Outcome analysis of management of liver trauma: A 10-year experience at a trauma center

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Correlation of liver stiffness and histological features in healthy persons and in patients with occult hepatitis B, chronic active hepatitis B, or hepatitis B cirrhosis

OBJECTIVES: Liver stiffness measurement using transient elastography has become a popular tool to assess liver fibrosis. The aim of this study was to determine liver stiffness values and histological features in healthy subjects and in patients with chronic hepatitis B (CHB).METHODS: A total of 157 people were included (28 healthy subjects and 18 patients with occult hepatitis B infection, 102 with active CHB, and 9 with end-stage hepatitis B cirrhosis). Histology and liver stiffness measurements were obtained from all patients.RESULTS: The median liver stiffness in healthy subjects and in occult hepatitis B, active hepatitis B, and end-stage cirrhosis patients was 4.6, 4.2, 8.7, and 33.8 kPa, respectively. In healthy subjects and in patients with occult hepatitis B infection, none had significant fibrosis on histology, and all had liver stiffness 7.2 kPa. In patients with active CHB, 32 (31%) had liver stiffness 11.0 kPa, but only four (12%) had cirrhosis on histology. Using liver stiffness to predict cirrhosis in this group had a sensitivity of 100%, a specificity of 69%, a positive predictive value of 10%, and a negative predictive value of 100%. All nine patients with end-stage liver cirrhosis had liver stiffness 11.0 kPa. The overall area under the ROC curve (AUROC) for diagnosing cirrhosis using a cutoff of 11.3 kPa was 0.89.CONCLUSIONS: Liver stiffness measurement has an overall good diagnostic accuracy with excellent negative predictive value. However, in active CHB with elevated alanine aminotransferase (ALT) levels, the positive predictive value for diagnosing cirrhosis is poor, and further studies are needed to optimize the use of transient elastography in this important group. © 2010 by the American College of Gastroenterology.postprin

Multimodality minimally invasive autopsy-A feasible and accurate approach to post-mortem examination

Background: Autopsy examination has been the bedrock of western medicine. With the decline in the autopsy rate secondary to the negative psychological impact to the deceased's relatives, the benefits of autopsy have been undermined. Minimally invasive autopsy has been introduced but has not been widely adopted as an alternative to the 'traditional' open approach. This technique not only provides information on the cause of death abut also minimizes the disfigurement induced to the deceased. Our study aims to explore the feasibility and evaluate the accuracy of this technique. Methods: A series of coroner cases ordered for autopsy were examined by a group including an experienced forensic pathologist and two experienced laparoscopic surgeons using thoracoscopic, laparoscopic, endoluminal or endovascular approaches. The procedure was video-recorded and the provisional diagnoses and causes of death were made based on the findings. These findings were subsequently correlated with the full autopsy examination. A few limited clinical post-mortem examinations were also performed with consent from relatives. Results: A total of 22 cases of minimally invasive autopsies were performed from November 2007 to March 2008. The median duration of the procedures was 78.3 ± 20.7 min. Thoracoscopies and laparoscopies were performed in 18 patients while additional arterioscopic examination with endoscope was performed in two patients with suspected aortic diseases. Four consented limited clinical autopsies were also performed: two of them involved thoracoscopic biopsies of lung tissues, one was a para-mortem upper endoscopy for the investigation of pathology of the stomach and the other one was laparoscopy for a patient, who died of unexplained acidosis. Comparison with full autopsies showed that the accuracy of the diagnosis was 94.4%, the sensitivity was 90%, the specificity was 100%, the positive predictive value was 100% and the negative predictive value was 88.9%. Conclusion: Minimally invasive autopsy is a feasible approach, yielding accurate findings when compared with conventional autopsies. The former can be a valuable tool for obtaining more valuable information in situations when the next-of-kin of the deceased does not consent to a conventional autopsy. © 2009 Elsevier Ireland Ltd. All rights reserved.postprin

Characterization of interleukin-1β in Helicobacter pylori-induced gastric inflammation and DNA methylation in interleukin-1 receptor type 1 knockout (IL-1R1-/-) mice

Helicobacter pylori infection induced interleukin-1b (IL-1b) production and is associated with aberrant DNA methylation and gastric diseases. Here, we investigated the role of IL-1b in H. pylori-induced gastric inflammation and DNA methylation using IL-1 receptor type 1 knockout (IL-1R1_/_) mice, and compared the therapeutic efficacy of antimicrobial therapy with IL-1 receptor antagonist (IL-1ra). IL-1R1_/_ and wild-type (WT) mice were infected with H. pylori for 16, 24 and 32 weeks. Infected WT mice at 24 weeks were given either antimicrobial therapy or IL-1ra. Comparing to the IL-1R1_/_ mice, infected WT mice with functional IL-1b signaling had higher gastritis scores, higher IL-1b and iNOS mRNA expression, higher nitric oxide (NO) production and increased frequency of E-cadherin (Ecad) methylation at all the time points analyzed. IL-1b release was significantly elevated in infected WT mice than normal controls at 16 weeks post-infection (p < 0.005). Treatment of infected mice with antimicrobial therapy and IL-1ra significantly reduced the degree of gastritis (p < 0.005; p < 0.05, respectively), iNOS expression (p < 0.0001; p < 0.01, respectively) and NO production (both p < 0.001) compared with untreated controls. Mice receiving antimicrobial therapy had significantly lower IL-1b expression than untreated controls (p < 0.0001). Both treatments reduced the incidence of E-cad methylation in infected mice compared with controls, however, no statistical significance was observed. There was no significant alteration of total DNA methyltransferase (DNMT) activity. These results demonstrated that IL-1b played a crucial role in H. pylori-induced gastric inflammation and DNA methylation. H. pylori eradication and IL-1ra administration could ameliorate inflammatory stress. © 2013 Elsevier Ltd. All rights reserved

Characterization of Interleukin-1β in Helicobacter pylori-induced Gastric Inflammation and DNA Methylation in IL-1 Receptor Type 1 Knockout (IL-1R1-/-) Mice

Conference Theme: Breakthroughs in Basic and Translational Cancer Researc

Asthma medication adherence and exacerbations and lung function in children managed in Leicester primary care

Poor adherence to asthma preventer medication is associated with life-threatening asthma attacks. The quality and outcomes framework mandated primary care annual asthma review does not include adherence monitoring and the effect of poor adherence on lung function in paediatric primary care patients is unknown. The aim was to investigate the link between inhaled corticosteroid (ICS) adherence and spirometry, fraction of exhaled nitric oxide (FeNO) and asthma control in asthmatic school-age children in this cross-sectional observational study involving three Leicestershire general practices. Children 5–16 years on the practice’s asthma registers, were invited for a routine annual asthma review between August 2018 and August 2019. Prescription and clinical data were extracted from practice databases. Spirometry, bronchodilator reversibility (BDR) and FeNO testing were performed as part of the review. 130 of 205 eligible children (63.4%) attended their review. Mean adherence to ICS was 36.2% (SEM 2.1%) and only 14.6% of children had good adherence (≥75% prescriptions issued). We found no differences in asthma exacerbations in the preceding 12 months between the adherence quartiles. 28.6% of children in the lowest and 5.6% in the highest adherence quartile had BDR ≥ 12% but this was not statistically significant (p = 0.55). A single high FeNO value did not predict adherence to ICS. Adherence to ICS in children with asthma in primary care is poor. The link between adherence to ICS and asthma exacerbations, spirometry and FeNO is complex but knowledge of adherence to ICS is critical in the management of children with asthma.</p

Liver stiffness and histological features in healthy persons, and patients with occult hepatitis B, chronic active hepatitis B, and hepatitis B-related cirrhosis.

Background: Liver stiffness measurement using transient elas-tography has become a popular tool to assess liver fibrosis.Aim: To determine liver stiffness values and histological featuresin healthy subjects and patients with chronic hepatitis B.Patients and Methods: A total of 157 persons were included(28 healthy subjects, 18 occult hepatitis B infection, 102 activechronic hepatitis B, and 9 end-stage hepatitis B cirrhosis). His-tology and liver stiffness measurements were obtained from allpatients. Results: The median liver stiffness in healthy subjects,occult hepatitis B, active hepatitis B, and end-stage cirrhosiswere 4.6, 4.2, 8.7, and 33.8 kPa respectively, with signifi-cantly higher values in the latter 2 groups compared to the for-mer 2 groups (p11.0kPa, but only 4 (12%) had cirrhosis on histology. Using liverstiffness to predict cirrhosis in this group had a sensitivity of100%, specificity of 69%, a positive predictive value of 10%,and a negative predictive value of 100%. All 9 patients withend-stage liver cirrhosis had liver stiffness >11.0 kPa. The over-all AUROC for diagnosing cirrhosis using a cut-off of 11.3 kPawas 0.89. Conclusion: Liver stiffness measurement has an over-all good diagnostic accuracy with excellent negative predictivevalue. In chronic active hepatitis B, the diagnostic accuracymay be reduced when underlying inflammatory activity issevere.link_to_OA_fulltex

PD-L1 hotspot in tumor-infiltrating lymphocytes of radically treated esophageal squamous cell carcinoma: Pattern of recurrence and long-term clinical outcomes

Poster discussion: no. PD-006Most cases of esophageal squamous cell carcinoma (ESCC) recurred and eventually succumbed to the disease despite radical treatment. Immune checkpoint inhibitor showed early promise in metastatic disease and preliminary evidence has suggested PD-L1 staining on tumor cells as a predictive marker for treatment outcomes. On the other hand, the role of PD-L1 on tumor-infiltrating lymphocytes (TILs) has not been fully elucidated. We retrospectively analysed PD-L1 immunohistochemical (IHC) staining on both tumor cells and TILs. The pattern of recurrence and long-term clinical outcomes are presented