma of B-lineage (B-NHL). Clonal rearrangement was detectable by Southern analysis using a Jδ1 probe in 41 per cent of ALL of B-lineage but in none of the B-NHL or AML. The samples were also studied further by monoclonal PCR amplification for TCRδ gene rearrangement. Three different sets of primers were employed to detect clonal rearrangement of the TCRδ gene. The Vδ1(D)Jδ1 recombination typically seen in T-cell malignancies were not seen in any of the of the non-T-cell malignancies. The Vδ2(D)Dδ3 recombination was found exclusively in ALL of B-lineage and was seen in 73 per cent of the Southern positive cases. Although clonal TCRδ gene rearrangement was undetectable by Southern analysis in our AML cases, 26 per cent had a Vδ2(D)Jδ1 recombination found by the PCR technique. Sensitivity of the PCR technique was determined by serial mixing and was up to 5–10 leukemic cells per 10⁴ nucleated cells. It was apparent from this study that it was feasible to detect clonal TCRδ gene rearrangement by the PCR technique in a proportion of the cases of non-T-cell hematological malignancies. The PCR technique can be applied to detect residual leukemic cells in marrow of patients in an apparent morphological complete remission. The value of this application requires further clinical evaluation and correlation.     

Prevalence of anti-HCV among Chinese patients with acute and chronic liver disease

To assess whether the hepatitis C virus plays an important role in Chinese patients with acute and chronic liver disease, antibodies to HCV (anti-HCV) were measured by enzyme immunoassay in 67 patients with type A and B acute viral hepatitis, 165 patients with non-A, non-B (NANB) hepatitis, 438 patients with chronic hepatitis, 200 patients with postnecrotic liver cirrhosis, 72 patients with alcoholic liver disease, 55 patients with non-alcoholic fatty liver, 24 patients with toxic and drug-induced hepatitis, and 20 patients with other chronic liver diseases. Anti-HCV was not detected in sera from patients with type A and B acute viral hepatitis, toxic and drug-induced hepatitis, primary biliary cirrhosis, Wilson's disease, or lupoid hepatitis. The anti-HCV prevalence was found to be highest in patients with NANB hepatitis (59% in sporadic and 73.2% in transfusion-associated), 16.4% in non-alcoholic fatty liver, 5.6% in alcoholic liver disease, 6.8% in chronic hepatitis, and 16% in postnecrotic liver cirrhosis. In patients with chronic hepatitis, the anti-HCV prevalence was significantly higher in HBsAg-negative (15/34, 44.1%) than in HBsAg-positive cases (15/404, 3.7%; P less than 0.0001). The results indicate that HCV is a major agent of NANB hepatitis and plays an important role in HBsAg-negative chronic liver disease in Taiwan.     

Effects of intravenous pantoprazole in gastric PH and recurrent bleeding for peptic ulcers

Objective: To study the effects of pantoprazole in gastric pH and recurrent bleeding after endoscopic treatment for bleeding peptic ulcers. Methods: After endoscopic treatment for bleeding gastric or duodenal ulcers, patients were randomly assigned to: group 1 (infusion group): 80 mg pantoprazole intravenous bolus, followed by continuous infusion 8 mg per hour for 72 h, group 2 (bolus group): 80 mg pantoprazole intraveneous bolus, followed by 40 mg intravenous bolus every 12 h for 72 h and group 3 (no treatment group). A pH probe was placed in stomach for 24 h during the first 72 h for pH monitoring. On day 4, they were given oral famotidine for 8 weeks. Suspected recurrent bleeding will be confirmed with endoscopy. The primary end‐point is the rate of rebleeding within 30 days. The secondary end‐points are operative rate, transfusion requirement, total hospital stay, mortality rate and gastric pH analysis. Results: 86 patients were recruited for analysis (group 1: n=22, group 2: n=30, group 3: n=34). In the first part of our analysis, group 1 and 2 (those receiving pantoprazole) were combined for comparison with Group 3. There was less rebleeding in those with pantoprazole (3.8 vs 17.6%, P=0.031). The transfusion requirement was also less (1.59 vs 3.01 units, P=0.007). There was no difference in need for operation and total hospital stay. Regarding gastric pH, those receiving pantoprazole had significantly higher mean pH (5.43 vs 1.87, P=0.001), median pH (5.58 vs 1.77, P=0.001) and percentage of time with Ph >*Τ*6 (52.97 vs 7.45%, P=0.001). In the second part of our analysis, the results between group 1 and 2 were compared. There was a tendency to favour pantoprazole infusion regarding rebleeding rate (0 vs 6.7%), operation rate (0 vs 3.3%), mean pH (5.73 vs 5.22), median pH (5.78 vs 5.43) and percentage of time with pH >*Τ*6 (54.71 vs 51.84%). However, they did not reach statistical significance. There was no mortality among the studied patients. Conclusion: After endoscopic treatment for bleeding peptic ulcer, patients receiving pantoprazole had significantly higher gastric pH and lower chance of rebleeding. Further data is needed to identify the better regime for administration of pantoprazole.     

A randomized prospective comparison of oral versus intraperitoneal ofloxacin as the primary treatment of CAPD peritonitis

Summary: Oral ofloxacin has been successfully used in our centres for the primary treatment of peritonitis complicating continous ambulatory peritoneal dialysis (CAPD). In view of the progressive rise in the resistance rate to ofloxacin among peritoneal bacterial isolates, a study was conducted to determine if oral ofloxacin remains a viable first line treatment for CAPD peritonitis in our centres and if the result can be improved by changing from an oral to an intraperitoneal (i.p.) route. In patients on three 2 L daily CAPD exchanges, ofloxacin given at the i.p. dosage of 200 mg loading followed by 25 mg/L of peritoneal dialysate achieved overnight trough peritoneal levels which are at least four times the minimal 90% inhibitory concentration (MIC90) of most bacterial pathogens without significant accumulation in the systemic circulation. This i.p. dosage was therefore chosen for the clinical study and the result was compared to that using ofloxacin given in the oral dosage of 400 mg loading followed by 300 mg once daily as maintenance. of all the recruited episodes, 35 were eligible for analysis. the overall primary cure rate including primary failures and relapses was 55.6% (10/18) in the oral treatment group and 70.6% (12/17) in the i.p. treatment group. the corresponding figures for gram positive bacterial (g +) infections were 36.4% and 50%, for gram negative bacterial (g -) infections were 66.7 and 80% and for culture negative infections were 75 and 80%. In culture positive cases, all treatment failures were due to resistant infections which were observed in 42.3% of all bacterial isolates, 47.1% of g + isolates and 33.3% of g - isolates. Due to the high background level of bacterial resistance among our CAPD population, ofloxacin monotherapy given either by the oral or the i.p. route can no longer be recommended for the primary treatment of CAPD peritonitis.     

Involvement of Ca~(2+) activated K~+channels in receptor regulated sperm motility in rats

Involvement of Ca~(2+) activated K~+channels in receptor regulated sperm motility in rats     

Verification of the Tip Position of the Intra-Aortic Balloon Pump Catheter by Perioperative Transesophageal Echocardiography

In some patients with advanced heart disease, low cardiac output may develop immediately after coronary artery bypass grafting (CABG). Appropriate measures are often required to ensure adequate perfusion of vital organs in such patients. Of the invasive rescue measures chosen for the support of low cardiac output, the intra-aortic balloon pump (IABP) prevails. In common practice, a fluoroscope or x-ray unit is used to guide the insertion of the IABP catheter to the correct position. Transesophageal echocardiography (TEE) can accomplish this more conveniently. Here we report on two cases of misplacement of the IABP catheter, one in the false lumen of a dissected upper abdominal aortic aneurysm and the other in the lumen of the inferior vena cava, both of which were diagnosed intraoperatively by TEE in CABG patients. The applications of TEE in the perioperative period are continuously expanding. One such application of TEE is the assessment of IABP catheter position.