Prognostic Indicators for Acute Liver Failure Development and Mortality in Patients with Hepatitis A: Consecutive Case Analysis

Purpose

Due to the seroepidemiological shift in hepatitis A (HA), its severity, mortality, and complications have increased in recent years. Thus, the aim of this study was to identify predictive factors associated with poor prognosis among patients with HA.

Materials and Methods

A total of 304 patients with HA admitted to our institution between July 2009 and June 2011 were enrolled consecutively. Patients with complications defined as acute liver failure (ALF) were evaluated, and mortality was defined as death or liver transplantation.

Results

The mean age of patients (204 males, 100 females) was 32 years. Eighteen (5.9%) patients had progressed to ALF. Of the patients with ALF, 10 patients (3.3%) showed spontaneous survival while 8 (2.6%) died or underwent liver transplantation. Multivariate regression analysis showed that Model for End-Stage Liver Disease (MELD) and systemic inflammatory response syndrome (SIRS) scores were significant predictive factors of ALF. Based on receiver operating characteristics (ROC) analysis, a MELD ≥23.5 was significantly more predictive than a SIRS score ≥3 (area under the ROC: 0.940 vs. 0.742, respectively). In addition, of patients with a MELD score ≥23.5, King''s College Hospital criteria (KCC) and SIRS scores were predictive factors associated with death/transplantation in multivariate analysis.

Conclusion

MELD and SIRS scores ≥23.5 and ≥3, respectively, appeared to be related to ALF development. In addition, KCC and SIRS scores ≥3 were valuable in predicting mortality of patients with a MELD ≥23.5.     

Minimalna choroba resztkowa w ostrych białaczkach u dzieci i dorosłych

Biological and genetic heterogeneity of acute leukemias is a major cause of therapeutic difficulties. Response to chemotherapy is one of the most important prognostic factors in this group of diseases. In acute lymphoblastic leukemia (ALL), and progressively more in acute myeloid leukemia (AML), the best parameter of that response is the presence of minimal residual disease (MRD). MRD monitoring is performed based on the flow cytometer analysis of leukemic immunophenotypes or detection of gene rearrangement by PCR. Both methods are characterized by high sensitivity and specificity, which clearly distinguishes them from the standard morphologic examination. This review presents the current state of knowledge of the importance and use of MRD in children and adults, in ALL and AML, emphasizing similarities and differences. Current opinions show that the MRD is the most important prognostic factor in ALL and an important factor in AML. Based on current data in children and adults, it seems that in acute lymphoblastic leukemia, presence of MRD is a continuous variable; the older the patient, the higher the risk of MRD and therapy failure. This paper presents also a new insight to the concept of MRD, because of the presence of leukemic stem cells that survive chemotherapy in AML and any of the maturational stages of leukemia-propagating cells in ALL. This idea combines the phenomenon of drug resistance of tumor stem cells and the presence of residual cells undetectable by methods of optical microscopy after applied chemotherapy. The concept of leukemic stem cells explains the occurrence of resistant clones both in ALL and AML. Based on studies of genetic profiles, there is growing evidence to suggest that acute leukemia is a highly heterogeneous disease, which goes hand in hand with the hierarchy of leukemic stem cells and leukemia initiating cells. In the light of the current knowledge based on MRD, it seems necessary to review the concept of complete remission in MRD-positive leukemic patients.     

复发性和首发性脑梗死患者头颈部CT血管成像特点分析

目的 通过比较复发性脑梗死与首发性脑梗死患者CT血管成像（CTA）的特点,探讨复发性脑梗死患者可能的影响因素。方法 回顾分析140例复发性脑梗死患者和235例首发性脑梗死患者头颈部CTA检查结果,比较两组患者头颈部血管病变的特点。结果 复发性脑梗死患者头颈部动脉狭窄发生率明显高于首发性脑梗死患者（90.0%比64.7%;P＜0.01）,复发性脑梗死患者头颈部动脉中、重度狭窄发生率高于首发性脑梗死患者（分别为34.9%和45.2%比19.7%和15.8%;P＜0.01）,复发性脑梗死患者头颈部动脉斑块发生率明显高于首发性脑梗死患者（91.4%比66.4%;P＜0.01）,复发性脑梗死患者头颈部动脉软斑、溃疡斑发生率明显高于首发性脑梗死患者（分别为36.3%和48.0%比22.7%和37.3%;P＜0.05）。结论 复发性脑梗死与头颈部动脉狭窄及狭窄程度和不稳定性斑块有关,动脉狭窄的程度和斑块性质可能是引起复发性脑梗死的原因之一。     

Role of gut microbiota on intestinal barrier function in acute pancreatitis

Acute pancreatitis(AP) is a common gastrointestinal disorder. Approximately15%-20% of patients develop severe AP. Systemic inflammatory response syndrome and multiple organ dysfunction syndrome may be caused by the massive release of inflammatory cytokines in the early stage of severe AP,followed by intestinal dysfunction and pancreatic necrosis in the later stage. A study showed that 59% of AP patients had associated intestinal barrier injury,with increased intestinal mucosal permeability, leading to intestinal bacterial translocation, pancreatic tissue necrosis and infection, and the occurrence of multiple organ dysfunction syndrome. However, the real effect of the gut microbiota and its metabolites on intestinal barrier function in AP remains unclear. This review summarizes the alterations in the intestinal flora and its metabolites during AP development and progression to unveil the mechanism of gut failure in AP.     

Imaging-based algorithmic approach to gallbladder wall thickening

Gallbladder(GB) wall thickening is a frequent finding caused by a spectrum of conditions. It is observed in many extracholecystic as well as intrinsic GB conditions. GB wall thickening can either be diffuse or focal. Diffuse wall thickening is a secondary occurrence in both extrinsic and intrinsic pathologies of GB, whereas, focal wall thickening is mostly associated with intrinsic GB pathologies. In the absence of specific clinical features, accurate etiological diagnosis can be challenging. The survival rate in GB carcinoma(GBC) can be improved if it is diagnosed at an early stage, especially when the tumor is confined to the wall. The pattern of wall thickening in GBC is often confused with benign diseases, especially chronic cholecystitis, xanthogranulomatous cholecystitis, and adenomyomatosis. Early recognition and differentiation of these conditions can improve the prognosis. In this minireview, the authors describe the patterns of abnormalities on various imaging modalities(conventional as well as advanced) for the diagnosis of GB wall thickening. This paper also illustrates an algorithmic approach for the etiological diagnosis of GB wall thickening and suggests a formatted reporting for GB wall abnormalities.