Progress in non-invasive detection of liver fibrosis

Liver fibrosis is an important pathological precondition for hepatocellular carcinoma.The degree of hepatic fibrosis is positively correlated with liver cancer.Liver fibrosis is a series of pathological and physiological process related to liver cell necrosis and degeneration after chronic liver injury,which finally leads to extracellular matrix and collagen deposition.The early detection and precise staging of fibrosis and cirrhosis are very important for early diagnosis and timely initiation of appropriate therapeutic regimens.The risk of severe liver fibrosis finally progressing to liver carcinoma is＆gt;50%.It is known that biopsy is the gold standard for the diagnosis and staging of liver fibrosis.However,this method has some limitations,such as the potential for pain,sampling variability,and low patient acceptance.Furthermore,the necessity of obtaining a tissue diagnosis of liver fibrosis still remains controversial.An increasing number of reliable non-invasive approaches are now available that are widely applied in clinical practice,mostly in cases of viral hepatitis,resulting in a significantly decreased need for liver biopsy.In fact,the noninvasive detection and evaluation of liver cirrhosis now has good accuracy due to current serum markers,ultrasound imaging,and magnetic resonance imaging quantification techniques.A prominent advantage of the non-invasive detection and assessment of liver fibrosis is that liver fibrosis can be monitored repeatedly and easily in the same patient.Serum biomarkers have the advantages of high applicability（〉95%）and good reproducibility.However,their results can be influenced by different patient conditions because none of these markers are liver-specific.The most promising techniques appear to be transient elastography and magnetic resonance elastography because they provide reliable results for the detection of fibrosis in the advanced stages,and future developments promise to increase the reliability and accuracy of the staging of hepatic fibrosis.This article aims to describe the recent progress in the development of non-invasive assessment methods for the staging of liver fibrosis,with a special emphasize on computer-aided quantitative and deep learning methods.

Sealing of the hepatic resection area using fibrin glue reduces significant amount of postoperative drain fluid

AIM: To investigate whether the routine use of fibrin glue applied onto the hepatic resection area can diminish postoperative volume of bloody or biliary fluids drained via intraoperatively placed perihepatic tubes and can thus lower the complication rate.METHODS: Two groups of consecutive patients with a comparable spectrum of recent hepatic resections were compared: (1) 13 patients who underwent application of fibrin glue immediately after resection of liver parenchyma;(2) 12 patients who did not. Volumes of postoperative drainage fluid were determined in 4-h intervals through 24 h indicating the intervention caused bloody and biliary segregation.RESULTS: Through the first 8 h postoperatively, there was a tendency of higher amounts of fluids in patients with no additional application of fibrin glue while through the following intervals, a significant increase of drainage volumes was documented in comparison with the first two 4-h intervals, e.g., after 12 h, 149.6 mL +/-110 mL vs 63.2 mL +/-78 mL. Using fibrin glue, postoperative fluid amounts were significantly lower through the postoperative observation period of 24 h (851 mL +/-715 mL vs 315 mL +/-305 mL).CONCLUSION: For hepatic resections, the use of fibrin glue appears to be advantageous in terms of a significant decrease of surgically associated segregation of blood or bile out of the resection area. This might result in a better outcome.

Pathophysiology of insulin resistance and steatosis in patients with chronic viral hepatitis

Chronic hepatitis due to any cause leads to cirrhosis and end-stage liver disease.A growing body of literature has also shown that fatty liver due to overweight or obesity is a leading cause of cirrhosis.Due to the obesity epidemic,fatty liver is now a significant problem in clinical practice.Steatosis has an impact on the acceleration of liver damage in patients with chronic hepatitis due to other causes.An association between hepatitis C virus (HCV) infection,steatosis and the onset of insulin resistance has been reported.Insulin resistance is one of the leading factors for severe fibrosis in chronic HCV infections.Moreover,hyperinsulinemia has a deleterious effect on the management of chronic HCV.Response to therapy is increased by decreasing insulin resistance by weight loss or the use of thiazolidenediones or metformin.The underlying mechanisms of this complex interaction are not fully understood.A direct cytopathic effect of HCV has been suggested.The genomic structure of HCV (suggesting that some viral sequences are involved in the intracellular accumulation of triglycerides),lipid metabolism,the molecular links between the HCV core protein and lipid droplets (the core protein of HCV and its transcriptional regulatory function which induce a triglyceride accumulation in hepatocytes) and increased neolipogenesis and inhibited fatty acid degradation in mitochondria have been investigated.

抛开“垃圾食品”

世界卫生组织最新公布的全球十大垃圾食物,再次让我们认真审视自己的食谱。所谓"垃圾食品",一方面指提供超过人体需求并造成多余成分的食品;另一方面指除热量外无其他营养成分的食物。

鱼、虾的加工和速冻

前言中国沿海具有丰富的水产资源,而且有适合于虾蟹养殖的很长的海岸线。因此,通过冷冻贮藏不但可供给国内很新鲜的蛋白质资源,可且可供大量出门。就虾而言,中国产的对虾,味道就很鲜美。目前,对食品的质量要求越来越高,特别是东南亚各国虾的养殖量有增加的趋势,

Heterotopic pancreas in the gastrointestinal tract

Heterotopic pancreas is defined as pancreatic tissue found outside the usual anatomical location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathological changes such as inflammation, bleeding, obstruction, and malignant transformation. In this report, a 60-year-old man with carcinoid syndrome caused by heterotopic pancreatic tissue in the duodenum is described, along with a 62-year-old man with abdominal pain caused by heterotopic pancreatic tissue in the gastric antrum. The difficulty of making an accurate diagnosis is highlighted. The patients remain healthy and symptom-free after follow-up of 1 year. Frozen sections may help in deciding the extent of resection intraoperatively. Although heterotopic pancreas is rare, it should be considered in the differential diagnosis of gastrointestinal stromal tumor.

Molecular landscape in acute myeloid leukemia: where do we stand in 2016

Acute myeloid leukemia(AML) is a clonal disorder characterized by the accumulation of complex genomic alterations that define the disease pathophysiology and overall outcome. Recent advances in sequencing technologies have described the molecular landscape of AML and identified several somatic alterations that impact overall survival. Despite all these advancement, several challenges remain in translating this information into effective therapy. Herein we will review the molecular landscape of AML and discuss the impact of the most common somatic mutations on disease biology and outcome.

Clinicopathological significance of B-cell-specific Moloney murine leukemia virus insertion site 1 expression in gastric carcinoma and its precancerous lesion

AIM： To explore the relation between B-cell-specific Moloney murine leukemia virus insertion site 1 （Bmi-1） expression and the clinicopathological features of gastric carcinoma （GC）.METHODS： Immunohistochemistry was used to detect the expression of Bmi-1 and ki-67. Doublelabeling staining was used to display the distribution of Bcl-2^＋/ki-67 cells in 162 cases of GC and its matched normal mucosa and precancerous lesion.RESULTS： The positive rate of Bmi-1 expression in GC（52.5%） was significantly higher than that in normal gastric mucosa （21.6%, X^2 = 33.088, P 〈 0.05）. The Bmi-1 expression in GC was closely related with the Lauren＇s and Borrmann＇s classification and clinicalstage （X^2 = 4.400, 6.122 and 11.190, respectively, P〈 0.05）. The expression of ki-67 was related to the Borrmann＇s classification （X^2 = 13.380, P 〈 0.05）.Bcl-2 expression was correlated with the Lauren＇s classification （Z2 = 4.725, P 〈 0.05）, and the Bmi-1 expression both in GC （rk = 0.157, P 〈 0.05） and inintestinal metaplasia （rk = 0.270, P 〈 0.05）.CONCLUSION： Abnormal Bmi-1 expression in GCmay be involved in cell proliferation, apoptosis andcancerization. This marker can objectively indicate theclinicopathological characteristics of GC.

烹饪过程中某些生物化学的变化

菜肴在烹制过程中,必须考虑保留人体所需要的各种营养素,同时又要做到质、色、香、味、型、器俱佳,就必须进行合理烹饪。本文仅例举某些菜肴原料及其烹制过程中所产生的某些生物化学的变化,说明掌握合理烹饪条件的必要性。鱼什么时候烹饪最鲜美鲜鱼死后究竟什么时候烹制味道最鲜?应该根据鱼体生物化学变化的原理来考虑。鱼体死后不久即出现全身僵硬状态,通常称"僵直期"。

CLINICAL PATHOLOGICAL FEATURE OF EARLY TONGUE AMYLOIDOSIS

To investigate the clinical pathological feature and diagnostic criteria of tongue amyloidosis （AL）. During 1992 to 2005, 25 patients pathologically diagnosed as tongue AL in our hospital were reviewed retrospectively, and all of them had no enlarged tongue. Haematoxylin and eosin （HE） and immunohistochemi ning were used to detect the amyloid deposition on the tongue. Results Totally 84% （21/25） patients had symptoms of xemstomia and taste-blindness, 44% （11/25） patients complained of activity limitation of tongue. Macroscopic observation showed mueosa pallescenee, punctuate hemorrhage, red grain particles, and ulcers on the tongue. HE staining indicated amyloid depositions in basement membrane, muscle cell, vessel wall, and nerve fiber, lmmunohistochemieal study demonstrated kappa light-chain deposition in 64% （16/25） eases, and lambda light-chain deposition in 36% （9/25） eases. They presented in vessel wall, nerve fiber, and muscle cells. Conclusion The biopsy is an important means for the diagnosis of early tongue AL, and the wide variety of amyloid fight chain is helpful to differential diagnosis.

Laryngo-tracheobronchial Amyloidosis:a Case Report and Review of Literature

AMYLOIDOSIS is a benign process which can have systemic involvement. Though larynx is the common site of localized amyloidosis in the head and neck region,I it was seldom reported with heterochronous implication of bilateral ventricles. Here we report a case of laryngeal amyloidosis heterochronously localized at bilateral ventricles with tracheobronchial involvement. Combined with our experience we reviewed the literature, and discuss the pertinent managements of this condition.

Perianal Crohn's disease: Is there something new?

Perianal lesions are common in patients with Crohn's disease, and display aggressive behavior in some cases. An accurate diagnosis is necessary for the optimal management of perianal lesions. Treatment of perianal Crohn's disease includes medical and/or surgical options. Recent discoveries in the pathogenesis of this disease have led to advances in medical and surgical therapy with good results. Perianal lesions in Crohn's disease remain a challenging aspect for both gastroenterologists and surgeons and lead to a greatly impaired quality of life for all patients affected by this disease. A multidisciplinary approach is mandatory to obtain the best results.

Association of rare SPINK1 gene mutation with another base substitution in chronic pancreatitis patients

AIM: To verify and expand the known spectrum of serine protease inhibitor Kazal type 1 (SPINK1) gene mutations in chronic pancreatitis. METHODS: DNA extracted from 172 chronic pancreatitis patients was assayed for SPINK1 gene mutations by PCR and DNA sequencing. A control cohort of 90 unrelated healthy individuals was analysed by the same methods for presence of common populational polymorphisms, and frequency of five-loci haplotypes was calculated. Linkages of gene aberrations in single SPINK1 gene copies were analysed by long-distance PCR followed by allele-specifi c PCR and DNA sequencing. RESULTS: The most frequent SPINK1 gene mutation N34S was found at a frequency of 6%. Furthermore, we detected the heterozygous intervening sequence (IVS) 3 + 2 T > C mutated gene in 2 German patients and 1 Macedonian chronic pancreatitis patient. In all three SPINK1 gene copies an additional rare base substitution was found: 5’untranslated region (UTR)-215 G > A. Poly-morphism analysis revealed that all three affected genes carried the same fi ve-loci haplotype. DNA sequencing of another chronic pancreatitis-related gene PRSS1 (cationic trypsinogen) did not reveal any mutations in these 3 pa-tients.CONCLUSION: We found in 3 (2%) of 172 chronic pancreatitis patients an IVS3 + 2 T > C SPINK1 gene mutation and a base substitution 5’UTR-215 G > A inthe same gene copy. Most probably the 5’UTR-215 G >A represents a rare polymorphism and not a mutationas previously concluded. Haplotype analysis suggests acommon origin of the IVS3 + 2 T > C mutation in thesepatients.

Clinical and Pathological Observation on Infectious Serositis of Duck

According to clinical and pathological observation in infectious serositis of duck, the main signs of this disease were diarrhoea, breathing with difficulty, head tremble and movement beyond coordination. The pathological changes that had been found in 30 experimental ducks were fibrous pericarditis, hepatitis, and encephalitis. The fibrous serositis, liver fatty degeneration or focus necrosis,nonsuppurative encephalitis and serous-fibrous pneumonia were typical pathological changes of histology.

Extramedullary plasmocytoma associated with a massive deposit of amyloid in the duodenum

We report a rare case of extramedullary plasmocytoma associated with a massive deposit of amyloid in the duodenum. A 72-year-old Japanese man was admitted to our hospital presenting with a 3-mo history of epigastric pain, vomiting and weight loss. On computed tomography （CT） a wall thickening of the fourth part of the duodenum was observed. Multiple biopsies obtained from the lesion showed infiltration of plasma cells and lymphocytes, but they were not conclusive. The patient underwent resection of the lesion and, on histopathological examination, the lesion consisted of a dense and diffuse infiltrate of plasma cells and a few admixed lymphocytes with reactive follicles extending to the muscular propria. An extensive deposition of amyloid was also observed. Immunohistochemical stains revealed that a few plasmacytoid cells showed λ light chain staining, though most were κ： light chain positive. These cells also were positive for CD138 and CD56 but negative for CD20 and CD79. The findings were consistent with extramedullary plasmocytoma associated with a massive deposit of amyloid in duodenum. A subsequent workup for multiple myeloma was completely negative. The patient showed no signs of local recurrence or dissemination of the disease after 12 mo follow-up. Because of the association of plasmocytoma and amyloidosis, the patient must be followed up because of the possible systemic involvement of the neoplasm and amyloidosis in future.

Gene expression of collagen types IX and X in the lumbar disc

Objective:To study gene expression of collagen types IX and X in human lumbar intervertebral discs during aging and degeneratio n and to explore the role of collagen types IX and X in disc degeneration. Methods:Fetal, adult and pathologic specimens were subjected t o in situ hybridization with cDNA probes to investigate mRNA-expressions of typ es IX and X collagen gene. Results:In fetal intervertebral discs, positive mRNA hybridiza tion signals of type IX collagen were concentrated in the nucleus pulposus and t he inner layer of anulus fibrosus. Interstitial matrix of the nucleus pulposus a lso showed positive type X collagen staining. Positive mRNA hybridization signal s of types IX and X were not detected in the middle and outer layers of anulus f ibrosus. In adult specimens, expression of type IX collagen mRNA was markedly de creased. No hybridization signals of type X collagen was observed. As for pathol ogical specimens, there was no gene expression of type IX collagen. In severe de generated discs from adults, there were focal positive expressions of type X col lagen. Conclusions:Obvious changes of collagen gene expression occur with aging. Expression of type IX collagen decreases in adult and pathological d iscs. Results of type X collagen expression suggest that type X collagen is expr essed only in older adult and senile discs (i.e., when disc degeneration has alr eady reached a terminal stage), indicating the terminal stage of degeneration.

Histopathological study using computer database of 10000 consecutive gastric specimens:(2)malignant lesions

Using a computer database,the author investigated the histopathology of 10000 consecutive gastric specimens collected in the last 12 years 2002–2013 at his pathology laboratory in a relatively large hospital in Japan.Examination of histological sections was done when appropriate.The gastric specimens were made up of 8579 benign conditions and 1421 malignant lesions.The latter comprised gastric carcinoma in 1342 cases(94.4%),gastrointestinal stromal tumor(GIST)in 34(2.4%),mucosal-associated lymphoid tissue(MALT)lymphoma in 25(1.8%),non-Hodgkin’s malignant lymphoma in 19(1.3%),and metastatic carcinoma in 1 case(0.1%).Of the 1342 cases of gastric carcinoma,the histological type was as follows:tubular adenocarcinoma in 755 cases,papillary adenocarcinoma in 176,mucinous adenocarcinoma in 147,signet ring cell carcinoma in 145,poorly differentiated adenocarcinoma in 114,adenosquamous carcinoma in 4,and metastatic small cell carcinoma from the lung in 1.In surgically resected cases,the number of early gastric carcinomas was 258 and of advanced carcinoma,521 cases.In GIST(n=34),there were 2 cases of the epithelioid type and 32 of the spindle cell type.The size of GIST ranged from 1–15 cm,with a mean of 5.6 cm.KIT(CD117)was positive in 34/34 cases,CD34 in 31/34,desmin 2/34,and S1004/34.A genetic analysis was performed in 6 cases of GIST,all of which showed point mutation of KIT and/or PDGFRA genes.In MALT lymphoma(n=25),centrocyte-like cells and lymphoepithelial lesions were seen in every case.Helicobactor pylori infection was noted in 92%.In non-Hodgkin’s lymphoma(n=19),17 cases were of diffuse large B-cell lymphoma,and 1 was peripheral T-cell lymphoma,while 1 was NK-cell lymphoma.