Clinical guidelines of non-alcoholic fatty liver disease: A systematic review

AIM To perform a systematic review to grade guidelines and present recommendations for clinical management of non-alcoholic fatty liver disease(NAFLD).METHODS A database search was conducted on Pub Med for guidelines published before May 2016, supplemented by reviewing relevant websites. The Appraisal of Guidelines for Research and Evaluation(ARGEE) instrument Ⅱ was a tool designed to appraise the methodological rigor and transparency in which a clinical guideline is developed and it is used internationally. it was used to appraise the quality of guidelines in this study. The inclusion criteria include: clinical NAFLD guidelines for adults, published in English, and released by governmental agencies or key organizations.RESULTS Eleven guidelines were included in this study. Since 2007, guidelines have been released in Asia(3 in China, 1 in South Korea, and 1 in Japan), Europe(1 in italy),America(1 in United States and 1 in Chile) and three international agencies [European associations joint, Asia-Pacific Working Party and World Gastroenterology Organization(WGO)]. Using the ARGEE Ⅱ instrument, we found US 2012 and Europe 2016 had the highest scores, especially in the areas of rigor of development and applicability. Additionally, italy 2010 and Korea 2013 also presented comprehensive content, rigorous procedures and good applicability. And WGO 2014 offered various algorithms for clinical practice. Lastly, a practical algorithm for the clinical management was developed, based on the recommended guidelines.CONCLUSION This is the first systematic review of NAFLD guidelines. it may yield insights for physicians and policy-makers in the development and application of guidelines.

Value of mean platelet volume in evaluating the severity of acute pancreatitis

Objective:To investigate the changes of mean platelet volume (MPV) in the course of acute pancreatitis (AP) and its value in evaluating the severity of AP.Methods: Retrospectively reviewed the clinical data of 214 patients with acute pancreatitis. According to the severity of the disease, the patients were divided into 64 patients with severe acute pancreatitis, 150 patients with non-severe acute pancreatitis. 63 healthy subjects were used as a control group. Compared the MPV levels between AP group and healthy control group. Compare the levels of MPV, CRP, LDH, Ca2+ and WBC between severe AP group and non-severe AP group. Compared the levels of MPV in acute phase and remission of acute pancreatitis. The receiver operating characteristic (ROC) curve was used to evaluate the value of MPV, CRP, LDH, Ca2+ and WBC in predicting severe acute pancreatitis.Results: Compared with the healthy control group, the MPV levels in the AP group were lower. In the acute phase and the remission period, the MPV levels in the severe AP group were lower than that in the non-severe group. The area under the ROC curve (AUC) of MPV, CRP, LDH, Ca2+ and WBC in predicting severe acute pancreatitis were 0.791, 0.655, 0.708, 0.707, 0.622.Conclusion:AP patients have lower MPV and MPV levels in remission period are higher than that in acute phase. In both acute phase and remission, MPV levels in severe AP group are lower than non-severe AP group. Compared with CRP, LDH, Ca2+ and WBC, MPV has obvious advantage in predicting severe AP.

Protection of ghrelin postconditioning on hypoxia/ reoxygenation in gastric epithelial cells

AIM: To investigate the protective effect and mechanisms of ghrelin postconditioning against hypoxia/reoxygenation (H/R)-induced injury in human gastric epithelial cells. METHODS: The model of H/R injury was established in gastric epithelial cell line (GES-1) human gastric epithelial cells. Cells were divided into seven groups: normal control group (N); H/R postconditioning group; DMSO postconditioning group (DM); ghrelin postconditioning group (GH); D-Lys3-GHRP-6 + ghrelin postconditioning group (D + GH); capsazepine + ghrelin postconditioning group (C + GH); and LY294002 + ghrelin postconditioning group (L + GH). 3-(4,5-dimethylthazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay was used to detect GES-1 cell viability. Hoechst 33258 fluorochrome staining and flow cytometry were conducted to determine apoptosis of GES-1cells. Spectrophotometry was performed to determine release of lactate dehydrogenate (LDH). Protein expression of Bcl-2, Bax, Akt, and glycogen synthase kinase (GSK)-3β was determined by western blotting. Expression of vanilloid receptor subtype 1 (VR1), Akt and GSK-3β was observed by immunocytochemistry. RESULTS: Compared with the H/R group, cell viability of the GH group was significantly increased in a dosedependent manner (55.9% ± 10.0% vs 69.6% ± 9.6%, 71.9% ± 17.4%, and 76.3% ± 13.3%). Compared with the H/R group, the percentage of apoptotic cells in the GH group significantly decreased (12.38% ± 1.51% vs 6.88% ± 0.87%). Compared with the GH group, the percentage of apoptotic cells in the D + GH group, C + GH group and L + GH groups significantly increased (11.70% ± 0.88%, 11.93% ± 0.96%, 10.20% ± 1.05% vs 6.88% ± 0.87%). There were no significant differences in the percentage of apoptotic cells between the H/R and DM groups (12.38% ± 1.51% vs 13.00% ± 1.13%). There was a significant decrease in LDH release following ghrelin postconditioning compared with the H/R group (561.58 ± 64.01 U/L vs 1062.45 ± 105.29 U/L). There was a significant increase in LDH release in the D + GH, C + GH and L + GH groups compared with the GH group (816.89 ± 94.87 U/L, 870.95 ± 64.06 U/L, 838.62 ± 118.45 U/L vs 561.58 ± 64.01 U/L). There were no significant differences in LDH release between the H/R and DM groups (1062.45 ± 105.29 U/L vs 1017.65 ± 68.90 U/L). Compared with the H/R group, expression of Bcl-2 and Akt increased in the GH group, whereas expression of Bax and GSK3β decreased. Compared with the GH group, expression of Bcl-2 decreased and Bax increased in the D + GH, C + GH and L + GH groups, and Akt decreased and GSK-3β increased in the L + GH group. The H/R group also upregulated expression of VR1 and GSK-3β and downregulated Akt. The number of VR1-positive and Akt-positive cells in the GH group significantly increased, whereas the number of GSK-3β-positive cells significantly decreased. These effects of ghrelin were reversed by capsazepine and LY294002.CONCLUSION: Ghrelin postconditioning protected against H/R-induced injury in human gastric epithelial cells, which indicated that this protection might be associated with GHS-R, VR1 and the PI3K/Akt signaling pathway.

Influence of PD-L1 gene polymorphism on clinicopathological characteristics and clinical prognosis quality of patients with esophageal cancer

Objective:To investigate the effect of programmed death-ligand 1(PD-L1)gene polymorphism on pathological characteristics and clinical prognosis quality in patients with esophageal cancer.Methods:86 patients with esophageal cancer treated in our hospital from January 2014 to January 2017 were selected as the observation group,and 100 healthy patients were selected as the control group during the same period.The single nucleotide polymorphisms of rs2890658,rs17718883,rs2297136 and rs4143185 at different sites were determined.And the impact of PD-L1 gene polymorphism on pathological features and prognosis of esophageal cancer were analyzed.Results:The observation group finally completed 84 cases,and the control group included 99 cases.There were differences between the observation group and the control group in the PD-L1 different genetic locus rs17718883,rs2890658,rs2297136(P<0.05).The PD-L1 locus rs17718883 was related to the pathological type and degree of differentiation of esophageal cancer,the difference was statistically significant(P<0.05),rs2890658 was related to the degree of differentiation of esophageal cancer,the difference was statistically significant(P<0.05).Log-rank test showed that the genotype of rs17718883 in patients with esophageal cancer was related to prognostic survival,and the difference was statistically significant(P<0.05).Cox proportional hazards model analysis showed that age,degree of differentiation,lymph node metastasis,and rs17718883 genotype were independent factors in the prognosis of patients with esophageal cancer,and the difference was statistically significant(P<0.05).Conclusion:The polymorphisms of rs17718883 and rs2890658 loci of PD-L1 gene have an impact on the clinicopathological characteristics of patients with esophageal cancer,and the polymorphisms of rs17718883 locus of PD-L1 gene have an impact on the clinical prognosis quality.