Background: Acute-on-chronic liver failure (ACLF) refers to the acute deterioration of liver function that occurs in patients with chronic liver disease. ACLF is characterized by acute decompensation, organ failure an...Background: Acute-on-chronic liver failure (ACLF) refers to the acute deterioration of liver function that occurs in patients with chronic liver disease. ACLF is characterized by acute decompensation, organ failure and high short-term mortality. Numerous studies have been conducted and remarkable progress has been made regarding the pathophysiology and pathogenesis of this disease in the last decade. The present review was to summarize the advances in this field. Data sources: A comprehensive search in PubMed and EMBASE was conducted using the medical subject words “acute-on-chronic liver failure”,“ACLF”,“pathogenesis”,“predictors”, and “immunotherapy” combined with free text terms such as “systemic inflammation” and “immune paralysis”. Relevant papers published before October 31, 2018, were included. Results: ACLF has two marked pathophysiological features, namely, excessive systemic inflammation and susceptibility to infection. The systemic inflammation is mainly manifested by a significant increase in the levels of plasma pro-inflammatory factors, leukocyte count and C-reactive protein. The underlying mechanisms are unclear and may be associated with decreased immune inhibitory cells, abnormal expression of cell surface molecules and intracellular regulatory pathways in immune cells and increased damageassociated molecular patterns in circulation. However, the main cause of susceptibility to infection is immune paralysis. Immunological paralysis is characterized by an attenuated activity of immune cells. The mechanisms are related to elevations of immune inhibitory cells and the concentration of plasma antiinflammatory molecules. Some immune biological indicators, such as soluble CD163, are used to explore the pathogenesis and prognosis of the disease, and some immunotherapies, such as glucocorticoids and granulocyte colony-stimulating factor, are effective on ACLF. Conclusions: Overwhelming systemic inflammation and susceptibility to infection are two key features of ACLF. A better understanding of the state of a patient’s immune system will help to guide immunotherapy for ACLF.展开更多
AIM: To investigate the association of hypertension and diabetes mellitus (DM) with interferon-associated retinopathy (IAR) risk in chronic hepatitis C (CHC).
Pneumonia caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection emerged in Wuhan City,Hubei Province,China in December 2019.By Feb.11,2020,the World Health Organization(WHO)officially named th...Pneumonia caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection emerged in Wuhan City,Hubei Province,China in December 2019.By Feb.11,2020,the World Health Organization(WHO)officially named the disease resulting from infection with SARS-Co V-2 as coronavirus disease 2019(COVID-19).COVID-19 represents a spectrum of clinical manifestations that typically include fever,dry cough,and fatigue,often with pulmonary involvement.SARS-CoV-2 is highly contagious and most individuals within the population at large are susceptible to infection.Wild animal hosts and infected patients are currently the main sources of disease which is transmitted via respiratory droplets and direct contact.Since the outbreak,the Chinese government and scientific community have acted rapidly to identify the causative agent and promptly shared the viral gene sequence,and have carried out measures to contain the epidemic.Meanwhile,recent research has revealed critical aspects of SARS-CoV-2 biology and disease pathogenesis;other studies have focused on epidemiology,clinical features,diagnosis,management,as well as drug and vaccine development.This review aims to summarize the latest research findings and to provide expert consensus.We will also share ongoing efforts and experience in China,which may provide insight on how to contain the epidemic and improve our understanding of this emerging infectious disease,together with updated guidance for prevention,control,and critical management of this pandemic.展开更多
基金supported by grants from the Science and Technology Major Projects of Zhejiang Province(2018C04016)the National Science and Technology Major Project of China(2018ZX10302206)the National Natural Science Foundation of China(81201291)
文摘Background: Acute-on-chronic liver failure (ACLF) refers to the acute deterioration of liver function that occurs in patients with chronic liver disease. ACLF is characterized by acute decompensation, organ failure and high short-term mortality. Numerous studies have been conducted and remarkable progress has been made regarding the pathophysiology and pathogenesis of this disease in the last decade. The present review was to summarize the advances in this field. Data sources: A comprehensive search in PubMed and EMBASE was conducted using the medical subject words “acute-on-chronic liver failure”,“ACLF”,“pathogenesis”,“predictors”, and “immunotherapy” combined with free text terms such as “systemic inflammation” and “immune paralysis”. Relevant papers published before October 31, 2018, were included. Results: ACLF has two marked pathophysiological features, namely, excessive systemic inflammation and susceptibility to infection. The systemic inflammation is mainly manifested by a significant increase in the levels of plasma pro-inflammatory factors, leukocyte count and C-reactive protein. The underlying mechanisms are unclear and may be associated with decreased immune inhibitory cells, abnormal expression of cell surface molecules and intracellular regulatory pathways in immune cells and increased damageassociated molecular patterns in circulation. However, the main cause of susceptibility to infection is immune paralysis. Immunological paralysis is characterized by an attenuated activity of immune cells. The mechanisms are related to elevations of immune inhibitory cells and the concentration of plasma antiinflammatory molecules. Some immune biological indicators, such as soluble CD163, are used to explore the pathogenesis and prognosis of the disease, and some immunotherapies, such as glucocorticoids and granulocyte colony-stimulating factor, are effective on ACLF. Conclusions: Overwhelming systemic inflammation and susceptibility to infection are two key features of ACLF. A better understanding of the state of a patient’s immune system will help to guide immunotherapy for ACLF.
基金Supported by National Natural Science Foundation of China,No.81201291National Science and Technology Major Project,No.2012ZX10002003Science and Technology Major Projects of Zhejiang Province,No.2009C03011-2
文摘AIM: To investigate the association of hypertension and diabetes mellitus (DM) with interferon-associated retinopathy (IAR) risk in chronic hepatitis C (CHC).
文摘Pneumonia caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection emerged in Wuhan City,Hubei Province,China in December 2019.By Feb.11,2020,the World Health Organization(WHO)officially named the disease resulting from infection with SARS-Co V-2 as coronavirus disease 2019(COVID-19).COVID-19 represents a spectrum of clinical manifestations that typically include fever,dry cough,and fatigue,often with pulmonary involvement.SARS-CoV-2 is highly contagious and most individuals within the population at large are susceptible to infection.Wild animal hosts and infected patients are currently the main sources of disease which is transmitted via respiratory droplets and direct contact.Since the outbreak,the Chinese government and scientific community have acted rapidly to identify the causative agent and promptly shared the viral gene sequence,and have carried out measures to contain the epidemic.Meanwhile,recent research has revealed critical aspects of SARS-CoV-2 biology and disease pathogenesis;other studies have focused on epidemiology,clinical features,diagnosis,management,as well as drug and vaccine development.This review aims to summarize the latest research findings and to provide expert consensus.We will also share ongoing efforts and experience in China,which may provide insight on how to contain the epidemic and improve our understanding of this emerging infectious disease,together with updated guidance for prevention,control,and critical management of this pandemic.
